Hypogonadal symptoms in young men are associated with a serum total testosterone threshold of 400 ng/dl

Size: px
Start display at page:

Download "Hypogonadal symptoms in young men are associated with a serum total testosterone threshold of 400 ng/dl"

Transcription

1 Sexual Medicine Hypogonadal symptoms in young men are associated with a serum total testosterone threshold of 400 ng/dl Jason M. Scovell, Ranjith Ramasamy, Nathan Wilken, Jason R. Kovac and Larry I. Lipshultz Department of Urology, Baylor College of Medicine, Houston, TX, USA Objective To investigate the association between hypogonadal symptoms and serum total testosterone (TT) levels in young men (aged <40 years), in an attempt to determine whether there exists a clear-cut discriminatory threshold of TT below which hypogonadal symptoms become more prevalent. Patients and methods We retrospectively reviewed the charts of 352 men who presented to an outpatient Men s Health Clinic with chief complaint of low testosterone. Sexual, psychological and physical symptoms were evaluated using the Androgen deficiency in Aging Male (ADAM) questionnaire. Serum levels of TT were collected on the same day that men completed their ADAM questionnaires. We subsequently performed univariate (t-test, chi-square) and multivariate analyses (ordinal logistic regression) to evaluate factors that predicted a low TT level. Results The probability of hypogonadal symptoms increased at a serum TT level of 400 ng/dl. A cluster of symptoms: two psychological ( decreased energy, sadness ), and three physical ( decreased strength and endurance, decreased ability to play sports,and deterioration in work performance ) were most strongly associated with serum TT levels of <400 ng/dl. On multivariable analysis, only lack of energy predicted a TT level of <400 ng/dl. Conclusions Hypogonadal symptoms in men aged <40 years can be associated with a TT level of <400 ng/dl. Of the hypogonadal symptoms evaluated with the ADAM questionnaire, lack of energy appears to be the most important symptom that predicts a TT level of <400 ng/dl. Keywords libido, erectile dysfunction, ADAM, androgen deficiency, ageing male Introduction Hypogonadism is a clinical disorder consisting of a cluster of symptoms in the presence of low serum levels of total testosterone (TT), traditionally defined as a solitary threshold value of <300 ng/dl [1]. It is important to note that the TT threshold of 300 ng/dl was solely determined via panel consensus by the Endocrine Society [2] and based upon observational studies. Several other societies have suggested varying testosterone thresholds from 230 to 350 ng/dl [3]. The uniform application of a single serum threshold to define hypogonadism is not appropriate given that men can exhibit different symptoms at different serum TT levels [4]. Studies surveying population-based cohorts, e.g. the Men in Australia Telephone Survey (MATeS) [5], the Massachusetts Male Aging Study (MMAS) [6], or the European Male Ageing Study (EMAS) [7], provide useful information about the prevalence and incidence of hypogonadal symptoms in community dwelling men. However, these cohorts do not represent men who are actually seeking diagnosis and possible treatment. Consequently, it is of paramount importance to assess the symptom profiles of young patients to provide physicians with necessary tools for adequate management. Another important issue is that we are not certain what thresholds should be used for the definition of testosterone deficiency in men of any age. To our knowledge, this is the first study to evaluate the association between TT levels and hypogonadal symptoms in young men. Given the increasing prevalence of testosterone use among men of all ages [8], it is important to understand hypogonadal symptomatology in young men whose chief complaint is low testosterone. Therefore, we conducted a study in young men who presented with a chief complaint of either low testosterone or symptoms of hypogonadism. These men had never received testosterone supplementation therapy (TST) allowing us to specifically characterise the BJU Int 2015; 116: wileyonlinelibrary.com BJU International ª 2014 BJU International doi: /bju Published by John Wiley & Sons Ltd.

