EFFICACY AND SAFETY OF TESTOSTERONE THERAPY FOR LATE-ONSET HYPOGONADISM: AN UPDATE

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "EFFICACY AND SAFETY OF TESTOSTERONE THERAPY FOR LATE-ONSET HYPOGONADISM: AN UPDATE"

Transcription

1 EFFICACY AND SAFETY OF TESTOSTERONE THERAPY FOR LATE-ONSET HYPOGONADISM: AN UPDATE Matthew Ho, PGY-2 Department of Urologic Sciences University of British Columbia OBJECTIVES 1. Review the characteristics of late-onset hypogonadism (LOH) 2. Review recent evidence on the efficacy of testosterone therapy (TT) 3. Discuss the controversies surrounding TT 4. Review recent evidence on cardiovascular risk associated with TT 5. Review recent evidence on VTE risk associated with TT 1

2 OBJECTIVES 1. Review the characteristics of late-onset hypogonadism (LOH) 2. Review recent evidence on the efficacy of TT 3. Discuss the controversies surrounding testosterone therapy (TT) 4. Review recent evidence on cardiovascular risk associated with TT 5. Review recent evidence on VTE risk associated with TT LATE-ONSET HYPOGONADISM Multiple population studies demonstrate gradual decrease in serum total/free T 0.4% T, 1.2% ft per year 0.1 nmol/l per year 1. O Donnell AB, Araujo AB, McKinlay JB. The health of normally aging men: The Massachusetts Male Aging Study ( ). Exp Gerontol Jul;39(7): Harman SM, Metter EJ, Tobin JD, Pearson J, Blackman MR, Baltimore Longitudinal Study of Aging. Longitudinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore Longitudinal Study of Aging. J Clin Endocrinol Metab Feb;86(2): Tajar A, Huhtaniemi IT, O Neill TW, Finn JD, Pye SR, Lee DM, Bartfai G, Boonen S, Casanueva FFF, Forti G, Giwercman A, Han TS, Kula K, Labrie F, Lean MEJ, Pendleton N, Punab M, Vanderschueren D, Wu FCW, EMAS Group. Characteristics of androgen deficiency in late-onset hypogonadism: results from the European Male Aging Study (EMAS). J Clin Endocrinol Metab May;97(5): Wu FCW, Tajar A, Beynon JM, Pye SR, Silman AJ, Finn JD, O Neill TW, Bartfai G, Casanueva FF, Forti G, Giwercman A, Han TS, Kula K, Lean MEJ, Pendleton N, Punab M, Boonen S, Vanderschueren D, Labrie F, Huhtaniemi IT. Identification of Late-Onset Hypogonadism in Middle-Aged and Elderly Men. New England Journal of Medicine Jul 8;363(2):

3 LATE-ONSET HYPOGONADISM Distinct from testicular/pituitary hypogonadism Elements of both: Decreased testicular response Decreased HP signal LATE-ONSET HYPOGONADISM Prevalence depends on definition 20% - 50%, increasing with age (BLSA) T < 325 ng/dl (11.4 nmol/l) 2.1% (EMAS) T < 11 nmol/l AND 3 sexual symptoms LOH = Symptoms + Low T + Improvement supplementation 1. O Donnell AB, Araujo AB, McKinlay JB. The health of normally aging men: The Massachusetts Male Aging Study ( ). Exp Gerontol Jul;39(7): Harman SM, Metter EJ, Tobin JD, Pearson J, Blackman MR, Baltimore Longitudinal Study of Aging. Longitudinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore Longitudinal Study of Aging. J Clin Endocrinol Metab Feb;86(2): Tajar A, Huhtaniemi IT, O Neill TW, Finn JD, Pye SR, Lee DM, Bartfai G, Boonen S, Casanueva FFF, Forti G, Giwercman A, Han TS, Kula K, Labrie F, Lean MEJ, Pendleton N, Punab M, Vanderschueren D, Wu FCW, EMAS Group. Characteristics of androgen deficiency in late-onset hypogonadism: results from the European Male Aging Study (EMAS). J Clin Endocrinol Metab May;97(5): Wu FCW, Tajar A, Beynon JM, Pye SR, Silman AJ, Finn JD, O Neill TW, Bartfai G, Casanueva FF, Forti G, Giwercman A, Han TS, Kula K, Lean MEJ, Pendleton N, Punab M, Boonen S, Vanderschueren D, Labrie F, Huhtaniemi IT. Identification of Late-Onset Hypogonadism in Middle-Aged and Elderly Men. New England Journal of Medicine Jul 8;363(2): Bebb, R. BCMJ

4 TREATMENT THRESHOLDS Endocrine Society T < 10.4 nmol/l (300 ng/dl) + symptoms EAU, International Society of Andrology T < 12.1 nmol/l (350 ng/dl) + symptoms SYMPTOMS OF HYPOGONADISM 1.Grober, E. D. Testosterone deficiency and replacement: Myths and realities. Canadian Urological Association Journal 8, (2014). 4

5 LATE-ONSET HYPOGONADISM Low T associated with Metabolic syndrome (OR 3.0 for T < 8 nmol/l) All-cause mortality (HR 2.2) CVD mortality (HR 1.2) Sexual dysfunction, decreased energy/mobility, decreased mood 1. Araujo AB, Dixon JM, Suarez EA, Murad MH, Guey LT, Wittert GA. Endogenous Testosterone and Mortality in Men: A Systematic Review and Meta-Analysis. J Clin Endocrinol Metab Oct 1;96(10): Wu FCW, Tajar A, Beynon JM, Pye SR, Silman AJ, Finn JD, O Neill TW, Bartfai G, Casanueva FF, Forti G, Giwercman A, Han TS, Kula K, Lean MEJ, Pendleton N, Punab M, Boonen S, Vanderschueren D, Labrie F, Huh 3. Traish AM, Haider A, Haider KS, Doros G, Saad F. Long-Term Testosterone Therapy Improves Cardiometabolic Function and Reduces Risk of Cardiovascular Disease in Men with Hypogonadism: A Real-Life Observ OBJECTIVES 1. Review the characteristics of late-onset hypogonadism (LOH) 2. Review recent evidence on the efficacy of TT 3. Discuss the controversies surrounding testosterone therapy (TT) 4. Review recent evidence on cardiovascular risk associated with TT 5. Review recent evidence on VTE risk associated with TT 5

6 TT BENEFITS Decreased fat mass Increased lean mass Increased bone mineral density (BMD) Improved glycemic, lipid control Mood Sexual function 1.Snyder, P. J. et al. Effect of testosterone treatment on body composition and muscle strength in men over 65 years of age. J. Clin. Endocrinol. Metab. 84, (1999). 2. Muraleedharan, V., Marsh, H., Kapoor, D., Channer, K. S. & Jones, T. H. Testosterone deficiency is associated with increased risk of mortality and testosterone replacement improves survival in men with type 2 diabetes. Eur J Endocrinol 169, (2013). 3. Giltay, E. J. et al. Effects of Testosterone Supplementation on Depressive Symptoms and Sexual Dysfunction in Hypogonadal Men with the Metabolic Syndrome. The Journal of Sexual Medicine 7, (2010). 4. Dohle et al, Guidelines on Male Hypogonadism. EAU Guidelines TESTOSTERONE TRIALS 7-armed RCT to assess efficacy of TT 3 main arms: sexual function, physical function, vitality N = 790 T gel (target: ng/dl) vs. placebo x 1 year 6

7 Included TESTOSTERONE TRIALS >65 years old Average T < 275 ng/dl (9.5 nmol/l) Symptoms of decreased sexual function, physical function or vitality Excluded PCa, PIN, PCRC > 35% or HG > 7%, MI/stroke within past 3 months, BP > 160/100 IPSS > 19, untreated OSA, meds affecting [T] SEXUAL FUNCTION Primary outcome: score on question 4 of PDQ Secondary outcomes: sexual desire, IIEF score 1.Lee, K. K. et al. A Simple Self-Report Diary for Assessing Psychosexual Function in Hypogonadal Men. Journal of Andrology 24, (2003). 7

