Concerns About Serum Androgens Monitoring During Testosterone Replacement Treatments in Hypogonadal Male Athletes: A Pilot Study

Luigi, Luigi Di; Sgrò, Paolo; Aversa, Antônio; Migliaccio, Silvia; Bianchini, Serena; Botrè, Francesco; Romanelli, Francesco; Lenzi, Andrea

doi:10.1111/j.1743-6109.2011.02600.x

Cited by 16 publications

(11 citation statements)

References 49 publications

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“… 250 mg TE/3 weeks 12 months 31.9 ± 2.5 (SD) 14 63.6 ng/dL ±14 (SD) hypogonadal Wang 2010 [ 70 ] open-label i.m. 750 mg TU/4 to 10 weeks 21 months >18 117 320 ng/dL ±111 (SD) low normal T Brockenbrough 2006 [ 48 ] RCT gel 10 mg T/day 6 months 58.9 ± 14.9 (SD) 19 218 ± 64 (SD) ng/dL hypogonadal, renal disease Cherrier 2003 [ 71 ] RCT gel 50-100 mg T/day 6 months 34 to 70 12 320 ± 90 (SD) ng/dL low normal T Chiang 2007 [ 72 ] RCT gel 50 mg T/day 3 months 20 to 75 17 213 ± 158 (SD) ng/dL hypogonadal Dean 2004 [ 73 ] open-label gel 50 mg T/day 9 months 58.5 (mean) 257 247 ng/dL (mean) hypogonadal Di Luigi 2012 [ 74 ] open-label gel 50 mg T/day 1.25 month 31.3 ± 7.5 (SD) 10 72 ng/dL (mean) hypogonadal Juang 2014 [ 75 ] RCT gel 100 mg T/day 3.5 months 24 to 51 14 302 ± 37 (SD) ng/dL hypogonadal, osteoporosis Kenny 2010 [ 53 ] RCT gel 50 mg T/day 12 months 79.9 ± 7.3 (SD) ...…”

Section: Resultsmentioning

confidence: 99%

Cardiovascular risks and elevation of serum DHT vary by route of testosterone administration: a systematic review and meta-analysis

Borst

Shuster

Zou

et al. 2014

BMC Med

111

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BackgroundPotential cardiovascular (CV) risks of testosterone replacement therapy (TRT) are currently a topic of intense interest. However, no studies have addressed CV risk as a function of the route of administration of TRT.MethodsTwo meta-analyses were conducted, one of CV adverse events (AEs) in 35 randomized controlled trials (RCTs) of TRT lasting 12 weeks or more, and one of 32 studies reporting the effect of TRT on serum testosterone and dihydrotestosterone (DHT).ResultsCV risks of TRT: Of 2,313 studies identified, 35 were eligible and included 3,703 mostly older men who experienced 218 CV-related AEs. No significant risk for CV AEs was present when all TRT administration routes were grouped (relative risk (RR) = 1.28, 95% confidence interval (CI): 0.76 to 2.13, P = 0.34). When analyzed separately, oral TRT produced significant CV risk (RR = 2.20, 95% CI: 1.45 to 3.55, P = 0.015), while neither intramuscular (RR = 0.66, 95% CI: 0.28 to 1.56, P = 0.32) nor transdermal (gel or patch) TRT (RR = 1.27, 95% CI: 0.62 to 2.62, P = 0.48) significantly altered CV risk. Serum testosterone/DHT following TRT: Of 419 studies identified, 32 were eligible which included 1,152 men receiving TRT. No significant difference in the elevation of serum testosterone was present between intramuscular or transdermal TRT. However, transdermal TRT elevated serum DHT (5.46-fold, 95% CI: 4.51 to 6.60) to a greater magnitude than intramuscular TRT (2.20-fold, 95% CI: 1.74 to 2.77).ConclusionsOral TRT produces significant CV risk. While no significant effects on CV risk were observed with either injected or transdermal TRT, the point estimates suggest that further research is needed to establish whether administration by these routes is protective or detrimental, respectively. Differences in the degree to which serum DHT is elevated may underlie the varying CV risk by TRT administration route, as elevated serum dihydrotestosterone has been shown to be associated with CV risk in observational studies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-014-0211-5) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Cardiovascular risks and elevation of serum DHT vary by route of testosterone administration: a systematic review and meta-analysis