2 Hypogonadal symptoms in young men with TT <400 ng/dl unique symptom profiles associated with endogenously low serum TT and free testosterone levels. Patients and Methods After approval by the Institutional Review Board at Baylor College of Medicine (Houston, TX, USA), we evaluated 352 men (aged <40 years) seen consecutively between May 2013 and March These men presented with a chief complaint of low testosterone. Men using testosterone or other androgenic anabolic steroids (AAS) either at, or 6 months prior to, the time of the survey were excluded. We also excluded men who had presented with a primary diagnosis of infertility, Kleinfelter s syndrome, or secondary hypogonadism after appropriate assessment of history and endocrine evaluation with gonadotrophins. All men answered the Androgen Deficiency in the Aging Male (ADAM) questionnaire [9,10] and on the same day their testosterone levels were measured. The ADAM questionnaire consists of 10 Yes/No questions about symptoms, although not all of them necessarily indicate treatable symptoms of testosterone deficiency. All venous blood samples were obtained under standardised conditions before 10:00 h from fasting patients. Serum or plasma were separated at 800g. Serum TT and sex hormone binding globulin measurements were done using the radioimmunoassay Beckman Access II platform (Beckman Coulter, Fullerton, CA, USA). TT levels were fitted on a scatter plot to determine inflection points and threshold levels. Data was analysed using Microsoft Excel (Microsoft, Redmond, WA, USA) and SPSS (SPSS Inc., Chicago, IL, USA). Chi-squared tests were used to compare percentages and the Student s t-test was used to compare means. The Q Q test was used to verify that the variables were continuously distributed. Univariate and multivariable analysis was performed for age and the 10 symptoms identified on the ADAM questionnaire. Variables that were statistically significant on the univariate analysis were included in the multivariable analysis. All values are reported as the mean (SD) and t-tests were used to evaluate differences in means between groups. A P 0.05 was considered to indicate statistical significance. Results Of the 352 men aged <40 years, 210 men had a TT level of <300 ng/dl; 67 men had levels of ng/dl; and 75 men had levels of >400 ng/dl. The mean (SD) age of the 352 men was 33.2 (4.2) years, and the mean (SD; range) TT level was 308 (170; ) ng/dl. Of the 10 hypogonadal symptoms, the probability of having five symptoms decreased (P < 0.05) in men with testosterone levels of >400 ng/dl (Table 1 and Fig. 1). These five symptoms included two psychological ( decreased energy, feeling sad ), and three physical ( decreased strength and endurance, decreased ability to play sports, and deterioration in work performance ). The probabilities of having the 10 hypogonadal symptoms that are part of the ADAM questionnaire, were similar in men with TT levels of <300 ng/dl and men whose levels were between 300 and 400 ng/dl (Fig. 1). On a univariate analysis, the presence of the same five symptoms predicted a testosterone level of <400 ng/dl. On multivariable analysis, only lack of energy predicted a testosterone level of <400 ng/dl. Of note, sexual symptoms (libido and erectile function) commonly thought to be associated with low testosterone did not identify men with testosterone levels of <400 ng/dl. In addition, none of the 10 symptoms evaluated predicted a testosterone level of <300 ng/dl. Discussion Hypogonadism is caused by insufficient concentrations of testosterone in the blood, resulting in symptoms of androgen deficiency. The reference range for most assays of TT is ng/dl [11,12], meaning that only 2.5% of healthy men have concentrations of <300 ng/dl. A clinical threshold of 300 ng/dl is often cited in the literature as the biochemical definition of hypogonadism [2]. One argument for using 300 ng/dl as the threshold for diagnosing male hypogonadism is that there is a functional correlation with erectile dysfunction (ED). This relationship was determined in a study of 162 elderly (mean age 64.1 years) men with ED (mean duration 45.6 months), where a Korean group reported that hypogonadism (serum TT level of <300 ng/dl) was among the strongest independent predictors of a poor response to sildenafil mg for 8 weeks [13]. The threshold TT level below which signs and symptoms of androgen deficiency occur and testosterone replacement is beneficial is not known and varies among individuals depending on age and comorbid conditions, and among affected target organs. Therefore, there is no absolute value of the TT level below which clinical androgen deficiency or hypogonadism can be confirmed in all patients, especially in young men. Consequently, we evaluated the association between hypogonadal symptoms and serum TT levels in men who came to our outpatient men s health clinic with a chief complaint of low testosterone. We identified a serum TT level threshold of 400 ng/dl by evaluating probabilities of the different hypogonadal symptoms across various TT levels. Most previous studies have identified an association of low testosterone with sexual symptoms, such as poor erectile function [7,14,15] and low libido [16]. However, in our present study we found that physical and psychological symptoms were most often closely associated with testosterone levels of <400 ng/dl. Interestingly, only lack of energy remained statistically significant on a multivariable analysis. None of the sexual BJU International ª 2014 BJU International 143

3 Scovell et al. Table 1 Probability of hypogonadal symptoms on the basis of levels of serum total testosterone (TT). Category Question N TT <400 ng/dl, % n TT >400 ng/dl, % P Sexual Do you have decreased libido? Are your erections less strong? Psychological Have you noticed a decreased enjoyment in life? Are you sad and/or grumpy? Do you have a lack of energy? <0.001 Physical Do you have a decrease in strength and or endurance? Has there been a recent deterioration in your work performance? <0.001 Are you falling asleep after dinner? Have you noticed a recent deterioration in your ability to play sports? Have you lost height? Bolded significance values indicate P < Fig. 1 Association between probability of hypogonadal symptoms and serum TT levels. P < 0.05 pairwise comparisons were performed between men with TT levels of >400 ng/dl (green), ng/dl (red) and <300 ng/dl (blue). 60% Probability of Hypogonadal Symptom 50% 40% 30% 20% 10% 0% Do you have decreased libido? Do you have a lack of energy? Do you have a decrease in strength and or endurance? Have you noticed a decreased enjoyment in life? Are you sad and/or grumpy? Are your erections less strong? Question Has there been a recent deterioration in your work performance? Are you falling asleep after dinner? Have you Have you lost noticed a recent height? deterioration in your ability to play sports? symptoms evaluated (libido and poor erectile function) predicted a low TT level. A large general population of community dwelling men aged years was evaluated in the EMAS [7]. The EMAS reported two important findings. First, sexual symptoms, such as ED and low libido, were most closely associated with low testosterone. Second, the TT threshold below which these sexual symptoms became more prevalent varied from 320 to 350 ng/dl. Although poor erectile function and low libido were among the most common symptoms seen in our present study, the presence of these symptoms did not predict TT levels of <400 ng/dl (Table 2). Although sexual symptoms may be a good indicator of low testosterone in community dwelling middle-aged, and elderly men, they remain a poor indicator for identifying low testosterone in men aged <40 years attending a men s health clinic. The cluster of symptoms that predict a low testosterone in young men suggests that appropriate age and population-based questions need to be asked before initiating hypogonadism treatment. In most men, serum TT concentrations of >300 ng/ml indicate that there is a low likelihood of clinically significant androgen deficiency. Threshold TT levels were calculated on the basis of symptoms for which the probability was significantly increased among men with a decreased TT level, as compared with men who had an increased level of TT. No thresholds were identified for sexual symptoms associated with TT. When evaluating prevalence of symptoms at the often-used TT threshold of 300 ng/dl, we did not find a significant difference between men. In our clinical experience, many patients with serum TT levels between 300 and 400 ng/dl, still report hypogonadal symptoms. Due to this discrepancy between standard practice and clinical experience, 144 BJU International ª 2014 BJU International