8 SEXUAL FUNCTION Significant increase in sexual activity Treatment effect (TE) 0.58 in SF group 0.62 in all patients Improved erection scores (TE: 2.64) Inferior to PDE-5 Increased sexual desire (TE: 2.93) PHYSICAL FUNCTION Primary outcome: 50 m improvement in 6-minute walk test Secondary outcomes: 6 minute walk test improvement from baseline Improvement in PF-10 score 8

9 PHYSICAL FUNCTION Among PF-enrolled patients: No difference in walk test Among all patients: OR 1.76 for increase of 50 m in 6 min walk test 6.7 m mean difference in walk test Improvement in pt s perception of walking ability VITALITY Primary outcome: 4 point increase in FACIT Fatigue scale Secondary outcomes: SF-36, PANAS, PHQ-9 score improvements 9

10 VITALITY No improvement in FACIT Fatigue score Small improvements in PANAS, PHQ-9 More likely to report better energy levels TESTOSTERONE TRIALS Anemia: 10 pt Hgb increase 54% T vs. 15% placebo for anemia NYD Bone density Significant increases in BMD and strength (TE 0.07, 0.085) Cognitive function No improvement Coronary plaque Increased non-calcified plaque 1.Roy, C. N. et al. Association of Testosterone Levels With Anemia in Older Men: A Controlled Clinical Trial. JAMA Intern Med 177, (2017). 2. Snyder, P. J. et al. Effect of Testosterone Treatment on Volumetric Bone Density and Strength in Older Men With Low Testosterone: A Controlled Clinical Trial. JAMA Intern Med 177, Resnick, S. M. et al. Testosterone Treatment and Cognitive Function in Older Men With Low Testosterone and Age-Associated Memory Impairment. JAMA 317, (2017). 4..Budoff, M. J. et al. Testosterone Treatment and Coronary Artery Plaque Volume in Older Men With Low Testosterone. JAMA 317, (2017). 10

11 META-ANALYSES 70 RCT, 19 NRS most at high or unclear risk of bias Median treatment duration 6 months Outcomes: QOL, depression, libido, erectile function, ADLs AEs: CV events, PCa, erythrocytosis Efficacy of TT as a class TT modalities head to head QOL improvement (SMD 0.26) Improved depression scores (SMD -0.23) Improved libido (SMD 0.33), erectile function (0.25) No difference in CV events or PCa 11

12 QOL CV events 12

13 16 RCTs, median treatment duration 6 months Score on Aging Men s Symptoms (AMS) questionnaire, BMI, weight, lean body mass, fat mass, total cholesterol AGING MEN S SYMPTOMS QUESTIONNAIRE 13

14 Significant improvement AMS score (1.7/85 pts) Increased lean body mass (1.2 kg) No decrease in weight or BMI No change in BMD Decreased total cholesterol (0.16 mg/dl) No increase in PSA or IPSS 5 RCTs incorporating use of AMS Significant decrease in score (3/85 points) 14

15 SUMMARY- EFFICACY Mild-moderate improvements Sexual function Mood QOL Lean body mass BMI BMD OBJECTIVES 1. Review the characteristics of late-onset hypogonadism (LOH) 2. Review recent evidence on the efficacy of TT 3. Discuss the controversies surrounding testosterone therapy (TT) 4. Review recent evidence on cardiovascular risk associated with TT 5. Review recent evidence on VTE risk associated with TT 15

16 CONTROVERSY FDA Drug Safety Warnings, Designed to test effects of TT on mobility Stopped early due to significantly increased adverse CV events Not designed or powered to detect CV outcomes 16

17 Sampled men receiving angiography Pre-adjusted risk favoured the treatment group 9% of sample was female Identified treatment group by Rx records No testing of T levels (Vigen et al., 2013) Self-controlled 90 days of follow-up Identified treatment group by Rx records 17

18 OBJECTIVES 1. Review the characteristics of late-onset hypogonadism (LOH) 2. Review recent evidence on the efficacy of TT 3. Discuss the controversies surrounding testosterone therapy (TT) 4. Review recent evidence on cardiovascular risk associated with TT 5. Review recent evidence on VTE risk associated with TT CV RISK Retrospective cohort study n = T < 300 ng/dl OR diagnosis hypogonadism Excluded: testis/prostate Ca, AIS, Klinefelter, pituitary disorder Outcome: MI/revascularization, stroke/tia, unstable angina, sudden cardiac death 18

19 Ever-T group: 8808 with filled T prescription 76% filled >1 Rx Mean duration 925 d Median follow-up 3.2 years untreated, 4.2 years treated Baseline T 212 ng/dl 318 on treatment 10.2% event rate untreated population vs. 8.2% treated population HR 0.67 (95% CI ) TT is protective against CV events 19

20 Matched retrospective cohort, N = years or older Treatment group: men receiving any TT (N = 10, 331) 5.3 (treated) vs. 5.1 (untreated) years follow-up Outcomes: mortality, CV event (MI/CVA/VTE), PCa dx Mortality benefit with treatment (19% vs 21%) HR 0.88 ( ) No difference in CV event rate 20

21 Stratification based on duration of T exposure Lowest tertile (median 2 months) Increased mortality (HR 1.11) Increased CV events (HR 1.26) Middle tertile Decreased mortality (HR 0.9) Highest tertile Decreased mortality (HR 0.67) Decreased CV events (HR 0.84) Retrospective VA cohort (N = ) Men with one low T level (lab dependent) Excluded: prior MI/stroke, subsequent normal T Outcomes: MI, stroke, mortality 21

22 3 analysis groups Untreated (18.5%) Treated, inadequate response (30.1%) Treated, adequate response (51.4%) Median follow-up 4.7 years untreated, 6.2 years treated Responders Mortality vs. untreated: HR

23 Responders MI vs. untreated: HR 0.76 CV events 23

24 SUMMARY- CV RISK According to recent evidence, multiple studies show a mortality benefit to TT At worst, CV event risk is similar; several studies show a protective event of TT OBJECTIVES 1. Review the characteristics of late-onset hypogonadism (LOH) 2. Review recent evidence on the efficacy of TT 3. Discuss the controversies surrounding testosterone therapy (TT) 4. Review recent evidence on cardiovascular risk associated with TT 5. Review recent evidence on VTE risk associated with TT 24

25 Retrospective cohort (N = ) Inclusion: 2 low T levels Excluded: Hx of VTE, warfarin use, cancer, coagulopathy 3 groups: Treated, adequate response (N = ) Mean follow-up 6.1 years Treated, inadequate response (N = ) Mean follow-up 4.5 years Untreated (N = ) Mean follow-up 4.6 years No significant difference in VTE incidence 25

26 Retrospective case control study (n = ) confirmed VTEs (DVT or PE) matched controls Current T use (<6 months vs. > 6 months) Recent within 2 years Not within 2 years RR =1.63 within 6 months of TT initiation 69/ VTEs while on TT (0.36%) 91/2107 TT users (within 2 years) developed PE (4%) RR = 1.00 after 6 months of TT 26

27 Flannigan R, Locke J et al testosterone users 135 PEs No association between TT and PE Regardless of duration of exposure or T level at entry SUMMARY- VTE Conflict in recent literature If TT increases risk of VTE, absolute increases and overall risk likely low 27

28 SUMMARY Mild-modest benefits Possible mortality benefit No increased CV risk Possible increase in VTE, but low overall EAU Guidelines GUIDELINES AUA Guidelines Endocrine Society Guidelines We recommend testosterone therapy for symptomatic men with classical androgen deficiency syndromes aimed at inducing and maintaining secondary sex characteristics and at improving their sexual function, sense of well-being, and bone mineral density. AUA Board of Directors. AUA Position Statement on Testosterone Therapy. AUA,

