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28 July 2015

Long-term testosterone treatment with different testosterone preparations

Long-term testosterone treatment with different testosterone preparations

- provocative results on diagnosis and adherence

Due to lack of consistent clear-cut guidelines for diagnosis and treatment of testosterone deficiency, there is a lot of confusion among both health professionals and suffering men. The multiple different testosterone preparations available further add to the complexity of testosterone treatment.

This editorial presents the intriguing results from a notable study that analyzed effects of testosterone therapy with seven different testosterone preparations, in symptomatic men who had previously been denied treatment because of "normal" baseline testosterone levels. The results are quite provocative and highlight several important practical issues relating to diagnosis and treatment of hypogonadism…

20 July 2015

Risk of Blood Clots in Men Receiving Testosterone Therapy

Risk of Blood Clots in Men Receiving Testosterone Therapy

Venous thromboembolism is a blood clot that forms in a vein deep inside a part of the body; it mainly affects the large veins in the lower leg and thigh.

Blood clot formation (venous thromboembolism) has been suggested to be one main risk with testosterone replacement therapy. In 2014, both the US Food and Drug Administration (FDA) and Health Canada implemented a requirement for manufacturers to add a warning about the potential risks of venous thromboembolism and deep vein thrombosis to the label of all testosterone products.

However, to date no comparative studies examining an association between testosterone replacement therapy and venous thromboembolism have been reported. Here we report the results of a recent case-control study – published July 20, 2015 - that specifically examined the risk of venous thromboembolism associated with testosterone therapy in middle-aged and older men.

15 May 2015

Associations between Testosterone, Estrogen and the Development of Metabolic Syndrome

Associations between Testosterone, Estrogen and the Development of Metabolic Syndrome

Associations between Sex Steroids and the Development of Metabolic Syndrome: a Longitudinal Study in European Men.
Antonio L, Wu FC, O'Neill TW, Pye SR, Carter EL, Finn JD, Rutter MK, Laurent MR, Huhtaniemi IT, Han TS, Lean ME, Keevil BG, Pendleton N, Rastrelli G, Forti G, Bartfai G, Casanueva FF, Kula K, Punab M, Giwercman A, Claessens F, Decallonne B, Vanderschueren D. J Clin Endocrinol Metab. 2015 Jan 30

Sex hormone binding globulin (SHBG) is a “hormone carrier” that binds and transports testosterone in the blood. It is well established that both low total testosterone and low SHBG levels are associated with an increased risk of existing and incident metabolic syndrome in men.

However, it is still debated whether testosterone and SHBG are independently associated with incident development of the metabolic syndrome. In addition, the potential role of estradiol (the main estrogen) in this association is unknown. A recently published study specifically investigated these issues, using data from the European Male Aging Study (EMAS), a prospective study of aging in European men.

1 May 2015

Testosterone, Cardiovascular Risk, Mortality and Longevity

Testosterone, Cardiovascular Risk, Mortality and Longevity

Testosterone Therapy and Cardiovascular Risk: Advances and Controversies. Morgentaler A, Miner MM, Caliber M, Guay AT, Khera M, Traish AM. Mayo Clin. Proc. 2015;90(2):224-251.

Testosterone and mortality. Muraleedharan V, Jones TH. Clin. Endocrinol. (Oxf). 2014;81(4):477-487.

One of the most debated issues related to testosterone replacement therapy is its effects on cardiovascular risk and clinical events, like for example heart attack. A few flawed studies over the past years made it appear that testosterone replacement therapy increases cardiovascular risk and incidence of heart attacks. However, less known is the vast and rapidly accumulating body of evidence showing the contrary; that higher testosterone levels and testosterone replacement therapy actually may reduce mortality and increase longevity.

This editorial summarises key conclusions from a special medical review article on testosterone and cardiovascular risk, written by the Androgen Study Group, as provides answers to the following two questions:

  1. Is testosterone deficiency directly involved in the pathogenesis of these conditions or is it merely a biomarker of ill health and the severity of underlying disease processes?
  2. Does testosterone replacement therapy retard disease progression and ultimately enhance the clinical prognosis and survival?

15 April 2015

Health Consequences of Subclinical Hypogonadism

Health Consequences of Subclinical Hypogonadism

Characteristics of compensated hypogonadism in patients with sexual dysfunction. Corona G, Maseroli E, Rastrelli G, et al. The journal of sexual medicine. 2014;11(7):1823-1834.

In discussions about diagnosis and health consequences of hypogonadism, the prime focus is given to testosterone levels and signs/symptoms. However, emerging research has identified a less clinically evident gonadal dysfunction called “subclinical” hypogonadism (or “compensated” hypogonadism).