4 Hypogonadal symptoms in young men with TT <400 ng/dl Table 2 Univariate and multivariable analysis of hypogonadal symptoms predicting a serum TT level of <400 ng/dl. Only factors that were statistically significant (P < 0.05) on univariate analysis were included in the multivariable analysis. Analysis Odds ratio 95% CI P Univariate Age Do you have decreased libido? Do you have a lack of energy? Do you have a decrease in strength or endurance? Have you noticed a decreased enjoyment in life? Are you sad and/or grumpy? Are your erections less strong? Has there been a recent deterioration in your work performance? Are you falling asleep after dinner? Have you noticed a recent deterioration in your ability to play sports? Have you lost height? Multivariable Do you have a lack of energy? Do you have a decrease in strength or endurance? Are you sad and/or grumpy? Has there been a recent deterioration in your work performance? Have you noticed a recent deterioration in your ability to play sports? Bolded significance values indicate P < we chose to investigate whether or not any hypogonadal symptoms predicted serum TT levels of <400 ng/dl in our present population. Our present findings support our clinical experience that many men with serum TT levels between 300 and 400 ng/dl can still present with hypogonadal symptoms. Other investigators have shown an association between energy and TT levels. In an age-matched cohort of young hypogonadal and euogonadal males, hypogonadal men reported greater fatigue (10 vs 7, P = 0.03) compared with their eugonadal counterparts [17]. A double-blind placebo control study has shown that hypogonadal males treated with TST report less fatigue (P = 0.03) [18]. Furthermore, in patients with obstructive sleep apnoea, which is commonly associated with fatigue, Bercea et al. [19] found in a case-control study that serum TT levels were the only independent predictors of physical fatigue (R 2 = 0.98, P = 0.033) and reduced activity (R 2 = 0.97, P = 0.002). Young men are less likely to have organic factors contributing to ED [20], and our present data suggests that the sexual symptoms often seen in elderly hypogonadal men are less important in diagnosing clinical hypogonadism in younger men. Our present study has both strengths and limitations. We minimised heterogeneity by surveying men as they were seen consecutively and by excluding men who had received AAS and TST in the previous 6 months. We used the ADAM questionnaire, which was originally validated in elderly men and was used to screen for adult-onset hypogonadism [21]. Despite poor specificity, ADAM remains one of the best-validated questionnaires for studying hypogonadal symptoms. We also recorded a single morning serum TT level for patients at the visit when they completed the ADAM questionnaire. While this provided a good record of the relationship between serum TT levels and hypogonadal symptoms, multiple evaluations of TT levels and symptoms could have yielded a more robust comparison. Our present observations should be extrapolated to the diagnosis of testosterone deficiency in patients with the caveat that a low TT level requires confirmation with repeated measurement. Furthermore, the documentation of low TT levels in symptomatic young men does not invariably imply that a low TT level is the only or foremost cause of their physical or psychological symptoms. A comprehensive general assessment is required to seek potential alternative explanations. Obviously, these data do not set the criteria for initiating testosterone replacement but give valuable guidance to the practicing physician about what threshold to use and what symptoms to evaluate in young hypogonadal men. In summary, among men aged <40 years of age visiting a Men s Health Clinic, lack of energy predicted a serum TT level of <400 ng/dl. As there were no differences in hypogonadal symptom probability at 300 ng/dl and presence of the symptoms did not predict a TT level of <300 ng/dl, we think a TT of 300 ng/dl should not be used to diagnose hypogonadism in young men. We propose the existence of unique hypogonadal symptoms that become increasingly prevalent in young men. Rather than using solitary, predefined levels of serum TT (i.e. <300 ng/dl) as thresholds for treatment, we recommend using a different threshold based on symptomatology. The notion that common and uniform concentrations of androgen levels can be applied to describe the increasing prevalence of testosterone-related symptoms in young men should be challenged on the basis of the conclusions from the present study. BJU International ª 2014 BJU International 145

