Testosterone replacement therapy--perceptions of recipients and partners

BACKGROUND: The androgenic hormones are important determinants of sexual behaviour in men. Testosterone replacement is important treatment for pituitary disease to maintain normal functioning. Although the physical effects of testosterone replacement have been well documented, little is known about the effects on relationships, particularly from the point of view of the sexual partners of men receiving testosterone replacement. AIMS: This paper reports a study exploring the perceptions of testosterone replacement on well-being and sexual functioning. METHODS: Semi-structured interviews were conducted with five men receiving testosterone implants (recipients), their permanent partners, and five recipients without partners. Recipient serum testosterone concentration was measured at 0, 1 and 4 months after testosterone implantation. RESULTS: The three groups reported similar effects of testosterone on well-being and sexual functioning. Recipient and partner ratings were also similar. Strength was less affected by decreasing testosterone concentration than energy in men with partners, but both strength and energy declined in men without partners. Decreased testosterone levels had a statistically significantly different effect on libido at time zero between men with and without partners (P < 0.015) and on ability to sustain an erection, but the ability to achieve an erection persisted over the 6 months in both male groups. Intercourse frequency increased from once per week at time 0 to > or =3 per week between 1 and 4 months after implant in men with partners. There were important effects of testosterone deficiency on general and sexual relationships, and these differed between men with partners and those without. CONCLUSIONS: Testosterone has important physical and psychological benefits that may be related to the age at which testosterone replacement commences and the indications for its use. The small sample size may limit the ability to generalize the findings outside the study.     

Testosterone replacement therapy for treatment refractory cluster headache

OBJECTIVES: To describe the clinical characteristics and laboratory findings of cluster headache patients whose headaches responded to testosterone replacement therapy. BACKGROUND: Current evidence points to hypothalamic dysfunction, with increased metabolic hyperactivity in the region of the suprachiasmatic nucleus, as being important in the genesis of cluster headaches. This is clinically borne out in the circadian and diurnal behavior of these headaches. For years it has been recognized that male cluster headache patients appear overmasculinized. Recent neuroendocrine and sleep studies now point to an association between gonadotropin and corticotropin levels and hypothalamically entrained pineal secretion of melatonin. RESULTS: Seven male and 2 female patients, seen between July 2004 and February 2005, and between the ages of 32 and 56, are reported with histories of treatment resistant cluster headaches accompanied by borderline low or low serum testosterone levels. The patients failed to respond to individually tailored medical regimens, including melatonin doses of 12 mg a day or higher, high flow oxygen, maximally tolerated verapamil, antiepileptic agents, and parenteral serotonin agonists. Seven of the 9 patients met 2004 International Classification for the Diagnosis of Headache criteria for chronic cluster headaches; the other 2 patients had episodic cluster headaches of several months duration. After neurological and physical examination all patients had laboratory investigations including fasting lipid panel, PSA (where indicated), LH, FSH, and testosterone levels (both free and total). All 9 patients demonstrated either abnormally low or low, normal testosterone levels. After supplementation with either pure testosterone in 5 of 7 male patients or combination testosterone/estrogen therapy in both female patients, the patients achieved cluster headache freedom for the first 24 hours. Four male chronic cluster patients, all with abnormally low testosterone levels, achieved remission. CONCLUSIONS: Abnormal testosterone levels in patients with episodic or chronic cluster headaches refractory to maximal medical management may predict a therapeutic response to testosterone replacement therapy. In the described cases, diurnal variation of attacks, a seasonal cluster pattern, and previous, transient responsiveness to melatonin therapy pointed to the hypothalamus as the site of neurological dysfunction. Prospective studies pairing hormone levels and polysomnographic data are needed.     

Testosterone replacement therapy to improve health in older males

ABSTRACT: This article provides an overview of current research and updated clinical guidelines regarding testosterone replacement therapy in older males positive for late-onset hypogonadism.     