29 ACKNOWLEDGEMENTS Dr. Ryan Flannigan Dr. Larry Goldenberg Dr. Jenn Locke BIBLIOGRAPHY 1.Araujo, A. B. et al. Endogenous Testosterone and Mortality in Men: A Systematic Review and Meta-Analysis. J Clin Endocrinol Metab 96, (2011). 2.Basaria, S. et al. Adverse Events Associated with Testosterone Administration. New England Journal of Medicine 363, (2010). 3.Basaria, S. et al. Effects of Testosterone Administration for 3 Years on Subclinical Atherosclerosis Progression in Older Men With Low or Low-Normal Testosterone Levels: A Randomized Clinical Trial. JAMA 314, (2015). 4.Bhasin, S. et al. Testosterone Therapy in Men with Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 95, (2010). 5.Brambilla, D. J., O Donnell, A. B., Matsumoto, A. M. & McKinlay, J. B. Intraindividual variation in levels of serum testosterone and other reproductive and adrenal hormones in men. Clin. Endocrinol. (Oxf) 67, (2007). 6.Budoff, M. J. et al. Testosterone Treatment and Coronary Artery Plaque Volume in Older Men With Low Testosterone. JAMA 317, (2017). 7.Cheetham, T. C. et al. Association of Testosterone Replacement With Cardiovascular Outcomes Among Men With Androgen Deficiency. JAMA Intern Med 177, (2017). 8.Dhindsa, S. et al. Insulin Resistance and Inflammation in Hypogonadotropic Hypogonadism and Their Reduction After Testosterone Replacement in Men With Type 2 Diabetes. Diabetes Care 39, (2016). 9.Elliott, J. et al. Testosterone therapy in hypogonadal men: a systematic review and network meta-analysis. BMJ Open 7, e (2017). 10.Finkle, W. D. et al. Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men. PLOS ONE 9, e85805 (2014). 11. Flannigan, R et al. Pulmonary Emboli in The Setting of Testosterone Therapy. A Nested Case Control Study Among 40,081 Testosterone Users. Abstract (2017) 11.Giltay, E. J. et al. Effects of Testosterone Supplementation on Depressive Symptoms and Sexual Dysfunction in Hypogonadal Men with the Metabolic Syndrome. The Journal of Sexual Medicine 7, (2010). 12.GUO, C. et al. Efficacy and safety of testosterone replacement therapy in men with hypogonadism: A meta-analysis study of placebo-controlled trials. Exp Ther Med 11, (2016). 13.Haring, R. Meta-Epidemiology of Testosterone s Risks and Benefits Will We Ever Know the Answer? JAMA Intern Med 177, (2017). 14.Harman, S. M. et al. Longitudinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore Longitudinal Study of Aging. J. Clin. Endocrinol. Metab. 86, (2001). 15.Huhtaniemi, I. Late-onset hypogonadism: current concepts and controversies of pathogenesis, diagnosis and treatment. Asian J. Androl. 16, (2014). 16.Kelsey, T. W. et al. A Validated Age-Related Normative Model for Male Total Testosterone Shows Increasing Variance but No Decline after Age 40 Years. PLoS One 9, (2014). 17.Lee, K. K. et al. A Simple Self-Report Diary for Assessing Psychosexual Function in Hypogonadal Men. Journal of Andrology 24, (2003). 18.Martinez, C. et al. Testosterone treatment and risk of venous thromboembolism: population based case-control study. BMJ 355, i5968 (2016). 19.Muraleedharan, V., Marsh, H., Kapoor, D., Channer, K. S. & Jones, T. H. Testosterone deficiency is associated with increased risk of mortality and testosterone replacement improves survival in men with type 2 diabetes. Eur J Endocrinol 169, (2013). 20.Nian, Y. et al. Testosterone replacement therapy improves health-related quality of life for patients with late-onset hypogonadism: a meta-analysis of randomized controlled trials. Andrologia 49, n/a-n/a (2017). 21.O Donnell, A. B., Araujo, A. B. & McKinlay, J. B. The health of normally aging men: The Massachusetts Male Aging Study ( ). Exp. Gerontol. 39, (2004). 22.Ohlsson, C. et al. High Serum Testosterone Is Associated With Reduced Risk of Cardiovascular Events in Elderly Men: The MrOS (Osteoporotic Fractures in Men) Study in Sweden. Journal of the American College of Cardiology 58, (2011). 23.Orwoll, E. et al. Testosterone and Estradiol among Older Men. J Clin Endocrinol Metab 91, (2006). 24.Piszczek, J., Mamdani, M., Antoniou, T., Juurlink, D. N. & Gomes, T. The Impact of Drug Reimbursement Policy on Rates of Testosterone Replacement Therapy among Older Men. PLOS ONE 9, e98003 (2014). 25.Resnick, S. M. et al. Testosterone Treatment and Cognitive Function in Older Men With Low Testosterone and Age-Associated Memory Impairment. JAMA 317, (2017). 26.Roy, C. N. et al. Association of Testosterone Levels With Anemia in Older Men: A Controlled Clinical Trial. JAMA Intern Med 177, (2017). 27.Saad, F., Haider, A., Doros, G. & Traish, A. Long-term treatment of hypogonadal men with testosterone produces substantial and sustained weight loss. Obesity (Silver Spring) 21, (2013). 28.Sharma, R. et al. Association Between Testosterone Replacement Therapy and the Incidence of DVT and Pulmonary Embolism: A Retrospective Cohort Study of the Veterans Administration Database. Chest 150, (2016). 29.Sharma, R. et al. Normalization of testosterone level is associated with reduced incidence of myocardial infarction and mortality in men. Eur Heart J 36, (2015). 30.Snyder, P. J. et al. Effects of Testosterone Treatment in Older Men. New England Journal of Medicine 374, (2016). 31.Snyder, P. J. et al. The Testosterone Trials: Seven coordinated trials of testosterone treatment in elderly men. Clinical Trials (2014). 32.Snyder, P. J. et al. Effect of Testosterone Treatment on Volumetric Bone Density and Strength in Older Men With Low Testosterone: A Controlled Clinical Trial. JAMA Intern Med 177, (2017). 33.Snyder, P. J. et al. Effect of testosterone treatment on body composition and muscle strength in men over 65 years of age. J. Clin. Endocrinol. Metab. 84, (1999). 34.Tajar, A. et al. Characteristics of Secondary, Primary, and Compensated Hypogonadism in Aging Men: Evidence from the European Male Ageing Study. J Clin Endocrinol Metab 95, (2010). 35.Tajar, A. et al. Characteristics of androgen deficiency in late-onset hypogonadism: results from the European Male Aging Study (EMAS). J. Clin. Endocrinol. Metab. 97, (2012). 36.Traish, A. M., Haider, A., Haider, K. S., Doros, G. & Saad, F. Long-Term Testosterone Therapy Improves Cardiometabolic Function and Reduces Risk of Cardiovascular Disease in Men with Hypogonadism: A Real-Life Observational Registry Study Setting Comparing Treated and Untreated (Control) Groups. J Cardiovasc Pharmacol Ther 22, (2017). 37.Travison, T. G., Araujo, A. B., O Donnell, A. B., Kupelian, V. & McKinlay, J. B. A Population-Level Decline in Serum Testosterone Levels in American Men. J Clin Endocrinol Metab 92, (2007). 38.Vigen, R. et al. Association of Testosterone Therapy With Mortality, Myocardial Infarction, and Stroke in Men With Low Testosterone Levels. JAMA 310, (2013). 39.Wallis, C. J. D. et al. Survival and cardiovascular events in men treated with testosterone replacement therapy: an intention-to-treat observational cohort study. The Lancet Diabetes & Endocrinology 4, (2016). 40.Wu, F. C. W. et al. Identification of Late-Onset Hypogonadism in Middle-Aged and Elderly Men. New England Journal of Medicine 363, (2010). 41.Wu, F. C. W. et al. Hypothalamic-pituitary-testicular axis disruptions in older men are differentially linked to age and modifiable risk factors: the European Male Aging Study. J. Clin. Endocrinol. Metab. 93, (2008). 29

