madman
Super Moderator
Controversies with testosterone therapy
Mohit Khera, MD
Department of Urology, Baylor College of Medicine, Houston, Texas, USA
Introduction: Over the past decade, there have been concerns with the safety of testosterone therapy (TTh) in hypogonadal men. Several concerns have centered on the use of TTh and its potential link to cardiovascular (CV) events, prostate cancer, and benign prostatic hyperplasia(BPH). There has also been controversy in determining which patients are appropriate candidates for TTh and if lifestyle modification has any role in improving serum testosterone values in hypogonadal men.
Materials and methods: A literature review of all articles assessing testosterone and the use of TTh and the association with CV events, prostate cancer, BPH, and lifestyle modification was conducted
Results: The majority of patients treated with TTh today are treated off-label. Low serum testosterone levels have been associated with increased CV events. Currently, there is inconclusive evidence to support that TTh increases the risk of CV events. There is an absence of evidence linking TTh to the development of prostate cancer or worsening of BPH symptoms. Finally, lifestyle modification, such as decreasing weight and improving sleep, can improve serum testosterone levels in hypogonadal men.
Conclusions: Clinicians prescribing testosterone should be aware of the current controversies associated with TTh. The current literature does not suggest that there is a significant risk with TTh and prostate cancer, worsening of BPH symptoms, or CV events. However, more studies, including randomized placebo-controlled trials, are needed. Finally, patients should be counseled appropriately regarding the indications for TTh and the benefits of lifestyle modification prior to initiating TTh.
*Testosterone therapy and cardiovascular risk
*Testosterone and the prostate
*Testosterone and lifestyle modification
Conclusions
Clinicians prescribing testosterone should be aware of the current controversies associated with TTh. Controversies associated with TTh include the potential risk of developing prostate cancer and the worsening of LUTS. In addition, there are concerns about TTh potentially increasing CV risk. The current literature does not suggest that there is a significant risk with TTh and prostate cancer, LUTS, and CV events. However, more studies, including randomized placebo-controlled trials, are needed. Clinicians prescribing TTh should also be aware that the majority of hypogonadal patients currently being treated with TTh are being treated off-label. Finally, lifestyle modification, such as weight loss and improvement in sleep, as well as varicocelectomy, can improve serum T values. Patients should be counseled appropriately regarding the indications for T therapy and the benefits of lifestyle modification prior to initiating TTh.
Mohit Khera, MD
Department of Urology, Baylor College of Medicine, Houston, Texas, USA
Introduction: Over the past decade, there have been concerns with the safety of testosterone therapy (TTh) in hypogonadal men. Several concerns have centered on the use of TTh and its potential link to cardiovascular (CV) events, prostate cancer, and benign prostatic hyperplasia(BPH). There has also been controversy in determining which patients are appropriate candidates for TTh and if lifestyle modification has any role in improving serum testosterone values in hypogonadal men.
Materials and methods: A literature review of all articles assessing testosterone and the use of TTh and the association with CV events, prostate cancer, BPH, and lifestyle modification was conducted
Results: The majority of patients treated with TTh today are treated off-label. Low serum testosterone levels have been associated with increased CV events. Currently, there is inconclusive evidence to support that TTh increases the risk of CV events. There is an absence of evidence linking TTh to the development of prostate cancer or worsening of BPH symptoms. Finally, lifestyle modification, such as decreasing weight and improving sleep, can improve serum testosterone levels in hypogonadal men.
Conclusions: Clinicians prescribing testosterone should be aware of the current controversies associated with TTh. The current literature does not suggest that there is a significant risk with TTh and prostate cancer, worsening of BPH symptoms, or CV events. However, more studies, including randomized placebo-controlled trials, are needed. Finally, patients should be counseled appropriately regarding the indications for TTh and the benefits of lifestyle modification prior to initiating TTh.
*Testosterone therapy and cardiovascular risk
*Testosterone and the prostate
*Testosterone and lifestyle modification
Conclusions
Clinicians prescribing testosterone should be aware of the current controversies associated with TTh. Controversies associated with TTh include the potential risk of developing prostate cancer and the worsening of LUTS. In addition, there are concerns about TTh potentially increasing CV risk. The current literature does not suggest that there is a significant risk with TTh and prostate cancer, LUTS, and CV events. However, more studies, including randomized placebo-controlled trials, are needed. Clinicians prescribing TTh should also be aware that the majority of hypogonadal patients currently being treated with TTh are being treated off-label. Finally, lifestyle modification, such as weight loss and improvement in sleep, as well as varicocelectomy, can improve serum T values. Patients should be counseled appropriately regarding the indications for T therapy and the benefits of lifestyle modification prior to initiating TTh.