Testosterone replacement therapy for bone loss prevention in HIV-infected males

OBJECTIVE: To review the use of testosterone for the prevention of bone loss in men with HIV infection. DATA SOURCES: A MEDLINE search (1966-May 2002) on the use of testosterone in osteoporosis/HIV infection was performed. A reference bibliography search was also completed. DATA SYNTHESIS: Osteopenia/osteoporosis is reported in HIV-infected men due to a myriad of factors. Sex hormone deficiency is a frequent endocrine abnormality in this population. CONCLUSIONS: In HIV-negative men, testosterone may be beneficial for preventing bone loss and hastening the resolution of fractures. Testosterone's role in preventing bone loss in HIV-infected men remains to be defined.     

Testosterone biases automatic memory processes in women towards potential mates

Female mate choice involves the comparative evaluation of potential mates. Females use a pooled comparison of sampled males to maximize the perceived reproductive fitness of their partner, implying the memorization of sampled males. However, hormonal and reproductive states influence female choosiness, and women's preference and memory for masculinity. Here, we investigated whether testosterone biases memory processes in women towards male faces using functional MRI. A single nasal testosterone dose was administered to healthy women in their early follicular phase, in a double-blind, placebo-controlled, crossover design. Testosterone increased the difference in reaction times to categorize male and female faces during encoding, without influencing subsequent recognition accuracy or response bias. The imaging results showed that testosterone shifted memory formation in the hippocampus and inferior temporal gyri from the encoding of female faces towards the encoding of male faces. In contrast, testosterone shifted memory formation in the left inferior frontal gyrus from the encoding of male faces towards the encoding of female faces. Furthermore, the hippocampal contribution to memory retrieval also shifted from female towards male faces. These results indicate that testosterone biases memory processes towards the relatively automatic encoding and retrieval of males in temporal brain regions and elaborate encoding of females in frontal brain regions, suggesting that testosterone may support female mate sampling and comparison by biasing automatic memory processes towards the encoding and retrieval of potential mates.     

Testosterone replacement therapy in hypogonadal men: assessing benefits, risks, and best practices

Hypogonadism is a common condition, especially among older men, but often goes undiagnosed and untreated. It can be associated with a number of signs and symptoms that affect health and quality of life, including feelings of low energy and fatigue; decreased sex drive and performance; decreased muscle mass and strength; decreased bone mineral density; and increased body fat, particularly abdominal fat, a putative risk factor for metabolic syndrome and type 2 diabetes mellitus. The evidence supporting testosterone replacement therapy (TRT) in improving these and related conditions is strong and consistent for body composition and sexual function; moderately consistent for bone mineral density; inconsistent for insulin sensitivity, glycemic control, and lipid profiles; and weak and inconsistent for mood and cognitive function. The concern of some physicians about the potential for TRT to stimulate prostate cancer is not supported by decades of data accumulated to date, though studies of longer duration (eg, 10 years or more) would be even more convincing. Other research needs are discussed. As the front line of health care delivery, primary care physicians need to be vigilant in diagnosing and treating symptomatic hypogonadism. Based on current guidelines, we recommend assessing testosterone levels when an adult man exhibits signs of hypogonadism, and as part of normal medical screening in men starting at age 40 to 50 years, to establish a baseline. A physician should discuss the possibility of TRT with symptomatic patients who have a serum total testosterone level < 300 ng/dL. If TRT is initiated, a patient's response and adverse events should be assessed every 3 to 6 months, and therapy adjusted accordingly.     

Testosterone replacement therapy and motor function in men with spinal cord injury: a retrospective analysis

OBJECTIVE: To evaluate motor function in men with spinal cord injury (SCI) given testosterone replacement therapy (TRT). DESIGN: American Spinal Injury Association (ASIA) rehabilitation discharge motor index scores were compared between men with SCI given TRT (testosterone cypionate, 200 mg, monthly; n = 50) and a comparison group (n = 480) in a retrospective study. Covariates included admission motor and FIM scores, level of injury (paraplegia/tetraplegia), days since injury, and age. RESULTS: ASIA discharge motor scores for ASIA impairment scale grades C and D were significantly different (P < 0.05) in men with incomplete SCI given TRT, relative to the comparison group. The covariate-adjusted mean discharge score for the TRT group was higher than for the comparison group. There were no significant differences in discharge FIM scores (P = 0.34) for men with incomplete injuries and no differences in the adjusted discharge ASIA motor scores (P = 0.92) or adjusted discharge FIM scores (P = 0.16) for men with complete injuries. CONCLUSION: The data support a relationship between TRT and strength gains in men with residual motor function after SCI. Prospective studies are necessary to validate these findings.     