30 Prospective observational study (N = 656) Symptomatic, T <12.1 nmol/l Patients self-selected treatment Outcomes: mortality, weight/wc/bmi, Hgb, FBG/A1C, BP/HR, lipids, prostate volume/psa, IPSS/AMS/IIEF Mean follow-up 73 months control, 74 months treatment 66-92% mortality benefit (8% ARR incidence of death/10 years) A1C reduced in treatment group (1.7%), vs increased in control (0.3%) BP reduced in treatment group (SBP 21/DBP 16) vs. stable in control Weight loss in treated (19.3 kg) vs gain in control (1.6 kg) 30

Testosterone Therapy in Men An update

Testosterone Therapy in Men An update Testosterone Therapy in Men An update SANDEEP DHINDSA Associate Professor of Medicine Director, Division of Endocrinology and Metabolism, Saint Louis University, St. Louis, MO Presenter Disclosure None

More information

Disclosures. Faculty 3/5/18. Testosterone, the FDA and CVD Risk Controversies. Matt Rosenberg, MD Director of Mid-Michigan Health Centers Jackson, MI

Disclosures. Faculty 3/5/18. Testosterone, the FDA and CVD Risk Controversies. Matt Rosenberg, MD Director of Mid-Michigan Health Centers Jackson, MI Testosterone, the FDA and CVD Risk Controversies Faculty Matt Rosenberg, MD Director of Mid-Michigan Health Centers Jackson, MI 2 Disclosures Matt Rosenberg, MD serves on the advisory board for Bayer,

More information

An Idea Whose Time Has Come-Male Health Programs: An Opportunity For Clinical Expansion and Better Health

An Idea Whose Time Has Come-Male Health Programs: An Opportunity For Clinical Expansion and Better Health An Idea Whose Time Has Come-Male Health Programs: An Opportunity For Clinical Expansion and Better Health KEVIN R. LOUGHLIN MD,MBA Harvard Medical School Boston, MA THE WEAKER SEX-MALES LIFE EXPECTANCY

More information

Men Getting Older Will Testosterone Keep Him Young?

Men Getting Older Will Testosterone Keep Him Young? Men Getting Older Will Testosterone Keep Him Young? Alvin M. Matsumoto, M.D. Associate Director, GRECC V.A. Puget Sound Health Care System Professor, Department of Medicine Division of Gerontology and

More information

Update on diagnosis and complications of adult and elderly male hypogonadism

Update on diagnosis and complications of adult and elderly male hypogonadism Hypoandrogenism in the elderly: to treat or not to treat? 12 th Italian AME Meeting; 6 th joint Meeting with AAC Bari november 10th Update on diagnosis and complications of adult and elderly male hypogonadism

More information

The reality of LOH-symptoms

The reality of LOH-symptoms The reality of LOH-symptoms PRISM IV Bruges, Belgium September 25-26, 2014 Dr. Herman Leliefeld Androsmannenkliniek The Netherlands The reality of LOH symptoms male external & internal genitalia Testosterone

More information

Prof Dato Dr TAN Hui Meng University of Malaya, Kuala Lumpur University of Pennsylvania, USA

Prof Dato Dr TAN Hui Meng University of Malaya, Kuala Lumpur University of Pennsylvania, USA Prof Dato Dr TAN Hui Meng University of Malaya, Kuala Lumpur University of Pennsylvania, USA Prevailing context Increase number of men who are potential candidates for Testosterone Replacement Therapy

More information

Erectile Dysfunction, Cardiovascular Risk and

Erectile Dysfunction, Cardiovascular Risk and Erectile Dysfunction, Cardiovascular Risk and Testosterone National Lipid Association (NLA) 2016 Fall Clinical Update August 26-28, 2016 Amelia Island, Fl Robert A. Kloner MD, PhD Director of the Cardiovascular

More information

Endocrine Update Mary T. Korytkowski MD Division of Endocrinology University of Pittsburgh

Endocrine Update Mary T. Korytkowski MD Division of Endocrinology University of Pittsburgh Endocrine Update 2016 Mary T. Korytkowski MD Division of Endocrinology University of Pittsburgh Disclosure of Financial Relationships Mary Korytkowski MD Honoraria British Medical Journal Diabetes Research

More information

Point-Counterpoint: Late Onset Hypogonadism (LOH)

Point-Counterpoint: Late Onset Hypogonadism (LOH) Point-Counterpoint: Late Onset Hypogonadism (LOH) We are Under-diagnosing and Treating Men with LOH LOH is a Non-existent Disease ~ Robert E. Donohue, MD Late Onset Hypogonadism LOH: underdx. & undertx

More information

Testosterone therapy in the new era of Food and Drug Administration oversight

Testosterone therapy in the new era of Food and Drug Administration oversight Review Article Testosterone therapy in the new era of Food and Drug Administration oversight Bethany Desroches 1, Taylor P. Kohn 2, Charles Welliver 3, Alexander W. Pastuszak 1,4 1 Scott Department of

More information

Disclosures. Learning Objectives. Effects of Hormone Therapy on the Metabolic Syndrome and Cardiovascular Disease. None

Disclosures. Learning Objectives. Effects of Hormone Therapy on the Metabolic Syndrome and Cardiovascular Disease. None Effects of Hormone Therapy on the Metabolic Syndrome and Cardiovascular Disease Micol S. Rothman, MD Associate Professor of Medicine Endocrinology, Diabetes and Metabolism Clinical Director Metabolic Bone

More information

What Is the Low T Syndrome? Is Testosterone Supplementation Safe?

What Is the Low T Syndrome? Is Testosterone Supplementation Safe? What Is the Low T Syndrome? Is Testosterone Supplementation Safe? UCSF Osher Mini Medical School March 7, 2018 Dolores Shoback, MD Staff Physician SF-VAMC Professor of Medicine, UCSF No disclosures or

More information

Is T for Me? Testosterone Replacement Therapy in Older Males

Is T for Me? Testosterone Replacement Therapy in Older Males Is T for Me? Testosterone Replacement Therapy in Older Males Natalia Malesa, PharmD, MSIS PGY1 Community Pharmacy Resident H-E-B Pharmacy The University of Texas at Austin Objectives At the end of this

More information

Corporate Medical Policy Testosterone Pellet Implantation for Androgen Deficiency

Corporate Medical Policy Testosterone Pellet Implantation for Androgen Deficiency Corporate Medical Policy Testosterone Pellet Implantation for Androgen Deficiency File Name: Origination: Last CAP Review: Next CAP Review: Last Review: testosterone_pellet_implantation_for_androgen_deficiency

More information

Late onset Hypogonadism. Dr KhooSay Chuan Department of Urology Penang General Hospital

Late onset Hypogonadism. Dr KhooSay Chuan Department of Urology Penang General Hospital Late onset Hypogonadism Dr KhooSay Chuan Department of Urology Penang General Hospital Late onset hypogonadism(loh) Definition LOH age associated testoteronedeficiency syndrome (TDS) Male menopause, andropause,

More information

PRISM Bruges June Herman Leliefeld Urologist. The Netherlands

PRISM Bruges June Herman Leliefeld Urologist. The Netherlands PRISM Bruges 25-26 June 2015 Herman Leliefeld Urologist The Netherlands Guidelines EAU 2015: a rich source of Knowledge! Epidemiology/ Aetiology / Pathology Diagnostic evaluation Disease management Follow-Up

More information

A dro r gen e R e R p e lac a e c m e e m n e t t T her e a r p a y Androgen Replacement Therapy in the Aging O j b ecti t ve v s Male

A dro r gen e R e R p e lac a e c m e e m n e t t T her e a r p a y Androgen Replacement Therapy in the Aging O j b ecti t ve v s Male Androgen Replacement Therapy in the Aging Male Thomas J. Walsh, MD, MS Department of Urology University of California, San Francisco Objectives 1. List 3 effects of androgens on normal male physiology.

