Testosterone Does Not Appear to Increase The Risk For Cardiovascular Disease

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Testosterone replacement therapy does not appear to increase the risk for cardiovascular disease or thromboembolic events in middle-aged men.

In fact, the risk for a cardiovascular event was lower in men taking supplemental testosterone than in those who were not, said lead investigator Julian Hanske, MD, from Ruhr University Bochum in Herne, Germany, who collaborated on the study during a fellowship at Brigham & Women’s Hospital in Boston.

But physicians should know whether a patient suffers from obstructive sleep apnea before prescribing testosterone, Dr Hanske said here at the European Association of Urology 2017 Congress.

Cohort studies of the cardiovascular and thromboembolic consequences of supplemental testosterone have generally relied on sources such as the Surveillance, Epidemiology, and End Results Medicare database, which is limited to an older population, he told Medscape Medical News.

To get a better handle on the relative risks associated with testosterone replacement therapy in a younger population, Dr Hanske and his team searched the TRICARE American military insurance database, which covers all retired and active-duty military personnel and their dependents.

They looked for men 40 to 65 years of age treated for low levels of testosterone. Patients were excluded if they had a history of heart disease, thromboembolism, prostate cancer, or obstructive sleep apnea.

For the final cohort, 3422 men who took testosterone were matched with 3422 control subjects who did not by year of birth, then by date of first testosterone prescription, and then by race and baseline comorbidities.

The study outcomes were event-free survival and absolute risk for cardiovascular disease, thromboembolism or obstructive sleep apnea.

We have so many fears of testosterone replacement therapy.

Cardiovascular event-free survival was significantly better in the testosterone group than in the control group (P = .0085), and risk for coronary artery disease was lower in the testosterone group (P = .0082).

There was no difference in thromboembolic event-free survival between the testosterone and control groups (P = .0998).

These findings are reassuring, said session comoderator Raanan Tal, MD, head of the male infertility program at Rambam Medical Center in Haifa, Israel.

“We have so many fears of testosterone replacement therapy, and actually what they showed is that so many beliefs that we have cannot be supported,” he told Medscape Medical News.

“The fact that you don’t have an increase in cardiovascular events or thrombotic events is an important message — more important than the risk of increased obstructive sleep apnea,” he explained.

But the other comoderator said he thinks the findings would be more compelling if the investigators had used propensity-score matching or a similar statistical method to ensure a close case–control match.

“Age is a risk factor,” Andrea Salonia, MD, from the Vita-Salute San Raffaele University in Milan, pointed out. “The younger the patient, the lower the probability of having difficulties sleeping at night, and they did not adjust for that specific issue, or at least they did not find any kind of difference according to this specific variable.”

“At the same time, the number of patients they considered was amazing, and it is probably one of the most important studies in terms of the huge cohort they selected,” Dr Salonia told Medscape Medical News.

Dr Hanske, Dr Tal, and Dr Salonia have disclosed no relevant financial relationships.

European Association of Urology (EAU) 2017 Congress: Abstract 256. Presented March 25, 2017.

Article Source: http://www.medscape.com/viewarticle/877786

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Testosterone therapy improves insulin sensitivity in diabetic men

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The January 2016 issue of the journal Diabetes Care reported the outcome of a randomized trial that revealed a beneficial role for testosterone treatment in men with diabetes.

“We hypothesized that testosterone may be an anti-inflammatory and insulin sensitizing agent since it has been known for some time that testosterone reduces adiposity and increases skeletal muscle,” remarked lead researcher Paresh Dandona, MD, PhD, who is a Distinguished Professor at the State University of New York and chief of endocrinology, diabetes and metabolism in the Department of Medicine in the Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo. “Our previous work has shown that obesity is associated with oxidative stress and inflammation, and inflammatory mediators are known to interfere with insulin signaling.”