5 Scovell et al. Funding R.R. and J.R.K. are National Institutes of Health (NIH) K12 Scholars supported by a Male Reproductive Health Research Career (MHRH) Development Physician-Scientist Award (HD ) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Program. Conflicts of Interest J.M.S., R.R., N.W., J.R.K. None. L.I.L. Clinical trials participant, Consultant, Speaker: Auxilium; Clinical trials, Consultant, Speaker: Endo. References 1 Rosen RC, Araujo AB, Connor MK et al. The NERI Hypogonadism Screener: psychometric validation in male patients and controls. Clin Endocrinol (Oxf) 2011; 74: Bhasin S, Cunningham GR, Hayes FJ et al. Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2006; 91: Wang C, Nieschlag E, Swerdloff R et al. ISA, ISSAM, EAU, EAA and ASA recommendations: investigation, treatment and monitoring of lateonset hypogonadism in males. Int J Impot Res 2009; 21: Morgentaler A, Khera M, Maggi M, Zitzmann M. Commentary: Who is a candidate for testosterone therapy? A synthesis of international expert opinions. J Sex Med 2014; 11: Holden CA, McLachlan RI, Pitts M et al. Men in Australia Telephone Survey (MATeS): a national survey of the reproductive health and concerns of middle-aged and older Australian men. Lancet 2005; 366: Feldman HA, Longcope C, Derby CA et al. Age trends in the level of serum testosterone and other hormones in middle-aged men: longitudinal results from the Massachusetts male aging study. J Clin Endocrinol Metab 2002; 87: Wu FC, Tajar A, Beynon JM et al. Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med 2010; 363: Baillargeon J, Urban RJ, Ottenbacher KJ, Pierson KS, Goodwin JS. Trends in androgen prescribing in the United States, 2001 to JAMA Intern Med 2013; 173: Chen W, Liu ZY, Wang LH, Zeng QS, Wang HQ, Sun YH. Are the Aging Male s Symptoms (AMS) scale and the Androgen Deficiency in the Aging Male (ADAM) questionnaire suitable for the screening of late-onset hypogonadism in aging Chinese men? Aging Male 2013; 16: Tancredi A, Reginster JY, Schleich F et al. Interest of the androgen deficiency in aging males (ADAM) questionnaire for the identification of hypogonadism in elderly community-dwelling male volunteers. Eur J Endocrinol 2004; 151: Taieb J, Mathian B, Millot F et al. Testosterone measured by 10 immunoassays and by isotope-dilution gas chromatography-mass spectrometry in sera from 116 men, women, and children. Clin Chem 2003; 49: Wang C, Catlin DH, Demers LM, Starcevic B, Swerdloff RS. Measurement of total serum testosterone in adult men: comparison of current laboratory methods versus liquid chromatography-tandem mass spectrometry. J Clin Endocrinol Metab 2004; 89: Park K, Ku JH, Kim SW, Paick JS. Risk factors in predicting a poor response to sildenafil citrate in elderly men with erectile dysfunction. BJU Int 2005; 95: Steidle C, Schwartz S, Jacoby K et al. AA2500 testosterone gel normalizes androgen levels in aging males with improvements in body composition and sexual function. J Clin Endocrinol Metab 2003; 88: Isidori AM, Giannetta E, Gianfrilli D et al. Effects of testosterone on sexual function in men: results of a meta-analysis. Clin Endocrinol (Oxf) 2005; 63: Travison TG, Morley JE, Araujo AB, O Donnell AB, McKinlay JB. The relationship between libido and testosterone levels in aging men. J Clin Endocrinol Metab 2006; 91: Lasaite L, Ceponis J, Preiksa RT, Zilaitiene B. Impaired emotional state, quality of life and cognitive functions in young hypogonadal men. Andrologia 2014; 46: Del Fabbro E, Garcia JM, Dev R et al. Testosterone replacement for fatigue in hypogonadal ambulatory males with advanced cancer: a preliminary double-blind placebo-controlled trial. Support Care Cancer 2013; 21: Bercea RM, Mihaescu T, Cojocaru C, Bjorvatn B. Fatigue and serum testosterone in obstructive sleep apnea patients. Clin Respir J 2014; [Epub ahead of print]. DOI: /crj Caskurlu T, Tasci AI, Resim S, Sahinkanat T, Ergenekon E. The etiology of erectile dysfunction and contributing factors in different age groups in Turkey. Int J Urol 2004; 11: Morley JE, Charlton E, Patrick P et al. Validation of a screening questionnaire for androgen deficiency in aging males. Metabolism 2000; 49: Correspondence: Larry I. Lipshultz, 6624 Fannin Street, #1700, Houston, Texas 77030, USA. larryl@bcm.edu Abbreviations: AAS, androgenic anabolic steroids; ADAM, Androgen Deficiency in the Aging Male (questionnaire); ED, erectile dysfunction; EMAS, European Male Ageing Study; TST, testosterone supplementation therapy; TT, total testosterone. 146 BJU International ª 2014 BJU International

6/14/2010. GnRH=Gonadotropin-Releasing Hormone.