More information

Outline. Classic Androgen deficiency. Cardiovascular Risk and Testosterone Fact vs Fiction. Professor Robert I McLachlan AM, FRACP, PhD

Outline. Classic Androgen deficiency. Cardiovascular Risk and Testosterone Fact vs Fiction. Professor Robert I McLachlan AM, FRACP, PhD Health Ed Brisbane Saturday 27 th October 2018 Cardiovascular Risk and Testosterone Fact vs Fiction Professor Robert I McLachlan AM, FRACP, PhD Hudson Institute of Medical Research, Monash University Department

More information

Androgen deficiency in men has attracted much

Androgen deficiency in men has attracted much Journal of Andrology, Vol. 33, No. 5, September/October 2012 Copyright E American Society of Andrology The Comparison of the Aging Male Symptoms (AMS) Scale and Androgen Deficiency in the Aging Male (ADAM)

More information

HORMONE THERAPY IN AGING MALE ATHLETES

HORMONE THERAPY IN AGING MALE ATHLETES DISCLOSURES HORMONE THERAPY IN AGING MALE ATHLETES No relevant affiliations or financial interests When, Why and is it Safe? OBJECTIVES Summarize the benefits of optimizing hormone balance Examine the

More information

Hormone Replacement Therapy

Hormone Replacement Therapy Hormone Replacement Therapy What Role Should It Play With Our Patients? Noel R. Williams MD, FACOG TESTOSTERONE FOR MEN: SALVATION OR SNAKE OIL? Definition Male hypogonadism means the testicles don't produce

More information

Androgen deficiency. Dr Rakesh Iyer Staff Specialist in Endocrinology Calvary hospital

Androgen deficiency. Dr Rakesh Iyer Staff Specialist in Endocrinology Calvary hospital Androgen deficiency Dr Rakesh Iyer Staff Specialist in Endocrinology Calvary hospital Outline Pathological androgen deficiency - Background, causes, interpretation - Indications for treatment Androgen

More information

Estrogens vs Testosterone for cardiovascular health and longevity

Estrogens vs Testosterone for cardiovascular health and longevity Estrogens vs Testosterone for cardiovascular health and longevity Panagiota Pietri, MD, PhD, FESC Director of Hypertension Unit Athens Medical Center Athens, Greece Women vs Men Is there a difference in

More information

Present and future association between obesity and hypogonadism in Italian male

Present and future association between obesity and hypogonadism in Italian male ORIGINAL PAPER DOI: 10.4081/aiua.2014.1.26 Present and future association between obesity and hypogonadism in Italian male Valentina Boddi 1, Valeria Barbaro 2, Paul Mc Nieven 3, Mario Maggi 1, Carlo Maria

More information

Hypogonadism 4/27/2018. Male Hypogonadism -- Definition. Epidemiology. Objectives HYPOGONADISM. Men with Hypogonadism. 95% untreated.

Hypogonadism 4/27/2018. Male Hypogonadism -- Definition. Epidemiology. Objectives HYPOGONADISM. Men with Hypogonadism. 95% untreated. Male Hypogonadism -- Definition - Low T, Low Testosterone Hypogonadism -...a clinical syndrome that results from failure of the testes to produce physiological concentrations of testosterone due to pathology

More information

Hypogonadism and erectile dysfunction as harbingers of systemic disease

Hypogonadism and erectile dysfunction as harbingers of systemic disease Review Article Hypogonadism and erectile dysfunction as harbingers of systemic disease Kelly A. Chiles 1,2 1 Department of Urology, George Washington University, Washington, DC, USA; 2 Weill Cornell Medical

More information

Testosterone: Current Opinion and Controversy

Testosterone: Current Opinion and Controversy Testosterone: Current Opinion and Controversy Ravi Kacker, MD Metrowest Urology (508) 655 4422 Medical Office Building at Leonard Morse Hospital Disclosures MHB Labs President and CEO of Drug Development

More information

Disclosures. Advisory Boards 6/10/2014

Disclosures. Advisory Boards 6/10/2014 Massachusetts Medical Society 12 th annual Men s Health Symposium 11 June 2014 Testosterone and Cardiovascular Disease Where Does The Real Answer Lie? Andre Guay MD, FACP, FACE, IF (Ret) Director, Center

More information

Take-Home Messages: Androgens

Take-Home Messages: Androgens Take-Home Messages: Androgens Anthony J. Bella MD, FRCSC Greta and John Hansen Chair in Men s Health Research Division of Urology, Department of Surgery University of Ottawa SUMMARY SLAMS Symposium Clinical

More information

Recognizing and Managing Testosterone Deficiency

Recognizing and Managing Testosterone Deficiency Recognizing and Managing Testosterone Deficiency J. Bruce Redmon, M.D. Professor Division of Endocrinology Departments of Medicine and Urologic Surgery Disclosure Information I have no financial relationships

More information

How to treat: TRT modalities and formulations

How to treat: TRT modalities and formulations How to treat: TRT modalities and formulations Paul PIETTE, PharmD Senior Research Fellow Clinique Antoine Depage - Belgium ppiette@besins-healthcare.com Bruges 2014, May 15 th Testosterone-replacement

More information

Testosterone Replacement Therapy for Hypogonadism: Learning Objectives. What Is the Evidence? Is It Safe? Case Study. Case Study contd.

Testosterone Replacement Therapy for Hypogonadism: Learning Objectives. What Is the Evidence? Is It Safe? Case Study. Case Study contd. 4 4:4pm Testosterone Therapy: Examining the Evidence SPEAKER Culley Carson, MD Presenter Disclosure Information The following relationships exist related to this presentation: Culley Carson, MD: Consultant

More information

HYPOGONADISM DEFINITION: PRODUCTION OF SEX HORMONES AND GERM CELLS IS INADEQUATE (ENDOCRINE SOCIETY)

HYPOGONADISM DEFINITION: PRODUCTION OF SEX HORMONES AND GERM CELLS IS INADEQUATE (ENDOCRINE SOCIETY) HYPOGONADISM DEFINITION: PRODUCTION OF SEX HORMONES AND GERM CELLS IS INADEQUATE (ENDOCRINE SOCIETY) DEFECT OF THE REPRODUCTIVE SYSTEM THAT RESULTS IN LACK OF FUNCTION OF THE GONADS (Wikipedia) REDUCTION

More information

Testosterone Replacement Therapy & Monitoring in HIV Infected Men. Adam B. Murphy, MD, MBA, MSCI October 29, 2014

Testosterone Replacement Therapy & Monitoring in HIV Infected Men. Adam B. Murphy, MD, MBA, MSCI October 29, 2014 Testosterone Replacement Therapy & Monitoring in HIV Infected Men Adam B. Murphy, MD, MBA, MSCI October 29, 2014 Acknowledgement Ramona Bhatia MD (HIV Research Fellow, First Author) Chad Achenbach MD (HIV

More information

Testosterone and PDE5 inhibitors in the aging male

Testosterone and PDE5 inhibitors in the aging male Testosterone and PDE5 inhibitors in the aging male Francesco Romanelli Department of Experimental Medicine Medical Pathophysiology, Food Science and Endocrinology Section Sapienza University of Rome 3005

More information

Does TRT Induce Prostate Cancer?

Does TRT Induce Prostate Cancer? Does TRT Induce Prostate Cancer? Prism VI, Bruges, Belgium 21-22November 2014 Herman Leliefeld, Urologist, Utrecht The Netherlands Does TRT Induce Prostate Cancer? Why is it a controversial topic? Is there

More information

FLAWED TESTOSTERONE ANALYSIS SPURS MISLEADING MEDIA HEADLINES

FLAWED TESTOSTERONE ANALYSIS SPURS MISLEADING MEDIA HEADLINES http://www.lef.org/ FLAWED TESTOSTERONE ANALYSIS SPURS MISLEADING MEDIA HEADLINES By Blake Gossard, Kira Schmid, ND, Luke Huber, ND, MBA, Steven V. Joyal, MD The precipitous decline of men's testosterone

More information

Lessons from the WHI HT Trials: Evolving Data that Changed Clinical Practice

Lessons from the WHI HT Trials: Evolving Data that Changed Clinical Practice Lessons from the WHI HT Trials: Evolving Data that Changed Clinical Practice JoAnn E. Manson, MD, DrPH, FACP Chief, Division of Preventive Medicine Interim Executive Director, Connors Center Brigham and

More information

Central hemodynamics and prediction of cardiovascular events in patients with erectile dysfunction

Central hemodynamics and prediction of cardiovascular events in patients with erectile dysfunction Central hemodynamics and prediction of cardiovascular events in patients with erectile dysfunction N.Skliros, N.Ioakeimidis, D.Terentes-Printzios, C.Vlachopoulos Cardiovascular Diseases and Sexual Health

More information

Regulatory Hurdles for Drug Approvals

Regulatory Hurdles for Drug Approvals Regulatory Hurdles for Drug Approvals William R. Hiatt, MD Professor of Medicine/Cardiology University of Colorado School of Medicine President, CPC Clinical Research 25 min Conflicts CPC Clinical Research

More information

The Male Andropause. What are the symptoms? What are the risks of hormone deficiencies?