Subclinical hypogonadism is characterized by normal testosterone levels in the presence of elevated LH level. As testosterone levels are not markedly reduced in subclinical hypogonadism, intuitively one may think it does not confer negative health consequences. However, a recent study which specifically was conducted to investigate the potential health ramifications of subclinical hypogonadism, shows that it should not be neglected.

1 April 2015

How well informed are general practitioners and cardiologists about testosterone deficiency and its consequences?

How well informed are general practitioners and cardiologists about testosterone deficiency and its consequences?

A rapidly growing body of medical research is showing that testosterone deficiency (aka hypogonadism and low-T) is strongly associated with a wide range of detrimental health outcomes, and that testosterone replacement therapy improves those health parameters that are negatively affected by testosterone deficiency. Therefore, leading testosterone scientists now view testosterone deficiency as a cardiovascular risk factor that contributes to the development of cardiovascular disease.

As general practitioners and cardiologists primarily care for these patients with cardiovascular disease, a survey study was conducted to assess their knowledge, beliefs and clinical practice with respect to testosterone deficiency and cardiovascular health.

A questionnaire was distributed to 20 cardiologists and 128 family practitioners in British Columbia, Canada. Of the 13 questions, 10 assessed knowledge and beliefs on testosterone deficiency and 3 assessed current practice patterns.

15 March 2015

Cardiovascular Risk and Elevation of Blood DHT Levels Vary by Testosterone Preparation

Cardiovascular Risk and Elevation of Blood DHT Levels Vary by Testosterone Preparation

Cardiovascular risks and elevation of blood DHT vary by route of testosterone administration: a systematic review and meta-analysis.
Borst SE, Shuster JJ, Zou B, et al. BMC medicine. 2014;12(1):211.

The cardiovascular effects of endogenous testosterone and testosterone replacement therapy are subject to intense investigation in medical research and have recently generated heated discussions among healthcare professionals.

While the main focus has been on testosterone per se, it is important to remember that testosterone is both a hormone in its own right, and a pro-hormone that gets converted to both estradiol and DHT (dihydrotestosterone), which exert effects themselves that are different from testosterone.

Therefore, when analyzing the effects of testosterone, especially exogenous testosterone administered as testosterone replacement therapy, it is critical to take into consideration how it affects downstream testosterone metabolites.

A recent systematic review and meta-analysis specifically investigated how different routes of testosterone replacement administration (i.e. different testosterone preparations) affect blood testosterone and DHT levels, and how this in turn relates to cardiovascular adverse events.

1 March 2015

Testosterone Deficiency - Prevalence and Treatment Rates

Testosterone Deficiency - Prevalence and Treatment Rates

Systematic Literature Review of the Epidemiology of Non-Genetic Forms of Hypogonadism in Adult Males. Victoria Zarotsky, Ming-Yi Huang, Wendy Carman, Abraham Morgentaler, Puneet Singhal, Donna Coffin, and T. H. Jones, Journal of Hormones 2014

Testosterone deficiency, also known as hypogonadism, is gaining recognition among both clinicians and the general population. This editorial summarizes the findings from a review on the prevalence of testosterone deficiency, as well as the proportion of hypogonadal men who are receiving testosterone treatment.

15 February 2015

Testosterone and Weight Loss - the Evidence

Testosterone and Weight Loss - the Evidence

Lowered testosterone in male obesity: mechanisms, morbidity and management. Ng Tang Fui M, Dupuis P, Grossmann M. Asian journal of andrology. 2014;16(2):223-231.

Testosterone and weight loss: the evidence. Traish AM. Current opinion in endocrinology, diabetes, and obesity. 2014;21(5):313-322.

Testosterone as potential effective therapy in treatment of obesity in men with testosterone deficiency: a review. Saad F, Aversa A, Isidori AM, Gooren LJ. Current diabetes reviews. 2012;8(2):131-143.

The role of testosterone in the etiology and treatment of obesity, the metabolic syndrome, and diabetes mellitus type 2. Saad F, Gooren LJ. Journal of obesity. 2011;2011.

It is well documented that obesity may cause hypogonadism, and that hypogonadism may cause obesity. This has generated debate about what condition comes first; obesity or hypogonadism? And what should be the first point of intervention?

In this editorial we summarize data from several reviews on the association of obesity and hypogonadism, and make the case that obesity and hypogonadism create a self-perpetuating vicious circle. Once a vicious circle has been established, it doesn’t matter where one intervenes; one can either treat the obese condition or treat hypogonadism first. The critical issue is to break the vicious circle as soon as possible before irreversible health damage arises.

