Risks of testosterone replacement therapy in ageing men

Abstract

Testosterone has been available to practitioners for several decades. However, testosterone prescriptions have increased in recent years partly because of the introduction of newer delivery systems that are topical and have good bioavailability. In the US alone, approximately 2 million prescriptions for testosterone were written in 2002. This represents a 30% increase from 2001 and a 170% increase from 1999. There has also been a 500% increase in prescription sales in the past 10 years. The rise in prescriptions may be in part due to the increasing recognition of hypogonadism in ageing males or andropause. Treatment relating to hypogonadism has relieved symptoms and improved the quality of life of many individuals. Epidemiological studies point toward an association with increased morbidity and mortality, with low testosterone states in ageing males. For example, there is a higher prevalence of depression, coronary heart disease, osteoporosis, fracture rates, frailty and even dementia with low testosterone states. Recently, there have been some concerns raised regarding the long-term safety of testosterone replacement therapy (TRT) from the Institute of Medicine. Current evidence suggests no causal relationship between prostate cancer and physiological dosing of testosterone, especially with careful selection and monitoring of patients. Cardiovascular risks have, overall, been neutral, although suggestions have been made that there are positive vasodilatory properties with testosterone. Mild eythrocytosis can be a common side effect of TRT, but thromboembolic events have rarely been reported in the literature. This paper addresses the evidence to date regarding the safety aspects of TRT. The medical-legal implications of TRT for men at this point in time is also discussed.

Testosterone therapy in hypogonadal men and potential prostate cancer risk: a systematic review

“…[5][6][7][8][9][10] When administered cautiously, testosterone therapy is safe and effective in mitigating the signs and symptoms of hypogonadism, 11 which include lower libido; erectile dysfunction; fatigue; decreased muscle strength, bone mineral density and body hair; increased body fat; anemia; hot flushes; and mood changes. 10,12,13 Testosterone therapy may also have beneficial effects on the lipid profile and cardiovascular system.…”

Evaluation of late-onset hypogonadism (andropause) treatment using three different formulations of injectable testosterone

“…Testosterone therapy may cause polycythemia when used at above-physiological doses (37). In spite of higher testosterone serum levels, patients treated with Nebido ® showed similar hematocrit/hemoglobin serum levels when compared to the other treatment groups.…”

The Use of Testosterone in the Treatment of Chronic Postvasectomy Pain Syndrome: Case Report and Review of the Literature

“…Relative contraindications are severe cardiac, renal, or hepatic disease, polycythemia, and sleep apnea. 18 Aspermatogenic autoantigens are expressed only by germ cells and can elicit an immune response that causes diminished sperm production and damage to germ cells. The expression of these autoantigens postdate the early lymphocyte interactions that confer immunologic tolerance of self antigens.…”