The Male Andropause. What are the symptoms? What are the risks of hormone deficiencies? The Male Andropause By: Dr. Sangeeta Pati MD, FACOG Although, the male andropause has not been widely recognized, increased medical research has turned attention to the gradual hormone decline in males

More information

Lessons From the Testosterone Trials

Lessons From the Testosterone Trials Lessons From the Testosterone Trials Peter J Snyder, 1 Shalender Bhasin, 2 * Glenn R. Cunningham, 3 * Alvin M. Matsumoto, 4 * Alisa J. Stephens-Shields, 5 * Jane A. Cauley, 6 Thomas M. Gill, 7 Elizabeth

More information

Testosterone Treatment: Myths Vs Reality. Fadi Al-Khayer, M.D, F.A.C.E

Testosterone Treatment: Myths Vs Reality. Fadi Al-Khayer, M.D, F.A.C.E Testosterone Treatment: Myths Vs Reality Fadi Al-Khayer, M.D, F.A.C.E The Biological Functions of Testosterone in Men Testosterone is essential to the musculoskeletal and metabolic systems throughout a

More information

Index. urologic.theclinics.com. Note: Page numbers of article titles are in boldface type.

Index. urologic.theclinics.com. Note: Page numbers of article titles are in boldface type. Note: Page numbers of article titles are in boldface type. A Acquired hypogonadism, prevalence of, 165 167 primary, 165 secondary, 167 Adipose tissue, as an organ, 240 241 Adrenal hyperplasia, congenital,

More information

The clinical importance of testosterone in men with type 2 diabetes

The clinical importance of testosterone in men with type 2 diabetes 22 The clinical importance of testosterone in men with type 2 diabetes GEOFF HACKETT Although the association of low testosterone with type 2 diabetes is well established, testosterone levels are not routinely

More information

Clomiphene citrate treatment for late onset hypogonadism: rise and fall

Clomiphene citrate treatment for late onset hypogonadism: rise and fall ORIGINAL ARTICLE Vol. 42 (x): 2016 July 4.[Ahead of print] doi: 10.1590/S1677-5538.IBJU.2016.0112 Clomiphene citrate treatment for late onset hypogonadism: rise and fall Marcelo Marconi 1, Renato Souper

More information

Clinical Controversies in Perioperative Medicine

Clinical Controversies in Perioperative Medicine Update on Perioperative Medicine Clinical Controversies in Perioperative Medicine Hugo Quinny Cheng, MD Division of Hospital Medicine University of California, San Francisco Cardiac Medications & Perioperative

More information

HHS Public Access Author manuscript Int J Impot Res. Author manuscript; available in PMC 2015 September 01.

HHS Public Access Author manuscript Int J Impot Res. Author manuscript; available in PMC 2015 September 01. Testosterone Therapy and Mortality Risk Michael L. Eisenberg, MD 1, Shufeng Li, MS 2, Danielle Herder, MD 3, Dolores J. Lamb, PhD 4, and Larry I. Lipshultz, MD 4 1 Assistant Professor, Departments of Urology

More information

Central pressures and prediction of cardiovascular events in erectile dysfunction patients

Central pressures and prediction of cardiovascular events in erectile dysfunction patients Central pressures and prediction of cardiovascular events in erectile dysfunction patients N. Ioakeimidis, K. Rokkas, A. Angelis, Z. Kratiras, M. Abdelrasoul, C. Georgakopoulos, D. Terentes-Printzios,

More information

Kathryn M. Rexrode, MD, MPH. Assistant Professor. Division of Preventive Medicine Brigham and Women s s Hospital Harvard Medical School

Kathryn M. Rexrode, MD, MPH. Assistant Professor. Division of Preventive Medicine Brigham and Women s s Hospital Harvard Medical School Update: Hormones and Cardiovascular Disease in Women Kathryn M. Rexrode, MD, MPH Assistant Professor Division of Preventive Medicine Brigham and Women s s Hospital Harvard Medical School Overview Review

More information

Diabetes Mellitus: A Cardiovascular Disease

Diabetes Mellitus: A Cardiovascular Disease Diabetes Mellitus: A Cardiovascular Disease Nestoras Mathioudakis, M.D. Assistant Professor of Medicine Division of Endocrinology, Diabetes, & Metabolism September 30, 2013 1 The ABCs of cardiovascular

More information

Diagnosis and management of testosterone deficiency syndrome in adult men: clinical practice guideline (CMAJ)

Diagnosis and management of testosterone deficiency syndrome in adult men: clinical practice guideline (CMAJ) Diagnosis and management of testosterone deficiency syndrome in adult men: clinical practice guideline (CMAJ) Alvaro Morales CM MD, Richard A. Bebb MD, Priya Manjoo MD MSc, Peter Assimakopoulos MD, John

More information

Over the past decade, androgen replacement

Over the past decade, androgen replacement J. Andrew Hoover, MD; Jeffrey T. Kirchner, DO, FAAFP Department of Family and Community Medicine, Lancaster General Hospital, Pa jhoover4@lghealth.org The authors reported no potential conflict of interest

More information

Supplementary Online Content

Supplementary Online Content Supplementary Online Content Basaria S, Harman SM, Travison TG, et al. The effects of testosterone administration for three years on subclinical atherosclerosis progression in older men with low or low

More information

Ischemic Heart and Cerebrovascular Disease. Harold E. Lebovitz, MD, FACE Kathmandu November 2010

Ischemic Heart and Cerebrovascular Disease. Harold E. Lebovitz, MD, FACE Kathmandu November 2010 Ischemic Heart and Cerebrovascular Disease Harold E. Lebovitz, MD, FACE Kathmandu November 2010 Relationships Between Diabetes and Ischemic Heart Disease Risk of Cardiovascular Disease in Different Categories

More information

TESTOSTERONE REPLACEMENT THERAPY. WHAT IS THE REAL RISK? WHAT TO DO IN PROSTATE CANCER?

TESTOSTERONE REPLACEMENT THERAPY. WHAT IS THE REAL RISK? WHAT TO DO IN PROSTATE CANCER? TESTOSTERONE REPLACEMENT THERAPY. WHAT IS THE REAL RISK? WHAT TO DO IN PROSTATE CANCER? TESTOSTERONE REPLACEMENT THERAPY (TRT) Nuno Tomada, MD, PhD Department of Urology of Hospital S. João Faculty of

More information

BIOCHEMICAL TESTS FOR THE INVESTIGATION OF COMMON ENDOCRINE PROBLEMS IN THE MALE

BIOCHEMICAL TESTS FOR THE INVESTIGATION OF COMMON ENDOCRINE PROBLEMS IN THE MALE Authoriser: Moya O Doherty Page 1 of 7 BIOCHEMICAL TESTS FOR THE INVESTIGATION OF COMMON ENDOCRINE PROBLEMS IN THE MALE The purpose of this protocol is to describe common tests used for the investigation

More information

NEW DEVELOPMENTS: T & CVD FDA & THE T TRIALS

NEW DEVELOPMENTS: T & CVD FDA & THE T TRIALS NEW DEVELOPMENTS: T & CVD FDA & THE T TRIALS 2017 UPDATE FDUS Martin Miner MD Clinical Professor of Family Medicine and Urology Co-Director The Men s Health Center The Miriam Hospital Warren Albert School

More information

Mechanism: How ADT accelerates CVD?

