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20 July 2015

Risk of Venous Thromboembolism in Men Receiving Testosterone Therapy

Risk of Venous Thromboembolism in Men Receiving Testosterone Therapy

Baillargeon, J., et al., Risk of Venous Thromboembolism in Men Receiving Testosterone Therapy.
Mayo Clin Proc, 2015. July 15 [Epub ahead of print].

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. In this editorial we report the results of a recent case-control study by Baillargeon et al., which specifically examined the risk of venous thromboembolism associated with testosterone therapy in middle-aged and older men.

Key Points

  • In June 2014 FDA mandated a requirement for manufacturers to add a warning about potential risks of venous thromboembolism and deep vein thrombosis to the label of all testosterone products.
  • The FDA warning was based on spontaneous reporting in post-marketing surveillance.
  • Testosterone may have both prothrombotic and protective endothelial effects.
  • Endogenous testosterone levels are not associated with venous thromboembolism.
  • A comparative study that specifically evaluated a possible link between testosterone therapy and venous thromboembolism in the general population shows no increased risk.

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

It is well documented that obesity may cause hypogonadism, and that hypogonadism may cause obesity.1-4 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 hypogonadism1-4, 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.”

Key Points

  • Non-obese men who become obese experience a decline of testosterone levels comparable to that of 10 years of aging.
  • Testosterone deficiency and obesity each contribute independently to a self-perpetuating vicious cycle. Long-term testosterone replacement therapy in men with hypogonadism improves body composition, metabolic syndrome components and quality of life, and thereby can help break the vicious cycle.
  • Treatment of hypogonadism with long-term testosterone replacement therapy, with or without lifestyle modifications, effectively treats obesity by correcting testosterone deficiency; one physiological root cause of obesity.
  • In contrast to the U-shaped curve for weight loss seen with traditional obesity treatments, which are characterized by weight loss and weight regain, treatment with testosterone replacement therapy results in a continuous reduction in obesity parameters (waist circumference, weight and BMI) for >5 years, or until metabolic abnormalities return to healthy ranges.
  • The significant effectiveness of testosterone replacement therapy in combating obesity in hypogonadal men remains largely unknown to doctors. Educational efforts are therefore critical to bring research findings into clinical practice in order to improve patient care and health outcomes.

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.”

Last updated: 2018
L.ZA.MKT.GM.10.2016.1381