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Monday 8 February 2016

TESTESTERONE REPLACEMENT THERAPY

Androgen or Testerone replacement therapy (ART),  is a class of hormone replacement therapy in which androgens, often testosterone, are replaced. ART is often prescribed to counter the effects of male hypogonadism. It typically involves the administration of testosterone, either by injection or by use of testosterone skin creams or gels.

ART may also be prescribed to lessen the effects or delay the onset of normal male aging. However, this is controversial and is the subject of ongoing clinical trials, assessing the benefits and harms of its use in otherwise healthy older men.
As men enter middle age they may notice changes caused by a relative decline in testosterone like fewer erections, fatigue, thinning skin, declining muscle mass and strength, more body fat.
This dissatisfaction with the changes of aging has led to the development of the idea of androgen replacement therapy.

 Androgen replacement therapy is also used for men who have lost testicular function to disease, cancer, or other causes. For men who have had prostate cancer or at elevated risk, androgen replacement therapy remains controversial because some studies have shown that it increases the risk for prostate cancer; others refute that risk.

Nonetheless,  testosterone replacement therapy has been under review for appropriateness and safety by the FDA due to the "potential for adverse cardiovascular outcomes"

Medical uses

Androgen replacement has a role in the treatment of hypogonadism, and may improve associated features such as low red blood cells, and fatigue.

In addition, a number of other effects of testosterone have led to research into possible therapeutic roles in: erectile dysfunction, osteoporosis, diabetes mellitus, chronic heart failure dementia, but the evidence base is small and the balance of benefit needs to be clarified

Diabetes and testosterone

The risks of diabetes and of testosterone deficiency in men over 45 ( i.e. hypogonadism, specifically hypoandrogenism) are strongly correlated. Testosterone replacement therapies have been shown to improve blood glucose management. Still, "it is prudent not to start testosterone therapy in men with diabetes solely for the purpose of improving metabolic control if they show no signs and symptoms of  hypogonadism."

Adverse effects

The FDA stated in 2015 that neither the benefits nor the safety of testosterone have been established for low testosterone levels due to aging. The FDA has required that testosterone labels include warning information about the possibility of an increased risk of heart attacks and stroke.

Heart disease

There are reports of strokes, heart attacks, and deaths in men taking testosterone-replacement led the FDA to announce that it would be investigating this issue. The FDA's action followed three peer-reviewed studies of increased cardiovascular events and deaths. Due to an increased rate of adverse cardiovascular events compared to a placebo group, a randomized trial stopped early.

Also, in a study reported an increase in deaths and heart attacks in older men.
Even after a correction was published, the "Androgen Study Group", a group with many members who have relationships with drug companies in the testosterone market, requested JAMA to retract the article as misleading due to substantial residual errors. Concerns have been raised that testosterone was being widely marketed ahead of large randomized controlled trials.As a result of the "potential for adverse cardiovascular outcomes", the FDA announced, a review of the appropriateness and safety of testosterone replacement therapy.

Other

Other significant adverse effects of testosterone supplementation include acceleration of pre-existing prostate cancer growth in individuals who have undergone androgen deprivation; increased hematocrit, which can require venipuncture in order to treat; and, exacerbation of sleep apnea. Adverse effects may also include minor side-effects such as acne and oily skin, as well as, significant hair loss and/or thinning of the hair, which may be prevented with 5-alpha reductase inhibitors ordinarily used for the treatment of benign prostatic hyperplasia, such as finasteride or dutasteride.Exogenous testosterone may also cause suppression of spermatogenesis, leading to, in some cases, infertility. It is recommended that physicians screen for prostate cancer with a digital rectal exam and prostate-specific antigen (PSA) level before starting therapy, and monitor PSA and hematocrit levels closely during therapy.

Athletic use

There is the possibility of abuse: some athletes may demand far higher levels of androgen than normal in order to out-perform others, other people may feel they require greater doses in order to achieve what they perceive as a feeling of greater well-being.
A UK study in 2013 showed that prescriptions for testosterone replacement, particularly transdermal products, almost doubled between 2000 and 2010.