Testosterone and vascular reactivity

The mechanisms by which male sex hormones modulate cardiovascular function are a subject of contemporary interest. Several lines of evidence indicate that androgens can exert acute vasorelaxing effects. On the other hand, chronic exposure to androgens has been shown to promote increases in blood pressure and compromise renal function. In the present issue of Clinical Science, Malkin and co-workers show that testosterone replacement impairs vascular reactivity in men with androgen deficiency. These studies may shed light on the functional and therapeutic significance of the diverging acute and chronic cardiovascular effects of androgens.     

Testosterone and the heart

Several large scale studies in recent years have demonstrated increased cardiovascular mortality in men with low testosterone, especially those with existing cardiovascular disease and type 2 diabetes. In some patients the baseline measurement was a single total testosterone level, in others the association was seen only with free or bioavailable testosterone. These differences are most likely related to different characteristics of the cohorts studied in terms of age, obesity and presence of metabolic syndrome. Other smaller studies show consistent benefit from testosterone replacement in terms of reduced insulin resistance, HbA1c, total, LDL-cholesterol, triglycerides and inflammatory markers for CHD. There is clear evidence for a reduction in visceral and lean fat mass, improvement in sexual function, mood and symptom scores. Whilst most of these benefits are modest, the combined effect on these surrogate markers for cardiovascular risk is considerable and the improvement in well-being is likely to be welcomed by patients. There is early evidence from non-randomised studies that physiological testosterone replacement is extremely safe and may reduce cardiovascular mortality. The fact that few patients in potentially risk groups are being screened and treated is probably because of the wide range of specialities involved and the reluctance of one discipline to embrace and manage testosterone deficiency.     

Testosterone and Cardiovascular Health

There is an ongoing debate in the medical community regarding the effects of testosterone on cardiovascular (CV) health. For decades, there has been conflicting evidence regarding the association of endogenous testosterone levels and CV disease (CVD) events that has resulted in much debate and confusion among health care providers and patients alike. Testosterone therapy has become increasingly widespread, and after the emergence of studies that reported increased CVD events in patients receiving testosterone therapy, the US Food and Drug Administration (FDA) released a warning statement about testosterone and its potential risk regarding CV health. Some of these studies were later found to be critically flawed, and some experts, including the American Association of Clinical Endocrinologists and an expert panel regarding testosterone deficiency and its treatment, reported that some of the FDA statements regarding testosterone therapy were lacking scientific evidence. This article summarizes the current evidence regarding the relationship between testosterone (endogenous and supplemental) and CV health. A literature review was conducted via search using PubMed and specific journal databases, including the New England Journal of Medicine and the Journal of the American College of Cardiology. Key search terms included testosterone and cardiovascular health, coronary artery disease, heart failure, androgen deprivation therapy, intima-media thickness, and adrenal androgens. Initial study selection was limited to publications within the past 10 years (January 1, 2007, through December 31, 2016); however, key publications outside of this time frame were selected if they provided important quantitative data or historical perspectives for the review of this topic. The search was further supplemented by reviewing references in selected articles.     

Low Testosterone

Low male testosterone levels impact multiple organ systems. Low testosterone impacts men's health with physiologic effects on cognition, muscle mass and strength, bone density, metabolic function, and mood. Differential diagnosis is based on history, physical exam, clinical symptoms, and testosterone levels. The medical management of low testosterone consists of replacement therapy and associated symptom management.     

改进型髋关节挡板在全髋关节置换术中的应用

目的:探讨改进型髋关节挡板在全髋关节置换术中的应用。方法:预实验时,模拟髋关节手术体位摆放,观察改进型髋关节挡板与传统体位摆放方法的组装时间、固定后前、后倾角度被动丢失角度、操作人员满意度4个项目;临床验证时将56例全髋关节置换术患者随机分成两组,分别记录两组术前体位摆放所用时间、术中需要再次调整体位的次数、患者术中舒适度。结果:预实验和临床验证中两种体位摆放方法效果的差异具有统计学意义(P<0.01)。结论:改进型髋关节挡板较传统体位摆放方法更适用于全髋关节置换术患者,可进行推广。