Low Serum Testosterone in Outpatient Psychiatry Clinics: Addressing Challenges to the Screening and Treatment of Hypogonadism

Smith, J.; Rosen, Jordan; Colbert, Adam E.

doi:10.1016/j.sxmr.2017.08.007

Cited by 22 publications

(15 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Several reports have also documented a dose- and duration-dependent association between chronic opioid treatment and new-onset depression [ 106 ]. One possible reason for this association is a reduction in testosterone levels caused by opioid administration [ 108 , 109 ], with OPIAD contributing to the development of depression in patients with CNCP. However, the relationship between low testosterone levels and the incidence of clinical depression is still unclear, as is the potential benefit of TTh in men with depression or OPIAD [ 109 ].…”

Section: Methodsmentioning

confidence: 99%

Testosterone deficiency in non-cancer opioid-treated patients

Coluzzi

Billeci

Maggi

et al. 2018

J Endocrinol Invest

View full text Add to dashboard Cite

PurposeThe use of opioids in patients with chronic non-cancer pain is common and can be associated with opioid-induced androgen deficiency (OPIAD) in men. This review aims to evaluate the current literature regarding the prevalence, clinical consequence and management of OPIAD.MethodsA database search was performed in Medline, Embase and Cochrane using terms such as “analgesics”, “opioids” and “testosterone”. Relevant literature from January 1969 to March 2018 was evaluated.ResultsThe prevalence of patients with OPIAD ranges from 19 to 86%, depending on the criteria for diagnosis of hypogonadism. The opioid-induced suppression of gonadotropin-releasing and luteinizing hormones represents the main important pathogenetic mechanisms. OPIAD has significant negative clinical consequences on sexual function, mood, bone density and body composition. In addition, OPIAD can also impair pain control leading to hyperalgesia, which can contribute to sexual dysfunction and mood impairment.ConclusionsOPIAD is a common adverse effect of opioid treatment and contributes to sexual dysfunction, impairs pain relief and reduces overall quality of life. The evaluation of serum testosterone levels should be considered in male chronic opioid users and the decision to initiate testosterone treatment should be based on the clinical profile of individuals, in consultation with the patient.

show abstract

Section: Methodsmentioning

confidence: 99%

Testosterone deficiency in non-cancer opioid-treated patients

Coluzzi

Billeci

Maggi

et al. 2018

J Endocrinol Invest

View full text Add to dashboard Cite

show abstract

“…Few placebo‐controlled RCTs have investigated the potential role of TRT for the treatment of depressive symptoms . TRT improved mood, and depressive symptoms using several self‐report instruments in the TTrials, although the magnitude of the effects was small .…”

Section: Treatment Outcomesmentioning

confidence: 99%

European Academy of Andrology (EAA) guidelines on investigation, treatment and monitoring of functional hypogonadism in males

et al. 2020

View full text Add to dashboard Cite

Background Evidence regarding functional hypogonadism, previously referred to as ‘late‐onset’ hypogonadism, has increased substantially during the last 10 year. Objective To update the European Academy of Andrology (EAA) guidelines on functional hypogonadism. Methods Expert group of academicians appointed by the EAA generated a series of consensus recommendations according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system. Results The diagnosis of functional hypogonadism should be based on both the presence of clinical symptoms supported by repeatedly low morning fasting serum total testosterone (T) measured with a well‐validated assay, after exclusion of organic causes of hypogonadism. Lifestyle changes and weight reduction should be the first approach in all overweight and obese men. Whenever possible, withdrawal/modification of drugs potentially interfering with T production should be advised. Testosterone replacement therapy (TRT) is contraindicated in men with untreated prostate or breast cancer, as well as severe heart failure. Severe low urinary tract symptoms and haematocrit >48%‐50% represent relative contraindications for TRT. Prostate‐specific antigen and digital rectal examination of the prostate should be undertaken in men >40 years of age before initiating TRT to exclude occult prostate cancer. Transdermal T should be preferred for initiation of TRT, whereas gonadotrophin therapy is only recommended when fertility is desired in men with secondary hypogonadism. TRT is able to improve sexual function in hypogonadal men. Other potential positive outcomes of TRT remain uncertain and controversial. Conclusion TRT can reliably improve global sexual function in men with hypogonadism in the short term. Long‐term clinical benefits, and safety of TRT in functional hypogonadism, remain to be fully documented. Clinicians should therefore explicitly discuss the uncertainties and benefits of TRT and engage them in shared management decision‐making.