The trial included 94 type 2 diabetic men, among whom 44 had low testosterone levels and reduced insulin signaling genes indicative of decreased insulin sensitivity. Participants with low testosterone received a weekly testosterone injection or a placebo for 24 weeks. Body weight, body fat, markers of inflammation, insulin sensitivity and other factors were assessed before and after treatment.

At the end of the trial, men who received testosterone experienced a more than six pound average loss of body fat and an equal increase in muscle mass. They also had lower levels of the inflammatory markers C-reactive protein, interleukin-1b and tumor necrosis factor-a. “Most importantly, we saw a dramatic increase in insulin sensitivity, demonstrated by a 32 percent increase in the uptake of glucose by tissues in response to insulin,” Dr Dandona reported.

“Testosterone treatment for men, where indicated, will improve sexual function and increase skeletal muscle strength and bone density,” Dr Dandona noted. “This is the first definitive evidence that testosterone is an insulin sensitizer and hence a metabolic hormone.”

Article Source: http://www.lifeextension.com/WhatsHot/2015/11/November-Whats-Hot-Articles/Page-01#test

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Jane Fonda reveals testosterone is the secret behind her sex success at 73

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She has attributed her youthful looks to a healthy love life and given hope to millions by saying she had the best sex of her life at 71.

So it is something of a let down to find out that even sex symbol Jane Fonda needs artificial help.

The Barbarella star has revealed she took the male sex hormone testosterone from the age of 70 to boost her libido.

Miss Fonda said it made ‘a huge difference’.

Advising other women of a certain age how to pep up their love lives, three-times married actress, political activist and fitness guru said: ‘Here’s something I haven’t said publicly yet: I discovered testosterone about three years ago, which makes a huge difference if you want to remain sexual and your libido has dropped.

‘Use testosterone, it comes in a gel, pill or patch.’

Earlier this year, Robbie Williams shocked his legions of female fans by admitting he was injecting himself with testosterone to boost his sex drive.

Although testosterone is usually thought of as a male hormone, it is also made by women, but in much smaller amounts.

Levels drop off after the menopause, leading to some doctors prescribing testosterone alongside more traditional hormone replacement therapy.

It is relatively cheap, costing around £50 for six months’ supply and comes in patches, implants and gels.

But a reinvigorated love life can come at a cost.

Miss Fonda, now 73, and in a relationship with music producer Richard Perry, who is four years her junior, told the Sunday Telegraph: ‘I had to stop because it was giving me acne.

‘It’s one thing to have plastic surgery, but it is quite another to have adolescence acne. That is going too far.’

Two years ago, she created envy in millions of bedrooms by telling how she was having the best sex of her life, despite having had spinal surgery and boasting an artificial knee and a titanium hip.

She said: ‘How do I still look good?  I owe 30 per cent to genes, 30 per cent to good sex, 30 per cent because of sports and healthy lifestyle with proper nutrition and for the remaining ten per cent, I have to thank my plastic surgeon.

But I’m happier, the sex is better and I understand life better. I don’t want to be young again.’

More recently, she has devoted 50 pages of her new autobiography to explaining how couples can keep the passion alive long after the vigour of their youth has failed.

However, her use of testosterone has remained secret until now.

British experts welcomed the revelation.

Professor John Studd, of the London PMS and Menopause Clinic has been prescribing testosterone for women for 30 years.

He said: ‘It is not just about libido.  The benefits include more energy, more self-confidence, better mood and all of those things.’

He added that carefully balancing the dose should remove the risk of side-effects such as acne and excessive bodily or facial hair.

Dr John Stevenson chairman of the charity Women’s Health Concern, said: ‘Jane Fonda clearly thinks there should be no time limit to being sexually active, which is fine. Good for her.’

However, the Royal College of Obstetricians and Gynaecologists warns that the long-term consequences of the treatment are unknown.

THE TRUTH BEHIND TESTOSTERONE

Testosterone can be part of the hormone replacement therapy given to menopausal women.

Gels that are rubbed into the skin are the most popular.  But patches, creams and implants are also available.