6/14/2010. GnRH=Gonadotropin-Releasing Hormone. Male Androgen Replacement Mitchell Sorsby, MD June 19, 2010. QUESTION # 1 Which of the following is not a symptom associated with low T levels? a) decreased libido b) erectile dysfunction c) depression

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

ISSN: (print), (electronic)

ISSN: (print), (electronic) http://informahealthcare.com/tam ISSN: 1368-5538 (print), 1473-0790 (electronic) Aging Male, 2014; 17(3): 147 154! 2014 Informa UK Ltd. DOI: 10.3109/13685538.2014.908460 ORIGINAL ARTICLE Performance of

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

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

Serum Total Testosterone Level and Identification of Late-Onset Hypogonadism: A Community-Based Study

Serum Total Testosterone Level and Identification of Late-Onset Hypogonadism: A Community-Based Study www.kjurology.org http://dx.doi.org/10.4111/kju.2013.54.9.619 Sexual Dysfunction/Male Infertility Serum Total Testosterone Level and Identification of Late-Onset Hypogonadism: A Community-Based Study Sungmin

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

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

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

Sexual Dysfunction. Jae Il Kang, Byeong Kuk Ham, Mi Mi Oh, Je Jong Kim, Du Geon Moon. DOI: /kju

Sexual Dysfunction. Jae Il Kang, Byeong Kuk Ham, Mi Mi Oh, Je Jong Kim, Du Geon Moon.  DOI: /kju www.kjurology.org DOI:10.4111/kju.2011.52.6.416 Sexual Dysfunction Correlation between Serum Total Testosterone and the AMS and IIEF Questionnaires in Patients with Erectile Dysfunction with Testosterone

More information

R. Charles Welliver, Jr.,* Herbert J. Wiser, Robert E. Brannigan, Kendall Feia, Manoj Monga and Tobias S. K ohler

R. Charles Welliver, Jr.,* Herbert J. Wiser, Robert E. Brannigan, Kendall Feia, Manoj Monga and Tobias S. K ohler Sexual Function/Infertility Validity of Midday Total Testosterone Levels in Older Men with Erectile Dysfunction R. Charles Welliver, Jr.,* Herbert J. Wiser, Robert E. Brannigan, Kendall Feia, Manoj Monga

More information

testosterone and LH concentrations in the morning ( hours) and evening ( hours).

testosterone and LH concentrations in the morning ( hours) and evening ( hours). Original Article SERUM TESTOSTERONE AND LH IN HEALTHY MEN BOYCE et al. Are published normal ranges of serum testosterone too high? Results of a cross-sectional survey of serum testosterone and luteinizing

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

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

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

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

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

Keywords: Position statement, expert opinion, hypogonadism, men, testosterone, calculated bioavailable testosterone

Keywords: Position statement, expert opinion, hypogonadism, men, testosterone, calculated bioavailable testosterone The Aging Male, December 2007; 10(4): 211 216 WORKSHOP REPORT Functional testosterone: Biochemical assessment of hypogonadism in men Report from a multidisciplinary workshop hosted by the Ontario Society

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

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

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

Androderm patch, AndroGel packets and pump, Axiron solution, First- Testosterone, First-Testosterone MC, Fortesta gel, Testim gel, Vogelxo

Androderm patch, AndroGel packets and pump, Axiron solution, First- Testosterone, First-Testosterone MC, Fortesta gel, Testim gel, Vogelxo Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.30.31 Subject: Testosterone Topical Page: 1 of 9 Last Review Date: September 23, 2016 Testosterone topical

More information

TRT and localized protate cancer

TRT and localized protate cancer TRT and localized protate cancer Frans M. J. Debruyne Professor of Urology PRISM BRUGES Increased risk of prostate cancer with TRT? Prostate cancer Testosterone and Prostate Cancer There appears to be

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

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

Testosterone therapy and cancer risk

Testosterone therapy and cancer risk Sexual Medicine Testosterone therapy and cancer risk Michael L. Eisenberg*, Shufeng Li*, Paul Betts, Danielle Herder, Dolores J. Lamb and Larry I. Lipshultz Departments of *Urology, Obstetrics/Gynecology

More information

ORIGINAL ARTICLE The quantitative ADAM questionnaire: a new tool in quantifying the severity of hypogonadism

ORIGINAL ARTICLE The quantitative ADAM questionnaire: a new tool in quantifying the severity of hypogonadism (21) 22, 2 24 & 21 Nature Publishing Group All rights reserved 955-993/1 $32. www.nature.com/ijir ORIGINAL ARTICLE : a new tool in quantifying the severity of hypogonadism O Mohamed 1, RE Freundlich 1,

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

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

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

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

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

Managing Testosterone Deficiency: A Practical Guide. John Grantmyre MD Professor of Urology Dalhousie University

Managing Testosterone Deficiency: A Practical Guide. John Grantmyre MD Professor of Urology Dalhousie University Managing Testosterone Deficiency: A Practical Guide John Grantmyre MD Professor of Urology Dalhousie University 1 2 Case Study #1 A 59-Year-Old Man with Erectile Dysfunction 3 Case History Robert is a

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

MALE HYPOGONADISM: CHOOSING THE APPROPRIATE THERAPY. Michael S. Irwig, M.D. Director, Center for Andrology Division of Endocrinology & Metabolism