show abstract

“…Several observational studies have documented a relationship between depressive symptoms and reduced T concentrations. 45 The specific relationship between HG and the incidence of clinical depression are still unclear. 45 Data derived from the TTrials showed that TRT modestly improved mood and depressive symptoms, using several instruments.…”

Section: Moodmentioning

confidence: 99%

“…45 The specific relationship between HG and the incidence of clinical depression are still unclear. 45 Data derived from the TTrials showed that TRT modestly improved mood and depressive symptoms, using several instruments. 10 In line with these data, the largest meta-analysis published so far, including 1890 men with HG (baseline total T < 12 nmol/L or fT < 225 pmol/L) from 27 RCTs, documented that a positive effect of TRT on depression was particularly evident only in patients with milder symptoms.…”

Section: Moodmentioning

confidence: 99%

Testosterone Therapy: What We Have Learned From Trials

Corona

Torres

Maggi

2020

The Journal of Sexual Medicine

View full text Add to dashboard Cite

Introduction: The role of testosterone (T) replacement therapy (TRT) in men is still conflicting. In particular, safety concerns and cardiovascular (CV) risk related to TRT have not been completely clarified yet. Similarly, the clear beneficial effects of TRT are far to be established. Aim: To systematically and critically analyze the available literature providing evidence of the benefit-risk ratio derived from TRT in aging men. Methods: A comprehensive PubMed literature search was performed to collect all trials, either randomized controlled trials (RCTs) or observational studies, evaluating the effects of TRT on different outcomes. Main Outcome Measure: Whenever possible, data derived from RCTs were compared with those resulting from observational studies. In addition, a discussion of the available meta-analyses has been also provided. Results: Data derived from RCT and observational studies clearly documented that TRT can improve erectile function and libido as well as other sexual activities in men with hypogonadism (total T < 12 nM). Conversely, the effect of TRT on other outcomes, including metabolic, mood, cognition, mobility, and bone, is more conflicting. When hypogonadism is correctly diagnosed and managed, no CV venous thromboembolism or prostate risk is observed. Clinical Implications: Before prescribing TRT, hypogonadism (total T < 12 nM) must be confirmed through an adequate biochemical evaluation. Potential contraindications should be ruled out, and an adequate follow-up after the prescription is mandatory. Strength & Limitations: When correctly diagnosed and administered, TRT is safe, and it can improve several aspects of sexual function. However, its role in complicated vasculogenic erectile dysfunction is limited. Conversely, TRT is not recommended for weight reduction and metabolic improvement. Further well-powered studies are advisable to better clarify TRT for long-term CV risk and prostate safety in complicated patients as well as in those curatively treated for prostate cancer. Conclusion: TRT results in sexual function improvement when men with hypogonadism (total T < 12 nM) are considered. Positive data in other outcomes need to be confirmed.

show abstract

Low Serum Testosterone in Outpatient Psychiatry Clinics: Addressing Challenges to the Screening and Treatment of Hypogonadism

Cited by 22 publications

References 55 publications

Testosterone deficiency in non-cancer opioid-treated patients

Testosterone deficiency in non-cancer opioid-treated patients

European Academy of Andrology (EAA) guidelines on investigation, treatment and monitoring of functional hypogonadism in males

Testosterone Therapy: What We Have Learned From Trials

Contact Info

Product

Resources

About