Mechanism: How ADT accelerates CVD? Mechanism: How ADT accelerates CVD? Professor Bertrand Tombal, MD, PhD Cliniques universitaires Saint-Luc Université catholique de Louvain Brussels, Belgium Credentials and conflict of interests Professor

More information

Hypogonadism in Men. CME Away India & Sri Lanka March 23 - April 7, 2018

Hypogonadism in Men. CME Away India & Sri Lanka March 23 - April 7, 2018 Hypogonadism in Men CME Away India & Sri Lanka March 23 - April 7, 2018 Richard A. Bebb MD, ABIM, FRCPC Consultant Endocrinologist Medical Subspecialty Institute Cleveland Clinic Abu Dhabi Copyright 2017

More information

Effects of Testosterone Levels on Functional Recovery with Rehabilitation in Stroke Patients

Effects of Testosterone Levels on Functional Recovery with Rehabilitation in Stroke Patients ORIGINAL ARTICLE Neurol Med Chir (Tokyo) 54, 794 798, 2014 doi: 10.2176/nmc.oa.2014-0078 Online September 29, 2014 Effects of Testosterone Levels on Functional Recovery with Rehabilitation in Stroke Patients

More information

Identification of Late-Onset Hypogonadism in Middle-Aged and Elderly Men

Identification of Late-Onset Hypogonadism in Middle-Aged and Elderly Men original article Identification of Late-Onset Hypogonadism in Middle-Aged and Elderly Men Frederick C.W. Wu, M.D., Abdelouahid Tajar, Ph.D., Jennifer M. Beynon, M.B., Stephen R. Pye, M.Phil., Alan J. Silman,

More information

HT: Where do we stand after WHI?

HT: Where do we stand after WHI? HT: Where do we stand after WHI? Hormone therapy and cardiovascular disease risk Experimental and clinical evidence indicate that hormone therapy (HT) reduces the risk of cardiovascular disease (CVD) Women

More information

New horizons in testosterone and the ageing male

New horizons in testosterone and the ageing male Age and Ageing 2015; 44: 188 195 doi: 10.1093/ageing/afv007 The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please

More information

HORMONE REPLACEMENT THERAPY

HORMONE REPLACEMENT THERAPY TRIALS OF HR RUTH (Barrett- Connor et al 29 ) JULY 2006 (Country) mean ± sd, range International trial 67.5 an Placebo component in 67.5 ± 6.7 women with Raloxifene or multiple 67.5 ± 6.6 risk factors

More information

PCa Commentary. Prostate Cancer? Where's the Meat? - A Collection of Studies Supporting the Safety of Its Use. Seattle Prostate Institute CONTENTS

PCa Commentary. Prostate Cancer? Where's the Meat? - A Collection of Studies Supporting the Safety of Its Use. Seattle Prostate Institute CONTENTS Volume 70 July - August 2011 PCa Commentary SEATTLE PROSTATE INSTITUTE CONTENTS TESTOSTERONE REPLACEMENT in Hypogonadal Men with Treated and Untreated Prostate Cancer? 1 TESTOSTERONE REPLACEMENT in Hypogonadal

More information

The Diabetes Link to Heart Disease

The Diabetes Link to Heart Disease The Diabetes Link to Heart Disease Anthony Abe DeSantis, MD September 18, 2015 University of WA Division of Metabolism, Endocrinology and Nutrition Oswald Toosweet Case #1 68 yo M with T2DM Diagnosed DM

More information

GUIDELINES ON. Introduction. G.R. Dohle, S. Arver, C. Bettocchi, S. Kliesch, M. Punab, W. de Ronde

GUIDELINES ON. Introduction. G.R. Dohle, S. Arver, C. Bettocchi, S. Kliesch, M. Punab, W. de Ronde GUIDELINES ON Male Hypogonadism G.R. Dohle, S. Arver,. Bettocchi, S. Kliesch, M. Punab, W. de Ronde Introduction Male hypogonadism is a clinical syndrome caused by androgen deficiency. It may adversely

More information

Naviga2ng the Adverse Effects of ADT: Improving Pa2ent Outcomes

Naviga2ng the Adverse Effects of ADT: Improving Pa2ent Outcomes Naviga2ng the Adverse Effects of ADT: Improving Pa2ent Outcomes E. David Crawford, M.D. Professor of Surgery/ Urology/ Radiation Oncology University of Colorado Greetings from Colorado Disclosures Consultant:

More information

Diagnosis and Clinical Evaluation of Hypogonadism in Adult Patients with Obesity and Diabetes

Diagnosis and Clinical Evaluation of Hypogonadism in Adult Patients with Obesity and Diabetes Diagnosis and Clinical Evaluation of Hypogonadism in Adult Patients with Obesity and Diabetes Adrian Dobs, M.D., M.H.S. Professor of Medicine and Oncology The Johns Hopkins University School of Medicine

More information

John J.P. Kastelein MD PhD Professor of Medicine Dept. of Vascular Medicine Academic Medial Center / University of Amsterdam

John J.P. Kastelein MD PhD Professor of Medicine Dept. of Vascular Medicine Academic Medial Center / University of Amsterdam Latest Insights from the JUPITER Study John J.P. Kastelein MD PhD Professor of Medicine Dept. of Vascular Medicine Academic Medial Center / University of Amsterdam Inflammation, hscrp, and Vascular Prevention

More information

Oral Hypoglycemics and Risk of Adverse Cardiac Events: A Summary of the Controversy

Oral Hypoglycemics and Risk of Adverse Cardiac Events: A Summary of the Controversy Oral Hypoglycemics and Risk of Adverse Cardiac Events: A Summary of the Controversy Jeffrey Boord, MD, MPH Advances in Cardiovascular Medicine Kingston, Jamaica December 7, 2012 VanderbiltHeart.com Outline

More information

Menopausal hormone therapy currently has no evidence-based role for

Menopausal hormone therapy currently has no evidence-based role for IN PERSPECTIVE HT and CVD Prevention: From Myth to Reality Nanette K. Wenger, M.D. What the studies show, in a nutshell The impact on coronary prevention Alternative solutions Professor of Medicine (Cardiology),

More information

Consent for Testosterone Therapy-Men Revised 4/10/18

Consent for Testosterone Therapy-Men Revised 4/10/18 Consent for Testosterone Therapy in Men You have been diagnosed with or have an increased risk of having a hormone deficiency and your provider has recommended treatment with bio-identical hormone replacement

More information

Metastatic disease. 80% will die of prostate cancer 5 year survival only 25% No major advances in cure since 1942

Metastatic disease. 80% will die of prostate cancer 5 year survival only 25% No major advances in cure since 1942 Prostate cancer Metastatic disease 80% will die of prostate cancer 5 year survival only 25% No major advances in cure since 1942 Impact of early prostate cancer 12 10 8 6 4 2 0 70-80 years 60-70 years

More information

Optimizing risk assessment of total cardiovascular risk What are the tools? Lars Rydén Professor Karolinska Institutet Stockholm, Sweden

Optimizing risk assessment of total cardiovascular risk What are the tools? Lars Rydén Professor Karolinska Institutet Stockholm, Sweden Optimizing risk assessment of total cardiovascular risk What are the tools? Lars Rydén Professor Karolinska Institutet Stockholm, Sweden Cardiovascular Disease Prevention (CVD) Three Strategies for CVD

More information

Menopausal Hormone Therapy & Haemostasis

Menopausal Hormone Therapy & Haemostasis Menopausal Hormone Therapy & Haemostasis The Haematologist Perspective Dr. Batia Roth-Yelinek Coagulation unit Hadassah MC Menopausal Hormone Therapy & Hemostasis Hemostatic mechanism Mechanism of estrogen

More information

THE RELEVANCE OF TESTOSTERONE THERAPY IN MANAGING PATIENTS WITH ERECTILE DYSFUNCTION

THE RELEVANCE OF TESTOSTERONE THERAPY IN MANAGING PATIENTS WITH ERECTILE DYSFUNCTION THE RELEVANCE OF TESTOSTERONE THERAPY IN MANAGING PATIENTS WITH ERECTILE DYSFUNCTION Aksam A. Yassin MD PhD EdD FEBU Professor of Urology & Human Sexuality Institute of Urology & Andrology, Segeberger

More information

Supplementary Online Material

Supplementary Online Material Supplementary Online Material Collet T-H, Gussekloo J, Bauer DC, et al; Thyroid Studies Collaboration. Subclinical hyperthyroidism and the risk of coronary heart disease and mortality. Arch Intern Med.