MALE HYPOGONADISM: CHOOSING THE APPROPRIATE THERAPY. Michael S. Irwig, M.D. Director, Center for Andrology Division of Endocrinology & Metabolism MALE HYPOGONADISM: CHOOSING THE APPROPRIATE THERAPY Michael S. Irwig, M.D. Director, Center for Andrology Division of Endocrinology & Metabolism Disclosures Aromatase inhibitors & clomiphene citrate are

More information

Prevalence of hypogonadism in males aged at least 45 years: the HIM study

Prevalence of hypogonadism in males aged at least 45 years: the HIM study ORIGINAL PAPER doi: 10.1111/j.1742-1241.2006.00992.x Prevalence of hypogonadism in males aged at least 45 years: the HIM study T. MULLIGAN, 1 M. F. FRICK, 2 Q. C. ZURAW, 2 A. STEMHAGEN, 2 C. MCWHIRTER

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

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

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

/04/ /0 Reprinted from Vol. 172, , August 2004 THE JOURNAL OF UROLOGY

/04/ /0 Reprinted from Vol. 172, , August 2004 THE JOURNAL OF UROLOGY 0022-5347/04/1722-0658/0 Reprinted from Vol. 172, 658 663, August 2004 THE JOURNAL OF UROLOGY Printed in U.S.A. Copyright 2004 by AMERICAN UROLOGICAL ASSOCIATION DOI: 10.1097/01.ju.0000132389.97804.d7

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

Andropause state of the art 2015 and review of selected aspects

Andropause state of the art 2015 and review of selected aspects DOI: 10.5114/pm.2015.49998 Prz Menopauzalny 2015; 14(1): 1-6 Featured paper Andropause state of the art 2015 and review of selected aspects Grzegorz Jakiel 1, Marta Makara-Studzińska 2, Michał Ciebiera

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

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

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

administered before treatment and during follow-up.

administered before treatment and during follow-up. BJUI Outcomes of clomiphene citrate treatment in young hypogonadal men Darren J. Katz, Omar Nabulsi, Raanan Tal and John P. Mulhall Male Sexual and Reproductive Medicine Programme, Urology Service, Department

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

PREVALENCE OF PROSTATE CANCER AMONG HYPOGONADAL MEN WITH PROSTATE-SPECIFIC ANTIGEN LEVELS OF 4.0 ng/ml OR LESS

PREVALENCE OF PROSTATE CANCER AMONG HYPOGONADAL MEN WITH PROSTATE-SPECIFIC ANTIGEN LEVELS OF 4.0 ng/ml OR LESS ADULT UROLOGY PREVALENCE OF PROSTATE CANCER AMONG HYPOGONADAL MEN WITH PROSTATE-SPECIFIC ANTIGEN LEVELS OF 4.0 ng/ml OR LESS ABRAHAM MORGENTALER AND ERNANI LUIS RHODEN ABSTRACT Objectives. To determine

More information

Didactic Series. Hypogonadism and HIV. Daniel Lee, MD UCSD Medical Center, Owen Clinic July 28, 2016

Didactic Series. Hypogonadism and HIV. Daniel Lee, MD UCSD Medical Center, Owen Clinic July 28, 2016 Didactic Series Hypogonadism and HIV Daniel Lee, MD UCSD Medical Center, Owen Clinic July 28, 2016 This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department

More information

Is Semen Analysis Necessary for Varicocele Patients in Their Early 20s?

Is Semen Analysis Necessary for Varicocele Patients in Their Early 20s? pissn: 22874208 / eissn: 22874690 World J Mens Health 2014 April 32(1): 5055 http://dx.doi.org/10.5534/wjmh.2014.32.1.50 Original Article Is Semen Analysis Necessary for Varicocele Patients in Their Early

More information

Current Data and Considerations Novel Testosterone Formulations

Current Data and Considerations Novel Testosterone Formulations Current Data and Considerations Novel Testosterone Formulations 1 Hypogonadism: Treatment Safety and Prostate Health 2 Monitoring for Testosterone Therapy DRE 1,2 PSA Parameter Voiding/IPSS 1,2 Hemoglobin

More information

Recommendations on the diagnosis, treatment and monitoring of Testosterone deficiency (TD) in adult men

Recommendations on the diagnosis, treatment and monitoring of Testosterone deficiency (TD) in adult men Recommendations on the diagnosis, treatment and monitoring of Testosterone deficiency (TD) in adult men Bruno Lunenfeld, George Mskhalaya, Svetlana Kalinchenko, Yulia Tishova, Michael Zitzmann, Stefan

More information

Testosterone therapy in erectile dysfunction

Testosterone therapy in erectile dysfunction The Aging Male 2004;7:312 318 Testosterone therapy in erectile dysfunction R. Department of Urology, Columbia University, New York, USA Key words: TESTOSTERONE, TESTOGEL 1, ERECTILE DYSFUNCTION, HYPOGONADISM,

More information

Clinical Policy Title: Implantable testosterone pellets

Clinical Policy Title: Implantable testosterone pellets Clinical Policy Title: Implantable testosterone pellets Clinical Policy Number: 18.03.05 Effective Date: June 1, 2018 Initial Review Date: April 10, 2018 Most Recent Review Date: May 1, 2018 Next Review