Borst

Shuster

Zou

et al. 2014

BMC Med

111

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“…Study‐related medications are (i) Gonadotropin‐releasing hormone (GnRH) antagonist (acyline, 300 μg/kg subcutaneous injection every 2 weeks) to suppress endogenous gonadotropin and T production [18], or saline placebo; (ii) T gel [19,20] (10 g daily Testim, Auxilium, Malvern, PA, USA) or placebo; and (iii) an enzyme inhibitor to block T metabolism, either anastrazole (1 mg daily Arimidex, AstraZeneca, Wilmington, DE, USA) or dutasteride (2.5 mg daily Avodart, GlaxoSmithKline, Philadelphia, PA, USA), or placebo. Dosages for T and dutasteride at 10 g and 2.5 mg daily, respectively, are higher than current recommended starting doses.…”

Section: Methodsmentioning

confidence: 99%

Testosterone with Dutasteride, but Not Anastrazole, Improves Insulin Sensitivity in Young Obese Men: A Randomized Controlled Trial

Juang

Peng

Allehmazedeh

et al. 2014

The Journal of Sexual Medicine

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Introduction Testosterone (T) administration to men increases T, estradiol (E2), dihydrotestosterone (DHT), and fat-free mass (FFM), and decreases fat mass (FM) but does not consistently improve insulin sensitivity (IS). Aim The aim of this study was to examine the effects of T administration in obese, nondiabetic men on body composition and IS, and to determine if inhibition (i) of metabolism of T to E2 with anastrazole or to DHT with dutasteride alters these effects. Methods This was a 98-day randomized, double-blind, parallel group, placebo-controlled trial of 57 men, 24–51 year, free T in the lower 25% of normal range (<0.33 nmol/L), body mass index ≥30.0 kg/m2. Subjects were randomized to one of four groups: (i) placebo: gel, pills, and injection; (ii) T/DHT/iE2: T gel, anastrazole, and acyline (gonadotropin releasing-hormone antagonist to suppress endogenous T); (iii) T/iDHT/E2: T gel, dutasteride, and acyline; (iv) T/DHT/E2: T gel, placebo pills, and acyline. Main Outcome Measures Main outcome measures are insulin sensitivity as percent change (%Δ) in glucose disposal rates (GDR) from a two-step euglycemic clamp (GDR1 and 2), and %FM and %FFM by dual X-ray absorptiometry scan. Results Insulin Sensitivity: %Δ GDR1 differed across groups (P = 0.02, anova) and was significantly higher in the dutasteride (T/iDHT/E2) compared with the placebo and T gel (T/DHT/E2) groups. %ΔGDR2 was higher in the dutasteride (T/iDHT/E2) compared with the anastrazole (T/DHT/iE2) group. Body Composition: T gel alone (T/DHT/E2) or with dutasteride (T/iDHT/E2) significantly increased %FFM (P < 0.05) and decreased %FM (P < 0.05). There was no change in %FFM or %FM after placebo or anastrazole (T/DHT/iE2). Conclusions The combination of T plus dutasteride improved body composition and IS while T alone improved body composition but not IS, suggesting that when T is administered to men, reduction to DHT attenuates the beneficial effects of aromatization to E2 on IS but not body composition.

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“…It is particularly helpful in patients who travel regularly, and the extended release decreases the “up and down” feeling often experienced with the IM injections. This “up and down” phenomenon is due to the variable release of the hormone into the bloodstream leading to peaks and troughs beyond the normal range of serum testosterone levels ( 5 , 7 , 28 , 29 ). The disadvantages of subdermal implants include the need for regular office visits, pain and bruising at the site of insertion, as well as the minimal risk of infection and pellet extrusion ( 7 ).…”

Section: Guidelines For Trtmentioning

confidence: 99%

Testosterone replacement therapy for physician assistants and nurse practitioners

Ramos

Patel

Ramasamy

2018

Transl. Androl. Urol.

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Physician assistants (PA) and nurse practitioners have been moving toward specialty practices, like urology. With increased training and education, they manage more complex conditions independently. Whether they are the primary provider or the follow up to a specialist, physician extenders can play a vital role in managing patients undergoing testosterone therapy. Physician extenders should be able to understand the indications, risks and associated adverse effects of administering testosterone in order to proficiently take care of patients with low testosterone. The goal of this review is to recognize the role and the limits to which physician extenders should manage hypogonadism, and when physician collaboration or referral is necessary.

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Concerns About Serum Androgens Monitoring During Testosterone Replacement Treatments in Hypogonadal Male Athletes: A Pilot Study

Cited by 16 publications

References 49 publications

Cardiovascular risks and elevation of serum DHT vary by route of testosterone administration: a systematic review and meta-analysis

Cardiovascular risks and elevation of serum DHT vary by route of testosterone administration: a systematic review and meta-analysis

Testosterone with Dutasteride, but Not Anastrazole, Improves Insulin Sensitivity in Young Obese Men: A Randomized Controlled Trial

Testosterone replacement therapy for physician assistants and nurse practitioners

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