Nevertheless, as we will explain here, treating hypogonadism first may prove more effective in that it to a large extent “automatically” takes care of the excess body fat and metabolic derangements, and also confers psychological benefits that will help obese men become more physically active. Thereby, restoring testosterone levels in hypogonadal obese men will relatively quickly break the self-perpetuating vicious circle, and transform it into a “health promoting circle.”

1 February 2015

Adherence to testosterone therapy

Adherence to testosterone therapy

Long-term treatment patterns of testosterone replacement medications.
Donatucci C, Cui Z, Fang Y, Muram D. The journal of sexual medicine. Aug 2014;11(8):2092-2099.

Medication adherence and treatment patterns for hypogonadal patients treated with topical testosterone therapy: a retrospective medical claims analysis.
Schoenfeld MJ, Shortridge E, Cui Z, Muram D. The journal of sexual medicine. May 2013;10(5):1401-1409.

Testosterone therapy confers a wide range of health benefits for hypogonadal men, including improvements in body composition (reduction in body fat, increase in muscle mass, weight loss), lipid profile, cardiovascular function, insulin sensitivity/glucose metabolism, bone mineral density, inflammatory parameters, quality of life and potentially longevity.

Despite this, there is a high discontinuation rate with testosterone therapy. This editorial presents findings from two studies which have investigated adherence to testosterone therapy and treatment patterns.

15 January 2015

Symptoms predicting low testosterone levels in young, middle-aged and elderly men

Symptoms predicting low testosterone levels in young, middle-aged and elderly men
This summary gives an overview of two research papers that discuss the link between testosterone (T) levels and how often symptoms of low T occur. One study looked at the relationship between T levels and symptom occurrence in 360 middle-aged and elderly men (aged 40-90 years), the other in 352 younger men (aged <40 years). All men filled out a questionnaire to assess their symptoms on the same day that their T levels were measured.

1 January 2015

Testosterone-boosting Medications and Cardiovascular Risk

Testosterone-boosting Medications and Cardiovascular Risk

- a systematic review and meta-analysis

Cardiovascular risk associated with testosterone-boosting medications: a systematic review and meta-analysis. Corona G, Maseroli E, Rastrelli G, et al. Expert opinion on drug safety. Oct 2014;13(10):1327-1351.

Accumulating evidence shows beneficial effects of testosterone therapy on a wide range of health outcomes, including inflammation, insulin sensitivity, muscle mass, body fat mass, lipid profiles, endothelial (blood vessel) function, bone mineral density, energy and vitality, mood, sexual function and overall quality of life. Despite this, concerns have been raised that testosterone therapy could have detrimental effects on cardiovascular disease.

This editorial summarizes results from a comprehensive systematic review and meta-analysis, the largest to date, of all placebo-controlled randomized clinical trials (RCTs) on the effect of testosterone therapy on cardiovascular-related problems.

15 December 2014

Late onset hypogonadism of men is not equivalent to menopause

Late onset hypogonadism of men is not equivalent to menopause

Many men who reach middle-age start to experience symptoms that resemble those of menopause; reduced libido, lack of energy, weight gain, fatigue, depression and osteoporosis, to name a few. Therefore these conditions are frequently seen as being equivalent, and late onset hypogonadism has therefore been called "andropause", "male climacteric", "male menopause" or "MANopause.

However, this is very misleading. Here we will contrast the differences between late onset hypogonadism, also known as testosterone deficiency, and menopause, and explain why these condition should not be regarded as being equivalent.

29 November 2014

Testosterone and Cardiovascular Risk in Men

Testosterone and Cardiovascular Risk in Men
Hypogonadism, also known as testosterone deficiency, is increasing in prevalence worldwide. While a rapidly expanding body of research is documenting the detrimental health consequences of hypogonadism, at the same time there is a prevailing concern and misunderstanding about the effects of testosterone therapy on cardiovascular risk.

5 September 2014

Effects of testosterone replacement therapy in men with hypogonadism

Alleged concerns regarding risk of cardiovascular disease with testosterone replacement therapy have been promulgated recently. However, a large and growing number of intervention studies (where medication was used) show to the contrary that testosterone therapy reduces cardiovascular risk factors (diseases of the heart and blood vessels) and confers multiple beneficial health effects. Thus, fears promoted by some recent flawed studies need to be critically re-evaluated.

This summary gives an overview of a comprehensive review of studies that have investigated health effects and safety of testosterone therapy. As outlined here, the position that hypogonadism (also known as testosterone deficiency) should be regarded as a risk factor for cardiovascular disease is supported by a rapidly expanding body of evidence.