More information

An Update on Men s Health and Sexual Function

An Update on Men s Health and Sexual Function An Update on Men s Health and Sexual Function Lawrence Jenkins, MD, MBA Assistant Professor Clinical Department of Urology The Ohio State University Wexner Medical Center Outline Testosterone Deficiency

More information

Preparing for the road ahead. LEARN MORE ABOUT these 5 risks

Preparing for the road ahead. LEARN MORE ABOUT these 5 risks Preparing for the road ahead LEARN MORE ABOUT these 5 risks to A MAN S health 3 4 5 2 6 1 7 0 8 9 WHY DOES IT SEEM LIKE SOME MEN TAKE BETTER CARE OF THEIR CARS THAN THEIR OWN HEALTH? When the check engine

More information

The Effectiveness of Clomiphene Citrate Compared to Exogenous Testosterone Therapy in Adult Males

The Effectiveness of Clomiphene Citrate Compared to Exogenous Testosterone Therapy in Adult Males Pacific University CommonKnowledge School of Physician Assistant Studies Theses, Dissertations and Capstone Projects Summer 8-8-2015 The Effectiveness of Clomiphene Citrate Compared to Exogenous Testosterone

More information

Severe erectile dysfunction is a marker for hyperprolactinemia

Severe erectile dysfunction is a marker for hyperprolactinemia (2001) 13, 176±182 ß 2001 Nature Publishing Group All rights reserved 0955-9930/01 $15.00 www.nature.com/ijir Severe erectile dysfunction is a marker for hyperprolactinemia AM Johri 1, JPW Heaton 1 * and

More information

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

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

More information

The association of time of day and serum testosterone concentration in a large screening population

The association of time of day and serum testosterone concentration in a large screening population Original Article TIME OF DAY AD SERUM TESTOSTEROE LEVEL I A LARGE SCREEIG POPULATIO CRAWFORD et al. Authors from the USA reviewed semen samples for their ational Prostate Cancer Awareness screening programme.

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

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

Can men on AS be treated with testosterone?

Can men on AS be treated with testosterone? Can men on AS be treated with testosterone? Professor Bertrand Tombal, MD, PhD Cliniques universitaires Saint-Luc Université catholique de Louvain Brussels, Belgium Conflicts of interest PI or member steering

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

Predicting Biochemical Response to Clomiphene Citrate in Men with Hypogonadism

Predicting Biochemical Response to Clomiphene Citrate in Men with Hypogonadism 2302 Predicting Biochemical Response to Clomiphene Citrate in Men with Hypogonadism Clarisse R. Mazzola, MD,* Darren J. Katz, MD,* Nina Loghmanieh, DO,* Christian J. Nelson, PhD,* and John P. Mulhall,

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

Pharmacy Coverage Guidelines are subject to change as new information becomes available.

Pharmacy Coverage Guidelines are subject to change as new information becomes available. TESTOSTERONE REPLACEMENT THERAPY: ANDRODERM transdermal patch ANDROGEL pump transdermal gel and transdermal gel AXIRON transdermal solution FORTESTA transdermal gel NATESTO nasal gel STRIANT buccal mucoadhesive

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

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

Testosterone Injection / Implant

Testosterone Injection / Implant Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Testosterone Injection / Implant Page: 1 of 9 Last Review Date: December 5, 2014 Testosterone

More information

The Global Online Sexuality Survey (GOSS) 2015: Erectile Dysfunction Among English-Speaking Internet Users in the United States

The Global Online Sexuality Survey (GOSS) 2015: Erectile Dysfunction Among English-Speaking Internet Users in the United States Original Article The Global Online Sexuality Survey (GOSS) 2015: Erectile Dysfunction Among English-Speaking Internet Users in the United States Osama Shaeer 1, Kamal Shaeer 2, Mikkel 3, Fode, Ege Serefoglu

More information

Testosterone Injection and Implant

Testosterone Injection and Implant Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.30.33 Subject: Testosterone Injection Implant Page: 1 of 10 Last Review Date: December 8, 2017 Testosterone

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

Testosterone Oral Buccal Nasal. Android, Androxy, Methitest, Natesto, Striant, Testred. Description

Testosterone Oral Buccal Nasal. Android, Androxy, Methitest, Natesto, Striant, Testred. Description 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.30.32 Subject: Testosterone Oral Buccal Nasal Page: 1 of 10 Last Review Date: March 17, 2017 Testosterone Oral Buccal Nasal Description

More information

Cigna Drug and Biologic Coverage Policy

Cigna Drug and Biologic Coverage Policy Cigna Drug and Biologic Coverage Policy Subject Testosterone Therapy Table of Contents Coverage Policy... 1 General Background... 6 Coding/Billing Information... 7 References... 7 Effective Date... 1/1/2018

More information

Sexual dysfunction in male LUTS. M. Gacci Department of Urology, University of Florence

Sexual dysfunction in male LUTS. M. Gacci Department of Urology, University of Florence Sexual dysfunction in male LUTS M. Gacci Department of Urology, University of Florence Roma, 25-26 June, 2015 Cross-sectional population-based study of 4800 men (40 79 yr of age) UK, Netherlands, France,

More information

Testosterone Oral Buccal Nasal. Android, Androxy, Methitest, Natesto, Striant, Testred. Description

