What are the absolute contraindications for testosterone replacement therapy?

Testosterone treatment for hypogonadal men with prostate cancer In patients undergoing radical prostatectomy, available data are limited, but testosterone treatment appears to be safe in carefully selected patients if they have favorable risk factors, negative surgical margins and undetectable PSA levels for at least two years. Sharing decision-making is recommended in these situations, as data is limited and the risk of malignant progression is increased compared to other hypogonadal men without prostate cancer.

What are the absolute contraindications for testosterone replacement therapy?

Testosterone treatment for hypogonadal men with prostate cancer In patients undergoing radical prostatectomy, available data are limited, but testosterone treatment appears to be safe in carefully selected patients if they have favorable risk factors, negative surgical margins and undetectable PSA levels for at least two years. Sharing decision-making is recommended in these situations, as data is limited and the risk of malignant progression is increased compared to other hypogonadal men without prostate cancer.

Physicians, advanced medical professionals, pharmacists and nurses who work as interprofessional healthcare teams should be aware of the risks, benefits, and contraindications of testosterone replacement therapy.

There are conflicting studies on the cardiovascular risks of testosterone therapy, most notably the TOM trial (testosterone in older men) and the TEAAM trials (the effects of testosterone on the progression of atherosclerosis in aging men).). Testosterone stimulates erythropoiesis, and testosterone therapy (in particular intramuscular esters) is associated with an increased risk of polycythemia, 50 Pre-existing polycythemia (hematocrit of more than 54%) is an absolute contraindication for initiating testosterone therapy.

The development of polycythemia during treatment should lead to the cessation of treatment, dose reduction, or switch to a lower-risk formulation to avoid an increased risk of myocardial infarction, stroke and venous thromboembolism. Testosterone treatment has been shown to increase hemoglobin levels and correct anemia in a significant proportion of older men with anemia of unknown etiology. Testosterone measurement should be considered in older men with unexplained anemia. Testosterone replacement therapy (TRT) is a widely used treatment in men with symptomatic hypogonadism.

The benefits seen with TRT, such as increased libido and energy level, beneficial effects on bone density, strength and muscles, and cardioprotective effects, are well documented. TRT is contraindicated in men with untreated prostate and breast cancer. Men treated with TRT should be monitored for side effects such as polycythemia, peripheral oedema, and heart and liver dysfunction. Testosterone tests and prescriptions have almost tripled in recent years; however, it is clear from clinical practice that there are many men who consume testosterone without a clear indication, 1-3 Some studies estimate that up to 25% of men who receive testosterone therapy do not have a testosterone test before the start of treatment, 2, 3 Of the men who receive testosterone treatment, almost half of their testosterone levels are not controlled after starting treatment, 2, 3 Although up to a A third of men who receive treatment with testosterone, almost half of their testosterone levels are not controlled after starting treatment, 2, 3 Although up to a third of men who receive treatment with testosterone, almost half of their testosterone levels are not controlled after starting treatment, 2, 3 Although up to a third of men who receive testosterone treatment, almost half have their testosterone levels not controlled, are undergoing testosterone therapy and do not meet the criteria For If diagnosed with testosterone deficiency, 2,3 there is a large percentage of men who need testosterone treatment who do not receive it due to medical problems, mainly related to the development of prostate cancer and cardiovascular events, although current evidence does not definitively support these concerns. Given the clinical and commercial landscape of testosterone, the American Urological Association (AUA) identified the need to produce an evidence-based document that informs doctors about the appropriate evaluation and treatment of patients with testosterone deficiency.

The AUA and the Testosterone Panel are committed to creating a guideline that ensures that men who need testosterone treatment receive effective and safe treatment. Testosterone tests and prescriptions have almost tripled in recent years; however, it is clear from clinical practice that there are many men who consume testosterone without a clear indication, 1-3 Some studies estimate that up to 25% of men who receive testosterone therapy are not tested for testosterone before starting treatment and that almost half of them do not control their testosterone levels once treatment has started, 2, 3 Although up to a third of men who receive testosterone therapy do not meet the criteria to be diagnosed as deficient in testosterone, 2, 3 there is a large percentage of men who need testosterone therapy and do not receive it due to clinical concerns, mainly related to the development of prostate cancer and cardiovascular events, although current evidence does not definitively support these concerns. Similarly, if patients have unexplained anemia that improves with testosterone treatment, continuing treatment may be considered even if other symptoms do not. they improve.

In vitro experiments have demonstrated that prostate cancer cells do not proliferate in the absence of testosterone; once testosterone is introduced, an initial proliferative response is observed followed by stagnation after reaching a certain testosterone concentration. It is very important for patients to understand that products containing testosterone are Schedule III substances, are approved only to treat hypogonadism, and should be used as directed by a doctor. Until there is definitive evidence to show that there is an association between testosterone treatment and subsequent MACE, the Panel recommends that doctors inform patients that the current scientific literature does not definitively prove that treatment with testosterone increases risk. However, the FDA added a warning to the labels of testosterone products after reviewing five observational studies and two meta-analyses of randomized controlled randomized trials that examined the effects of the treatment.

with testosterone in the MACE. It is rapidly metabolized in the liver; therefore, achieving consistent therapeutic levels of testosterone is a challenge. Since the most commonly used testosterone preparations in women are oral, increased hepatotoxic risk is associated with extensive first-pass testosterone metabolism. Testosterone is the predominant androgen in men and is involved in a multitude of physiological and biochemical processes throughout the body.

The European Study on Male Aging (EMAS) 8 studied 3,369 men (with an average age of 59) and collected data on their sexual, physical and psychological symptoms, together with morning measurements of total testosterone. When measuring testosterone levels, acute diseases must be taken into account, the presence of which can affect the accuracy of the test and cause an artificial decrease in testosterone measurements. Physicians should advise patients on the association between low testosterone levels and an increased risk of cardiovascular events, as well as on the ill-defined cardiovascular risks and benefits of testosterone treatment in patients with testosterone deficiency. An analysis of the benefits of discontinuing testosterone treatment should include the possibility of a decrease in PSA.

Healthcare professionals should inform patients about this potential risk when deciding whether to start or continue testosterone treatment in a patient. Health professionals should prescribe testosterone therapy only to men with low testosterone levels caused by certain medical conditions and confirmed by laboratory tests.

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