19 August 2014

Adverse health effects of testosterone deficiency in men

Adverse health effects of testosterone deficiency in men

Adverse health effects of testosterone deficiency (TD) in men. Traish AM. Steroids. 2014 Jun 2. pii: S0039-128X(14)00122-6. doi: 10.1016/j.steroids.2014.05.010. [Epub ahead of print]

Testosterone deficiency, also known as hypogonadism, is a state with sub-optimal circulating levels of testosterone concomitant with clinical signs and symptoms attributed to low physiological testosterone levels.

Sexual dysfunction is the most commonly recognized symptom of testosterone deficiency. However, testosterone also plays a broader role in men's health. A growing body of evidence has established associations between low testosterone levels and multiple risk factors and diseases including the metabolic syndrome, obesity, type 2 diabetes, sarcopenia (loss of muscle mass), frailty, mobility limitations, osteoporosis, cognitive impairment, depression, cardiovascular disease, and reduced longevity.

This summary gives an overview of a comprehensive review of studies that have investigated the detrimental impact of testosterone deficiency on a wide range of health outcomes.

19 August 2014

Testosterone Treatment and Heart Attack Risk

Testosterone Treatment and Heart Attack Risk

- New study shows testosterone treatment can even be beneficial

Risk of Myocardial Infarction in Older Men Receiving Testosterone Therapy. Baillargeon, J., et al., Ann Pharmacother 1060028014539918, first published on July 2, 2014 as doi:10.1177/1060028014539918, 2014

Testosterone therapy has been in use for more than 70 years for the treatment of hypogonadism, also called testosterone deficiency. Over the past 30 years there has been a growing body of scientific research demonstrating that testosterone deficiency is associated with increased body weight/adiposity/waist circumference, insulin resistance, type 2 diabetes, hypertension, inflammation, atherosclerosis and cardiovascular disease, erectile dysfunction (ED) and increased risk of mortality. In line with the detrimental health outcomes seen with testosterone deficiency, testosterone therapy has been shown to confer beneficial effects on multiple risk factors and risk biomarkers related to these clinical conditions.

Despite these well-documented health benefits, testosterone therapy is still controversial, in large part due to a few flawed studies about potential elevated heart attack risk with testosterone therapy. On July 2, 2014, a study was published which demonstrated that testosterone therapy is not associated with an increased risk of heart attack, and may actually confer protection against heart attack.

16 July 2014

Testosterone and Prostate Cancer - a paradigm shift

Testosterone and Prostate Cancer - a paradigm shift

"Bye-bye Androgen Hypothesis, Welcome Saturation Model"

A new era of testosterone and prostate cancer: from physiology to clinical implications. Khera M, Crawford D, Morales A, et al., Eur Urol 2014; 65(1): 115-23.

A long-held belief is that testosterone stimulates development of prostate cancer (PCa) and/or accelerates its growth. This summary gives an overview of an in-depth review of current literature regarding the relationship of serum testosterone and PCa and the effect of testosterone replacement therapy (TRT) on PCa progression and recurrence. Key studies which have refuted the old belief that testosterone has harmful effects on the prostate are presented, along the new testosterone-prostate paradigm known as the saturation model.

14 July 2014

Effects of testosterone deficiency on body composition, strength and sexual function in men

Effects of testosterone deficiency on body composition, strength and sexual function in men
This paper presents the findings from a study that looked at the effects of testosterone on body fat, lean mass, thigh-muscle area and strength, and sexual function in healthy men who had their testosterone levels experimentally reduced. As the majority of estradiol (a form of estrogen) is obtained from testosterone, the concomitant decrease in estradiol was also investigated and the effects differentiated from those of testosterone.

20 August 2013

Obesity is strongly linked to low testosterone levels in men

Obesity is strongly linked to low testosterone levels in men
This summary gives an overview of four research papers which discuss the link between obesity and low testosterone levels (also known as hypogonadism): one review focusing on the association between obesity, diabetes and low testosterone, and three clinical studies. The studies looked at the relationship between body mass index (BMI) and testosterone levels in men, and the effects of weight loss on testosterone levels in a group of very obese men (BMI >40 kg/m2) undergoing weight loss surgery; the link between obesity and testosterone levels in young men aged 14-20 years; and the relationship between health and lifestyle factors, including weight loss, and testosterone levels in men as they get older.

22 July 2013

Testosterone deficiency: a risk factor for heart failure

Testosterone deficiency - a risk factor for heart failure
This review summarizes the available evidence on the role of low testosterone levels (also known as testosterone deficiency syndrome [TDS] or hypogonadism) as a modifiable risk factor for heart failure. It also underlines the benefits and potential side effects of testosterone replacement therapy (TRT) in men suffering from chronic heart failure (CHF).