Testosterone Oral Buccal Nasal. Android, Androxy, Methitest, Natesto, Striant, Testred. Description 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.30.32 Subject: Testosterone Oral Buccal Nasal Page: 1 of 10 Last Review Date: November 30, 2018 Testosterone Oral Buccal Nasal

More information

Androgens and male aging: current evidence of safety and efficacy

Androgens and male aging: current evidence of safety and efficacy 136 Review Asian Journal of Andrology (2010) 12: 136 151 2010 AJA, SIMM & SJTU All rights reserved 1008-682X/09 $ 32.00 www.nature.com/aja Androgens and male aging: current evidence of safety and efficacy

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

Monitoring of Late-Onset Hypogonadism in Males: ISA, ISSAM, EAU, EAA, and Recommendations

Monitoring of Late-Onset Hypogonadism in Males: ISA, ISSAM, EAU, EAA, and Recommendations Journal of Andrology, Vol. 30, No. 1, January/February 2009 Copyright E American Society of Andrology Investigation, Treatment, and Monitoring of Late-Onset Hypogonadism in Males: ISA, ISSAM, EAU, EAA,

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

Outcomes of Prostate Biopsy in Men with Hypogonadism Prior or During Testosterone Replacement Therapy

Outcomes of Prostate Biopsy in Men with Hypogonadism Prior or During Testosterone Replacement Therapy ORIGINAL ARTICLE Vol. 41 (6): 1167-1171, November. December, 2015 doi: 10.1590/S1677-5538.IBJU.2014.0528 Outcomes of Prostate Biopsy in Men with Hypogonadism Prior or During Testosterone Replacement Therapy

More information

CURRICULUM VITAE Robert Brannigan, M.D. Revised : 04/01

CURRICULUM VITAE Robert Brannigan, M.D. Revised : 04/01 CURRICULUM VITAE Robert Brannigan, M.D. Revised : 04/01 CURRICULUM VITAE Robert Brannigan, M.D. Address The Center for Human Reproduction 60 East Delaware Place The Annex to the 900 North Michigan Building

More information

Serum Testosterone (T) Level Variability in T Gel-Treated Older Hypogonadal Men: Treatment Monitoring Implications

Serum Testosterone (T) Level Variability in T Gel-Treated Older Hypogonadal Men: Treatment Monitoring Implications ORIGINAL ARTICLE Serum Testosterone (T) Level Variability in T Gel-Treated Older Hypogonadal Men: Treatment Monitoring Implications Ronald S. Swerdloff, Youngju Pak, Christina Wang, Peter Y. Liu, Shalender

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

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

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

Comparison of the Effects of Testosterone Gels, Injections, and Pellets on Serum Hormones, Erythrocytosis, Lipids, and Prostate-Specific Antigen

Comparison of the Effects of Testosterone Gels, Injections, and Pellets on Serum Hormones, Erythrocytosis, Lipids, and Prostate-Specific Antigen ORIGINAL RESEARCH PHARMACOTHERAPY Comparison of the Effects of Testosterone Gels, Injections, and Pellets on Serum Hormones, Erythrocytosis, Lipids, and Prostate-Specific Antigen Alexander W. Pastuszak,

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

The CATCH checklist to investigate adult-onset hypogonadism

The CATCH checklist to investigate adult-onset hypogonadism ISSN: 2047-2919 REVIEW ARTICLE Correspondence: Giuseppe Defeudis, Department of Experimental Medicine, Sapienza University of Rome, Italy and Unit of Endocrinology and Diabetes, Department of Medicine,

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

HORMONE BALANCE QUESTIONNAIRE FOR MEN

HORMONE BALANCE QUESTIONNAIRE FOR MEN HORMONE BALANCE QUESTIONNAIRE FOR MEN Name: Date: Address: City: State: Zip: Home Phone: Cell Phone: Work Phone: Date of Birth: Age: Height: Weight: Primary Care Doctor: Health History Do you have a personal

More information

Testosterone Injection and Implant

Testosterone Injection and Implant Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.30.33 Subject: Testosterone Injection Implant Page: 1 of 10 Last Review Date: March 17, 2017 Testosterone

More information

Design: This was a retrospective incident user cohort.

Design: This was a retrospective incident user cohort. ORIGINAL ARTICLE Endocrine Care Testosterone Lab Testing and Initiation in the United Kingdom and the United States, 2000 to 2011 J. Bradley Layton, Dongmei Li, Christoph R. Meier, Julie L. Sharpless,

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

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

Testosterone Oral Buccal Nasal. Android, Androxy, Methitest, Natesto, Striant, Testred. Description

Testosterone Oral Buccal Nasal. Android, Androxy, Methitest, Natesto, Striant, Testred. Description 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.30.32 Subject: Testosterone Oral Buccal Nasal Page: 1 of 10 Last Review Date: June 24, 2016 Testosterone Oral Buccal Nasal Description

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

Assessment and management of male androgen disorders: an update

Assessment and management of male androgen disorders: an update Irene Chan Mark Ng Tang Fui Jeffrey D Zajac Mathis Grossmann Assessment and management of male androgen disorders: an update Background Male hypogonadism, caused by intrinsic pathology of the hypothalamic

More information