More information

Testosterone replacement therapy among elderly males: the Testim Registry in the US (TRiUS)

Testosterone replacement therapy among elderly males: the Testim Registry in the US (TRiUS) Clinical Interventions in Aging open access to scientific and medical research Open Access Full Text Article Original Research Testosterone replacement therapy among elderly males: the Testim Registry

More information

ISSM QUICK REFERENCE GUIDE ON TESTOSTERONE DEFICIENCY FOR MEN

ISSM QUICK REFERENCE GUIDE ON TESTOSTERONE DEFICIENCY FOR MEN International Society for Sexual Medicine - www.issm.info ISSM QUICK REFERENCE GUIDE ON TESTOSTERONE DEFICIENCY FOR MEN Version: September 2015 What is testosterone deficiency? Testosterone deficiency

More information

Male hypogonadism & testosterone replacement therapy

Male hypogonadism & testosterone replacement therapy Male hypogonadism & testosterone replacement therapy Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard Adverse events should also be reported

More information

Initial Hormone Therapy

Initial Hormone Therapy Initial Hormone Therapy Alan Horwich Institute of Cancer Research and Royal Marsden Hospital, London, UK Alan.Horwich@icr.ac.uk MANAGEMENT OF PROSTATE CANCER Treatment windows Subclinical Localised PSA

More information

VENOUS THROMBOEMBOLISM AND CORONARY ARTERY DISEASE: IS THERE A LINK?

VENOUS THROMBOEMBOLISM AND CORONARY ARTERY DISEASE: IS THERE A LINK? VENOUS THROMBOEMBOLISM AND CORONARY ARTERY DISEASE: IS THERE A LINK? Ayman El-Menyar (1), MD, Hassan Al-Thani (2),MD (1)Clinical Research Consultant, (2) Head of Vascular Surgery, Hamad General Hospital

More information

Influence of testosterone replacement therapy on metabolic disorders in male patients with type 2 diabetes mellitus and androgen deficiency

Influence of testosterone replacement therapy on metabolic disorders in male patients with type 2 diabetes mellitus and androgen deficiency Janjgava et al. European Journal of Medical Research 2014, 19:56 EUROPEAN JOURNAL OF MEDICAL RESEARCH RESEARCH Open Access Influence of testosterone replacement therapy on metabolic disorders in male patients

More information

Testosterone Therapy and Risk of Myocardial Infarction: A Pharmacoepidemiologic Study

Testosterone Therapy and Risk of Myocardial Infarction: A Pharmacoepidemiologic Study Testosterone Therapy and Risk of Myocardial Infarction: A Pharmacoepidemiologic Study Mahyar Etminan, 1,2, * Sean C. Skeldon, 3,4 Sheldon Larry Goldenberg, 3 Bruce Carleton, 1,2 and James M. Brophy 5 1

More information

Implantable Hormone Pellets

Implantable Hormone Pellets Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the Company ), unless otherwise provided

More information

Androgen Pattern and Erectile Function in Newly Diagnosed Type 2 Diabetes

Androgen Pattern and Erectile Function in Newly Diagnosed Type 2 Diabetes Med. J. Cairo Univ., Vol. 84, No. 3, December: 341-347, 2016 www.medicaljournalofcairouniversity.net Androgen Pattern and Erectile Function in Newly Diagnosed Type 2 Diabetes AHMED I. EL-SAKKA, M.D.*;

More information

Testim 1 Gel: Review of Clinical Data

Testim 1 Gel: Review of Clinical Data European Urology Supplements European Urology Supplements 4 (2005) 24 30 Testim 1 Gel: Review of Clinical Data Tom A. McNicholas* Department of Urology, Lister Hospital, Corey s Mill Lane, Stevenage, Hertfordshire

More information

Male Menopause: Disease or Pseudoscience? March 4, 2015 story: FDA to require warning on labels of testosterone products.

Male Menopause: Disease or Pseudoscience? March 4, 2015 story: FDA to require warning on labels of testosterone products. Male Menopause: Disease or Pseudoscience? March 4, 2015 story: FDA to require warning on labels of testosterone products. 3-30-2015; web William E. Winter, MD University of Florida Departments of Pathology

More information

JAMA. 2011;305(24): Nora A. Kalagi, MSc

JAMA. 2011;305(24): Nora A. Kalagi, MSc JAMA. 2011;305(24):2556-2564 By Nora A. Kalagi, MSc Cardiovascular disease (CVD) is the number one cause of mortality and morbidity world wide Reducing high blood cholesterol which is a risk factor for

More information

LATE BREAKING STUDIES IN DM AND CAD. Will this change the guidelines?

LATE BREAKING STUDIES IN DM AND CAD. Will this change the guidelines? LATE BREAKING STUDIES IN DM AND CAD Will this change the guidelines? Objectives 1. Discuss current guidelines for prevention of CHD in diabetes. 2. Discuss the FDA Guidance for Industry regarding evaluating

More information

Testosterone Therapy and the Prostate. Frans M.J. Debruyne Professor of Urology The Netherlands

Testosterone Therapy and the Prostate. Frans M.J. Debruyne Professor of Urology The Netherlands Testosterone Therapy and the Prostate Frans M.J. Debruyne Professor of Urology The Netherlands TRT- Risks Prostate ( Cancer, BPH )? Cardiac? Lipids? Polycythemia Sleep apnea Gynecomastia Edema Testosterone

More information

Best Practices to Improve Patient Outcomes

Best Practices to Improve Patient Outcomes Best Practices Pearls Practical Primary Care Strategies for Diagnosing and Managing Hypogonadism in Men Utilize lab testing in appropriate patients who have complaints consistent with the often subtle

More information

2/9/2017. Financial Disclosures/Unapproved Use. Achieving Harmony in Blood Pressure Guidelines Around the Globe. Roger S. Blumenthal, MD.

2/9/2017. Financial Disclosures/Unapproved Use. Achieving Harmony in Blood Pressure Guidelines Around the Globe. Roger S. Blumenthal, MD. Achieving Harmony in Blood Pressure Guidelines Around the Globe Roger S. Blumenthal, MD The Kenneth Jay Pollin Professor of Cardiology Director, The Johns Hopkins Ciccarone Center for the Prevention Of

More information

The Clinical Unmet need in the patient with Diabetes and ACS

The Clinical Unmet need in the patient with Diabetes and ACS The Clinical Unmet need in the patient with Diabetes and ACS Professor Kausik Ray (UK) BSc(hons), MBChB, MD, MPhil, FRCP (lon), FRCP (ed), FACC, FESC, FAHA Diabetes is a global public health challenge

More information

In addition to critical development and reproductive

In addition to critical development and reproductive Journal of Andrology, Vol. 33, No. 6, November/December 2012 Copyright E American Society of Andrology Seasonal Fluctuations in Testosterone-Estrogen Ratio in Men From the Southwest United States DANIEL

More information

Testosterone and the Prostate

Testosterone and the Prostate Testosterone and the Prostate E. David Crawford, MD Professor of Surgery (Urology) and Radiation Oncology Head, Urologic Oncology E. David and Vicki M. Crawford Endowed Chair in Urologic Oncology University

More information

Postmenopausal hormone therapy - cardiac disease risks and benefits

Postmenopausal hormone therapy - cardiac disease risks and benefits Postmenopausal hormone therapy - cardiac disease risks and benefits Tomi S. Mikkola, MD Helsinki University Central Hospital Department of Obstetrics and Gynecology Helsinki, Finland Disclosures Speaker/consulting

More information