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Testosterone replacement
therapy (TRT) has been used in millions of men worldwide to treat decreased libido and erectile dysfunction, and to improve strength and physical function.The estimated likelihood of long-term adverse effects of TRT is still essentially unknown, since there is a lack of high-quality general evidence based on prospective randomized trials that recommend or does not recommend its use in most men with testosterone (TD) deficiency. Evidence to suggest that TRT increases the risks of cardiovascular morbidity and mortality is scarce, as results vary depending on the populations studied and their baseline comorbidities. While TRT can increase serum levels of prostatic specific antigens in some men, it often stays within clinically acceptable limits and has not been shown to increase the risk of prostate cancer. The current literature supports that TRT does not substantially worsen lower urinary tract symptoms and, in fact, may improve symptoms in some men.
Limited evidence suggests that TRT may initially worsen obstructive sleep apnea in some men, but that this is not a lasting effect. TRT may cause erythrocytosis in some men; however, long-term studies have not reported significant adverse effects (e.g., strokes, vascular occlusive events, or venous thromboembolism). Future research will need to focus exclusively on evaluating large multiethnic cohorts of men using prospective trials to better elucidate the risk-to-risk ratios of TRT with regard to cardiovascular diseases, prostate cancer, lower urinary tract symptoms, obstructive sleep apnea, erythrocytosis and other theoretical risks to be determined in men with or without cardiovascular risk equivalents. To date, few studies have addressed the potential long-term adverse effects associated with TRT. This article will summarize current evidence, focusing on the possible risks associated with CVD, increased prostatic specific antigen (PSA) and prostate cancer, lower urinary tract symptoms (LUTS), obstructive sleep apnea (OSA) and erythrocytosis, with the objective of analyzing the literature on the safety of TRT and identifying areas where future research is needed.
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 outstanding studies discussed in this article can be used to guide doctors on the best way to monitor patients receiving TRT, especially those with comorbid conditions which are detailed below. Similar to the possible increased risk of prostate cancer, it has long been postulated that TRT causes an increase in prostate volume and a worsening due to benign prostatic hyperplasia (BPH). Until now, the current literature has been heterogeneous, but it tends to show that TRT does not worsen LUTS and, in fact, may improve symptoms in some cohorts.
TRT will continue to offer the possibility of substantially improving the quality of life for many men around the world. The sensible and appropriate use of TRT will be essential to minimize the theoretical risk of adverse effects in high-risk populations. Future research should require a specific focus on evaluating large multiethnic cohorts of men using prospective trials to better elucidate the risk-risk relationship of TRT with regard to cardiovascular and metabolic diseases, prostate cancer, LUTS, OSA, erythrocytosis and other theoretical risks yet to be determined in men with or without cardiovascular risk equivalents. Available evidence indicates that TRT is considered largely safe in most men, with a small inherent risk of adverse events in selected populations of high-risk men with multiple medical comorbidities.
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. TRT has been associated with occasional moderate increases in serum PSA, although within safe clinical parameters and without convincing and substantial evidence to support an increased risk of cancer. of prostate. LUTS appear to remain stable or to improve slightly with the use of the TRT, which offers a different point of view than previously held opinions.
There is still little data on TRT in relation to the long-term outcomes of OSA; however, current evidence suggests that TRT may transiently worsen the objective parameters of OSA and then disappear. TRT appears to be associated with erythrocytosis, but data are lacking on the importance of this trend in relation to patient outcomes. Anthony Grech, University of Michigan, Family Medicine, Ann Arbor, MI, USA. UU.
John Breck, University of Michigan - Family Medicine, Ann Arbor, MI, USA UU. Joel Heidelbaugh, University of Michigan, Family Medicine, Ypsilanti Health Center, 200 Arnet Suite 200, Ypsilanti, MI 48198, USA UU. Here you will find articles from Therapeutic Advances in Drugs, courtesy of SAGE Publications. Earlier observational studies suggested that long-term use of testosterone could increase your risk of cardiovascular disease. Testosterone is also known to stimulate the growth of prostate cancer in men diagnosed with the 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. Prolonged TTh in hypogonadal men, regardless of baseline weight, resulted in improvements in body weight, waist circumference (WC), and body mass index (BMI). In addition, TTh lowered fasting blood glucose and HbA1c and improved lipid profiles.
Gradual decreases in blood pressure (systolic and diastolic) and pulse pressure occurred in men treated with testosterone in each group. There were notable reductions in mortality and serious cardiovascular events in men who received TTh. The beneficial effects on body composition, sexual function, hematocrit and BMD must be weighed against the detrimental effects on androgenic alopecia, prostate cancer, hypertension and spinal stenosis, and the absence of detectable beneficial effects on other criteria of important clinical evaluations. Mendelian randomization analyses were performed to infer the effects of free testosterone on the whole phenomenon in 461 results in 161 268 men from the UK Biobank study.
Scientists use so-called randomized controlled trials to establish the causal relationship and reduce biases. The Mendelian randomization analysis allowed us to examine the effects of naturally elevated testosterone levels over a lifetime on 469 traits and diseases. The increased risk of prostate cancer mimics the effects of testosterone seen in a previous MRI analysis using independent data from the PRACTICAL consortium, and further supports the role of testosterone in obtaining these results. Studies have shown that using a smaller needle and injecting it subcutaneously or subcutaneously is as effective as the intramuscular approach, which involves an injection with a larger needle that is injected deeper into the muscle. In addition, a key strength of this study was the strict attempt to control the pleiotropic effects of SHBG on free testosterone by conservatively eliminating any genetic variant in the GRS that were associated with SHBG (e.g.
there was only significant heterogeneity between the effects on BMD for MRI and ACE), but it is difficult to make direct comparisons due to the variable change in testosterone levels after testosterone administration in each RCT, to the different methods and anatomical sites of Estimation of BMD and differences between short-term effects in RCTs in relation to lifetime effects on MRI The results with expected beneficial effects were fractures anywhere, heel BMD, percentage of body fat, percentage of body fat free of body fat, dementia, depression, grip strength and level of physical activity measured with a wrist accelerometer. A relatively small number of men experience immediate side effects of testosterone supplementation, such as acne, breathing disorders while sleeping (worsening of sleep apnea), breast swelling or tenderness, or swelling in the ankles. In a meta-analysis of the adverse effects of TRT in men with arterial distension disorder, it was found that 11 trials highlighted erythrocytosis as a major side effect of extractive therapy. Given the multifactorial nature of this disease, the apparent discrepancy between blood pressure and hypertension can be explained by the effect on other risk factors that become hypertension. Testosterone products are prescribed to men for a variety of potential health benefits, but the causal effects are not clear.
Testosterone therapy can help reverse the effects of hypogonadism, but it's not clear if testosterone therapy would benefit older men who are otherwise healthy. In addition, the UK Biobank generally has a healthier and higher socioeconomic status than that of the general population, so there are not enough cases to detect the effects on certain less common effects, such as Alzheimer's disease, and there is not enough capacity to identify the weaker effects of free testosterone in the results common.
