 |
 |
www.andropause.org.uk |
 |
| Heart Considerations |
| Treatment |
| Potency |
| Erectile Dysfunction |
| Viagra |
| Safety |
| Oestrogen |
| Midlife Crisis diagnosis |
| <%if session("patid") = 5438 then%>
<%end if%> |
| Info Articles |
| Benefits and safety of
treatment Testosterone
replacement therapy has been widely available for over 60 years and has been used
extensively to treat men with low levels of the hormone.
The aim of treatment is to return the level of testosterone in the blood to
normal that is from a state of deficiency to sufficiency.
Such a concept is true for diabetes and other hormonal deficiency states
such as an underactive thyroid gland as well of course as hormone replacement therapy for
menopausal women. There
has been concern in the past that testosterone replacement therapy can cause prostate
cancer, principally because prostate cancer, when it exists, is often made worse by
testosterone. Although clearly the presence
of prostate cancer is a contra-indication to testosterone treatment, there is no evidence
that testosterone treatment causes prostate cancer. Prostate
cancer appears to arise because of genetic and environmental factors and it is believed
that a high fat diet may also be implicated. In
a review of over 1,000 patients at a London clinic, the chance of getting prostate cancer
whilst on testosterone therapy appears no greater than in the normal population. Other studies have also failed to show that
testosterone precipitates prostate cancer1,2.
In order to make sure that patients do not have prostate cancer before testosterone
replacement therapy is initiated, all patients have a blood sample taken to measure the
level of prostate specific antigen a marker for prostate cancer. The PSA level should be checked 6 monthly
thereafter in line with World Health Organisation guidelines. Testosterone
can increase the amount of red blood cells and the pigment haemaglobin however it is
common to find that men with low levels of testosterone have low levels red cells and
haemaglobin before treatment is started, infact some are clearly anaemic. In such cases testosterone replacement therapy
merely normalises their blood picture. There
has been great interest recently about the benefits of testosterone on the cardiovascular
system. It has been reported that men with
abnormally low levels of testosterone may be at greater risk of cardiovascular disease3,4,5. Such men with heart disease when given TRT to
normalise their testosterone levels gain cardiovascular benefit and one study has shown
that blood flow in the coronary arteries is improved4,5. Other studies have shown that men with low levels
of testosterone have an adverse cholesterol, blood sugar and blood clotting factor profile
and therefore may be at greater risk of cardiac problems6. Testosterone replacement therapy reverses these
adverse profiles when they are present. It
has also been shown that men with abnormally low levels of testosterone are at greater
risk of osteoporosis and fracture of the hip and that replacement may benefit the bones7,8. Depression
and lack of well-being are also common associations with low testosterone levels and that
treatment with testosterone improves symptoms9 Testosterone
deficiency, like thyroid deficiency or diabetes is an abnormal state of affairs with
physiological and psychological consequences. As
it is an abnormality it should be treated. References 1. Atkinson
LE, Chang YL, Snyder P. Long-term experience
with testosterone replacement through scrotal skin. In:
Nieschlag E, Behre HM (eds) Testosterone. Action deficiency substitution. Springer-Verlag,
Germany. 1998, 364-88. 2. Schroder
FH. The prostate and androgens: the risk of
supplementation. In: Oddens B, Vermeulen A (eds) Androgens
and the aging male. Parthenon publishing Group., New York, 1996, pp223-6. 3. English
KM, Mandour O, Steeds RP et al. Men
with coronary artery diseas have lower levels of androgens than men with normal coronary
angiograms. Eur Heart J. 2000; 21: 890-4. 4. Rosanno
GMC, Leonardo F, Pagnotta P et al. Acute anti-ischaemic effect of testosterone in men
with coronary artery disease. Circulation. 1999; 99: 1666-70. 5. Webb
CM, McNeill DCRR, Hayward CS et al. Effect of testosterone on coronary vasomotor
regulation in men with coronary heart disease. Circulation. 1999, 100, 1690-6. 6. Phillips
GB, Pinkernell BH, Jing TY. The association
of hypotestosteronaemia with coronary artery disease in men. Arterioscler Thromb. 1994; 14: 701-6. 7. Jackson
JA, Riggs MW, Spiekerman M. Testosterone
deficiency as a risk factor for hip fracture in men; a case control study. Am J Med Sci.
1992; 304: 4-8. 8. Finkelstein
JS. Androgens and bone metabolism. In: Nieschlag E, Behre HM (eds). Testosterone. Action deficiency substitution. Springer-Verlag,
Germany. 1998, 187-207. 9. Wang
C, Alexander G, Berman N et al. Testosterone replacement therapy improves mood in
hypogonadal men - a clinical research centre
study. J Clin Endocrinol Metab. 1996; 81: 3578-83. |