Earlier observational studies suggested that long-term use of testosterone could increase the risk of cardiovascular disease. Testosterone is also known to stimulate the growth of prostate cancer in men who have been diagnosed with this condition. Recent clinical trials, which provide more accurate information compared to observational studies, have provided some peace of mind regarding the risk of heart and prostate cancer. For men who are clearly deficient in testosterone, there is no apparent increased risk of having a heart attack or stroke or of developing a new prostate cancer from testosterone replacement therapy.
The estimated likelihood of long-term adverse effects of TRT is still essentially unknown, as there is a lack of high-quality general evidence to discourage its use in most men with TD. The prominent studies discussed in this article can be used to guide doctors on how to best monitor patients receiving TRT, especially those with the comorbid conditions listed below. Testosterone products are prescribed to men for a variety of potential health benefits, but the causal effects are not clear. It is difficult to obtain evidence from randomized trials, especially with regard to effects on long-term or rare outcomes. Mendelian randomization analyses were performed to infer the effects of free testosterone on the whole phenomenon in 461 results on 161,268 men from the UK Biobank study.
The increase in free testosterone over a lifetime had beneficial effects on increasing bone mineral density and decreasing body fat; had adverse effects on lowering HDL and increasing the risk of prostate cancer, androgenic alopecia, spinal stenosis, and hypertension; and had context-dependent effects on increasing hematocrit and decreasing C-reactive protein. No benefit was seen with regard to type 2 diabetes or to cardiovascular or cognitive outcomes. Mendelian randomization suggests that the benefits of a prolonged increase in testosterone should be considered against adverse effects, in particular the increase in prostate cancer. and hypertension.
Well-founded randomized trials are needed to conclusively address the risks and benefits of testosterone treatment in relation to these outcomes. As men age, there is a decrease in testicular production of testosterone, as well as an increase in sex hormone binding globulin, both of which decrease the bioavailability of testosterone. With this gradual decline, the beneficial effects of testosterone may diminish and negatively affect physical and emotional well-being.
Testosterone replacement therapy
(TRT) is a reasonable treatment option that is often tested for men with low testosterone levels and symptoms of hypogonadism.When replaced, many of the positive effects of testosterone are recovered. These positive results have led to a dramatic increase in the use of testosterone substitutes in men with symptomatic hypogonadism, although long-term data on their safety is lacking. TRT doesn't cure low testosterone levels, so symptoms may come back if you stop taking it. For men aged 65 and over, the relative risks (RR) were 2.19 (95% CI: 1.27—3.7) for those who received TRT and 1.15 (95% CI: 0.83—1.5) for men who received PDE5I.
This study then evaluated the effect of TRT on mortality in men in the group with low testosterone, which was divided into men who received and did not receive TRT. The risk of prescribing TRT increased with age, from 0.95 (95% CI: 0.54-1.6) in men younger than 55 to 3.43 (95% CI: 1.5—7.5) in men aged 75 and over. A limitation of this study focuses on the use of a health care database that did not include information on serological or diagnostic criteria for men who received TRT. To allow the therapy to take full effect, healthcare providers usually wait 30 days after starting TRT to check levels of testosterone.
TD is associated with an increased risk of developing cardiovascular and metabolic diseases; however, the nature of the relationship remains unclear and recent evidence suggests that TRT may increase the risk of adverse cardiovascular events in men with significant comorbidities. Men treated with TRT should be monitored for side effects such as polycythemia, peripheral oedema, and heart and liver dysfunction. Within 1 to 2 years after TRT, your doctor will measure your bone density if you had osteoporosis when you started treatment. For men who have previously undergone definitive treatment for prostate cancer, the use of TRT is increasingly accepted.
TRT, when administered to appropriately selected patients with vigilant surveillance, as described in this review and in Table 1, can improve quality of life, energy level, libido, muscle mass, cognition and bone density. Testosterone replacement therapy (TRT) is a treatment widely used in men with symptomatic hypogonadism. The remaining three trials did not adequately assess the relationship between TRT and OSA, but they offered some interesting results. Although it was demonstrated that IPSS scores improved significantly with TRT during the first 5 years of treatment, it could be posited that if prostate volume continues to increase with continued use of TRT, LUTS may worsen later after a period of improvement.
Current literature supports that TRT does not substantially worsen lower urinary tract symptoms and, in fact, may improve symptoms in some men. Men who had started treatment with TRT before angiography or before obtaining serum testosterone levels were excluded, since “time 0” was defined as the time when the angiography was performed, not the time when treatment with testosterone began.
