madman
Super Moderator
Abstract
Purpose Late-onset hypogonadism (LOH) is an age-dependent reduction of testosterone associated with alterations of metabolic profile, including glucose control, insulin sensitivity, and lipid profile. The purpose of this study was to investigate the efficacy of testosterone replacement therapy (TRT) for treating metabolic disturbances through a meta-analysis of randomized clinical trials (RCTs).
Methods A systematic review of the literature published from 1964 to November 2019 was performed using the PubMed/Medline, Embase, and Cochrane databases. Among the 1562 articles screened, 17 articles were selected for qualitative analysis, and 16 articles (n=1373) were included for data synthesis following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). Criteria for final inclusion were RCTs.
Results Sixteen studies were fnally included (TRT group, n=709; placebo group, n=664). Among the metabolic markers, HbA1C [Mean diference (MD)=− 0.172, 95% CI − 0.329, − 0.015], HOMA IR (MD =− 0.514, 95% CI − 0.863, − 0.165), serum insulin (MD=− 12.622, 95% CI − 19.660, − 5.585), and leptin (MD =− 2.381, 95% CI − 2.952, − 1.810) showed signifcant improvement after TRT versus placebo. Among the lipid profles, total cholesterol showed signifcant improvement (MD=− 0.433, 95% CI − 0.761, − 0.105) after TRT. However, HDL showed a decrease (MD =− 0.069, 95% CI − 0.121, − 0.018) after TRT. Among anthropometric markers, waist circumference showed signifcant improvement (MD=− 0.1640, 95% CI − 2.857, − 0.423).
Conclusion This study demonstrated greater improvement in metabolic profiles for patients given TRT versus placebo. Further well-designed trials are needed to verify our findings and further elucidate the effects of TRT on lipid profiles. This systematic review demonstrates that TRT can exert a net beneficial effect on metabolic profiles.
Introduction
It is well established that testosterone levels will decline with age. An age-related decrease of testosterone level combined with hypogonadal signs and symptoms in the absence of Hypothalamic–Pituitary–Thyroid axis pathology, which is called functional hypogonadism, can increase the risks of cardiovascular disease (CVD), diabetes, dementia, osteoporosis, and loss of libido and fertility [1–3]. Late-onset hypogonadism (LOH) is more prevalent in old age because of its direct relationship with the aging process, which might impair the function or production of sex steroid hormones, including testosterone, follicular stimulating hormone (FSH), luteinizing hormone (LH), and gonadotropin-releasing hormone (GnRH) [2, 4]. Moreover, it is important to note that LOH is often associated with metabolic disturbances, including metabolic syndrome (MS), obesity, type 2 DM, and hyperlipidemia clinically [1, 2]. Although sexual dysfunction is regarded as a typical clinical symptom of androgen deficiency for decreased androgen activity in LOH, commonly combined conditions, such as CVD, dementia, MS, type 2 DM, hyperlipidemia, and osteoporosis should also, be considered to maintain a healthy life in old age.
*To date, there have been various systematic reviews and meta-analyses about TRT used to treat sexual dysfunction, lower urinary tract symptoms, CVD, DM, and dementia [2, 5, 8]. However, there has been no study about the effect of TRT on metabolic disturbances. Thus, the purpose of this study was to suggest quantitative evidence for the use of TRT on metabolic disturbances.
Conclusion
Our study showed a positive effect of TRT on metabolic disturbances among RCT trials for the first time. It could provide useful information for clinicians who treat LOH patients. It also gives guidance for individual personalized treatment care of LOH patients. Proper guidance could prevent both overprescribing and passive treatment of TRT. For better shared decision-making, future studies are needed to show the long-term efficacy and safety of TRT for nonorganic LOH.
Purpose Late-onset hypogonadism (LOH) is an age-dependent reduction of testosterone associated with alterations of metabolic profile, including glucose control, insulin sensitivity, and lipid profile. The purpose of this study was to investigate the efficacy of testosterone replacement therapy (TRT) for treating metabolic disturbances through a meta-analysis of randomized clinical trials (RCTs).
Methods A systematic review of the literature published from 1964 to November 2019 was performed using the PubMed/Medline, Embase, and Cochrane databases. Among the 1562 articles screened, 17 articles were selected for qualitative analysis, and 16 articles (n=1373) were included for data synthesis following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). Criteria for final inclusion were RCTs.
Results Sixteen studies were fnally included (TRT group, n=709; placebo group, n=664). Among the metabolic markers, HbA1C [Mean diference (MD)=− 0.172, 95% CI − 0.329, − 0.015], HOMA IR (MD =− 0.514, 95% CI − 0.863, − 0.165), serum insulin (MD=− 12.622, 95% CI − 19.660, − 5.585), and leptin (MD =− 2.381, 95% CI − 2.952, − 1.810) showed signifcant improvement after TRT versus placebo. Among the lipid profles, total cholesterol showed signifcant improvement (MD=− 0.433, 95% CI − 0.761, − 0.105) after TRT. However, HDL showed a decrease (MD =− 0.069, 95% CI − 0.121, − 0.018) after TRT. Among anthropometric markers, waist circumference showed signifcant improvement (MD=− 0.1640, 95% CI − 2.857, − 0.423).
Conclusion This study demonstrated greater improvement in metabolic profiles for patients given TRT versus placebo. Further well-designed trials are needed to verify our findings and further elucidate the effects of TRT on lipid profiles. This systematic review demonstrates that TRT can exert a net beneficial effect on metabolic profiles.
Introduction
It is well established that testosterone levels will decline with age. An age-related decrease of testosterone level combined with hypogonadal signs and symptoms in the absence of Hypothalamic–Pituitary–Thyroid axis pathology, which is called functional hypogonadism, can increase the risks of cardiovascular disease (CVD), diabetes, dementia, osteoporosis, and loss of libido and fertility [1–3]. Late-onset hypogonadism (LOH) is more prevalent in old age because of its direct relationship with the aging process, which might impair the function or production of sex steroid hormones, including testosterone, follicular stimulating hormone (FSH), luteinizing hormone (LH), and gonadotropin-releasing hormone (GnRH) [2, 4]. Moreover, it is important to note that LOH is often associated with metabolic disturbances, including metabolic syndrome (MS), obesity, type 2 DM, and hyperlipidemia clinically [1, 2]. Although sexual dysfunction is regarded as a typical clinical symptom of androgen deficiency for decreased androgen activity in LOH, commonly combined conditions, such as CVD, dementia, MS, type 2 DM, hyperlipidemia, and osteoporosis should also, be considered to maintain a healthy life in old age.
*To date, there have been various systematic reviews and meta-analyses about TRT used to treat sexual dysfunction, lower urinary tract symptoms, CVD, DM, and dementia [2, 5, 8]. However, there has been no study about the effect of TRT on metabolic disturbances. Thus, the purpose of this study was to suggest quantitative evidence for the use of TRT on metabolic disturbances.
Conclusion
Our study showed a positive effect of TRT on metabolic disturbances among RCT trials for the first time. It could provide useful information for clinicians who treat LOH patients. It also gives guidance for individual personalized treatment care of LOH patients. Proper guidance could prevent both overprescribing and passive treatment of TRT. For better shared decision-making, future studies are needed to show the long-term efficacy and safety of TRT for nonorganic LOH.
