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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

Evolution of testosterone treatment over 25 years: symptom responses, endocrine profiles and cardiovascular changes. Carruthers M, Cathcart P, Feneley MR. The aging male : the official journal of the International Society for the Study of the Aging Male. Published online July 28, 2015.

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…

Key Points

  • Symptoms indicative of testosterone deficiency do not correlate with either total or free testosterone levels a baseline. Symptomatic patients with testosterone levels in the “normal range” benefit as much as do those with very low testosterone levels.
  • Symptomatic relief may require longer than 1 year to achieve – this underscores the critical importance of long-term adherence to testosterone therapy.
  • None of the commonly available testosterone preparations cause any adverse effects on prostate or cardiovascular related parameters.

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…

1 February 2015

Adherence to testosterone therapy

Adherence to testosterone therapy

- short term treatment is not sufficient for achievement of maximal benefits

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.

Key Points

  • 66% of patients discontinued testosterone therapy with a topical gel after 2 months, and only 31% and 14% of patients remained on therapy for 6 months and 1 year, respectively.
  • The rates of testosterone therapy discontinuation are similar between men using topical testosterone formulations and short-acting testosterone injections.
  • A large proportion of patients stop and restart therapy every 2 to 3 months.
  • Majority of patients who begin testosterone therapy discontinue its use within 3 years.
  • Because continuous therapy over a longer period (years, if not indefinitely) is necessary to derive all the benefits of testosterone therapy, these low adherence rates mean that the majority of men who start testosterone therapy will not achieve maximum benefits from it.

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.

6 April 2012

Time-course of biological effects of testosterone replacement therapy

Picture: Wheel

Onset of effects of testosterone treatment and time span until maximum effects are achieved. Saad F, Aversa A, Isidori AM, et al. Eur J Endocrinol 2011;165(5):675-685.

This article reviewed the published literature of studies analyzing the effects of testosterone administration in hypogonadal men to estimate the onset or time-dependency effects of testosterone. The analysis consisted of studies performed with testosterone (including testosterone esters and dihydrotestosterone preparations, independent of delivery method) where:

  • the use of an active treatment group was compared with a matched placebo or control group
  • a description of the time course of the effect of active treatment was included, and
  • randomization, adherence to protocol and single/double-blind study design was reported.

Key Points

Time-course of effects of testosterone replacement therapy in hypogonadal men as shown in clinical studies:

  • Effects on sexual interest appear after 3 weeks and plateau at 6 weeks
  • Changes in erections/ejaculations occur within 6 months
  • Effects on quality of life evident within 3–4 weeks and continue thereafter
  • Effects on depressive mood noted after 3–6 weeks and reach a maximum after 18–30 weeks
  • Effects on glycaemic control become evident after 3–12 months, although insulin sensitivity may improve within a few days
  • Changes in body composition and muscle strength occur within 12–16 weeks and stabilize at 6–12 months
  • Effects on bone mineral density are detectable after 6 months and continue for at least 3 years
  • Beneficial effects on lipids appear after 4 weeks and reach a maximum after 6–12 months
  • Prostate-specific antigen and prostate volume marginally rise, plateauing at 12 months.
Last updated: 2018
L.ZA.MKT.GM.10.2016.1381