19 June 2013

Aortic stiffness is increased in patients with low testosterone levels

Arterial stiffness contributes to cardiovascular conditions that can increase the risk of mortality. Sex hormones have been suggested to play a role in vascular function and in this study the elastic properties of the aorta (the largest artery in the body) in men with low blood levels of testosterone (hypogonadism) were compared with those of a control group who naturally produce normal levels of testosterone.

22 April 2013

Metabolic syndrome may influence the development of prostatic diseases, including benign prostatic hyperplasia and prostate cancer

Whilst metabolic syndrome is known to be directly associated with a number of cardiovascular diseases and type 2 diabetes there is now growing evidence of its influence on the initiation and clinical progression of prostatic diseases such as benign prostatic hyperplasia (BPH) and prostate cancer (PCa). A recent review of the scientific literature evaluated studies providing evidence of the role of metabolic syndrome in the development and progression of BPH and PCa. In this evaluation the authors considered relevant articles published between 1995 and September 2011 that were identified using one of the main scientific citation databases – PubMed.

21 August 2012

Study finds that low testosterone levels are common in men with sexual problems and may be related to chronic illnesses

Image: Senior person getting blood pressure examination by a cardiologist
This large retrospective observational study of 990 men with erectile dysfunction (problems achieving or maintaining an erection) looked at the link between low levels of testosterone (also known as hypogonadism) and various chronic illnesses. The average age of men in this study was 57 years and many had chronic conditions such as diabetes mellitus, high blood pressure, work stress and anxiety/depression. Overall, 36% of these men had low testosterone levels.

21 May 2012

Evidence of a key role for testosterone in the cause and treatment of obesity, the metabolic syndrome and diabetes

Image: overweighted man
The rapid increase in rates of obesity in both the developed and the developing world has serious consequences. Nearly all obese adults suffer from at least one obesity-related disease, such as type 2 diabetes, high blood pressure, cardiovascular disease, cancer, or joint disorders. A recent comprehensive review has looked beyond the place of testosterone in the male reproductive system and for the treatment of erectile dysfunction (impotence) to examine the key role of testosterone in the development and treatment of obesity and associated diseases. The article reviewed the evidence for the effects on insulin sensitivity, visceral fat and cholesterol levels of returning low testosterone levels to normal, and addressed the safety of testosterone, particularly in elderly men.

2 April 2012

Current state of knowledge on low testosterone in middle-aged and older men

Image: compass
This article reviewed what is known about the consequences of low testosterone (also known as hypogonadism) in middle-aged and older men, with practical information on the benefits and risks of testosterone replacement. The authors examined evidence from a wide range of studies about low testosterone and its treatment to prepare their review.

8 March 2012

Link between low testosterone and frailty in elderly men

Image: Senior patient and doctor
This review discussed the relationship between low testosterone levels and frailty in elderly men and evaluated the evidence which shows that testosterone replacement therapy improves the physical functioning and quality of life of elderly frail men with confirmed low testosterone levels.

8 June 2011

Evidence-based criteria for diagnosing low testosterone in aging men defined

Image: Sleeping man

This study, published in the New England Journal of Medicine, identified the most important symptoms linked to late-onset hypogonadism (low testosterone levels in aging men) in a large group of men representative of the general population. When testosterone levels were also taken into consideration, having these three symptoms and low testosterone levels was a specific diagnosis of late-onset hypogonadism.

1 April 2011

Increased risk of dying from cardiovascular disease for men with erectile dysfunction and low testosterone

Image: Human heart

There is increasing evidence that erectile dysfunction may be a warning sign of a number of disease conditions, such as high blood pressure, metabolic syndrome, diabetes mellitus, depression and coronary heart disease.

Nearly 1700 men attending an andrology clinic for erectile dysfunction were monitored for an average of 4.3 years to find out whether those with low testosterone levels were more likely to suffer a major cardiovascular disease event, such as a heart attack or stroke.

14 September 2010

Testosterone reduces fat and increases muscle mass in non-obese men aged ≥55 years

Aging is associated with a reduction in testosterone levels in the blood. This reduction causes a number of symptoms, one of which is losing muscle mass.

This small, well-designed 12-month study looked at the effect of the testosterone patch ( the testosterone patch is not available in South Africa) on body composition and hormones in 60 men aged ≥55 years who were healthy and not obese, and who had low-to-normal testosterone levels and typical testosterone deficiency symptoms.
Last updated: 2018
L.ZA.MKT.GM.10.2016.1381