Topping up levels of the hormone can give a woman in her 50s or 60s the libido of someone half her age, as well as boost energy and mood.

But too high a dose carries the risk of acne and greasy skin and hair.

‘Masculine’ side-effects such as excessive bodily and facial hair and a deepened voice are also possible.

Testosterone pills aren’t given to women but can raise cholesterol, increasing the odds of heart attacks and strokes.

The Royal College of Obstetricians and Gynaecologists urges caution when prescribing the libido-boosting treatment to women other than those who have had their ovaries removed.

It advises: ‘Testosterone replacement may be associated with adverse clinical and metabolic side effects and long-term consequences are unknown.

Written By: Fiona Macrae

Read more: http://www.dailymail.co.uk/femail/article-2028544/Jane-Fonda-reveals-testosterone-secret-sex-success-73.html#ixzz4cj0r8L4x

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Effects of taking tadalafil 5 mg once daily on erectile function and total testosterone levels in patients with metabolic syndrome.

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We aimed to evaluate the efficacy of tadalafil 5 mg once-daily treatment on testosterone levels in patients with erectile dysfunction (ED) accompanied by the metabolic syndrome. A total of 40 men with metabolic syndrome were evaluated for ED in this study. All the patients received 5 mg tadalafil once a day for 3 months. Erectile function was assessed using the five-item version of the International Index of Erectile Function (IIEF) questionnaire. Serum testosterone, follicle-stimulating hormone and luteinising hormone levels were also evaluated, and blood samples were taken between 08.00 and 10.00 in the fasting state. All participants have three or more criteria of metabolic syndrome. At the end of 3 months, mean testosterone values and IIEF scores showed an improvement from baseline values (from 3.6 ± 0.5 to 5.2 ± 0.3, from 11.3 ± 1.9 to 19 ± 0.8 respectively). After the treatment, serum LH levels were decreased (from 5.6 ± 0.6 to 4.6 ± 0.5). There was significantly difference in terms of baseline testosterone and luteinising hormone values and IIEF scores (p < .05). Based on our findings, we recommend tadalafil 5 mg once daily in those men with erectile dysfunction especially low testosterone levels accompanied by metabolic syndrome.

Article Source: https://www.ncbi.nlm.nih.gov/pubmed/28295481

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Exploring the role of testosterone in the cerebellum link to neuroticism: From adolescence to early adulthood

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Highlights

  • Cerebellar volumes correlate inversely with neurotic personality traits in adolescents and young adults.
  • In males, higher endogenous testosterone levels is associated with lower scores on neurotic personality traits and larger cerebellar gray matter volumes.
  • Testosterone significantly mediates the relation between cerebellar gray matter and measures of neuroticism.

Abstract

Previous research has found an association between a smaller cerebellar volume and higher levels of neuroticism. The steroid hormone testosterone reduces stress responses and the susceptibility to negative mood. Together with in vitro studies showing a positive effect of testosterone on cerebellar gray matter volumes, we set out to explore the role of testosterone in the relation between cerebellar gray matter and neuroticism. Structural magnetic resonance imaging scans were acquired, and indices of neurotic personality traits were assessed by administering the depression and anxiety scale of the revised NEO personality inventory and Gray’s behavioural avoidance in one hundred and forty-nine healthy volunteers between 12 and 27 years of age. Results demonstrated an inverse relation between total brain corrected cerebellar volumes and neurotic personality traits in adolescents and young adults. In males, higher endogenous testosterone levels were associated with lower scores on neurotic personality traits and larger cerebellar gray matter volumes. No such relations were observed in the female participants. Analyses showed that testosterone significantly mediated the relation between male cerebellar gray matter and measures of neuroticism. Our findings on the interrelations between endogenous testosterone, neuroticism and cerebellar morphology provide a cerebellum-oriented framework for the susceptibility to experience negative emotions and mood in adolescence and early adulthood.

Article Source: http://www.psyneuen-journal.com/article/S0306-4530(16)30688-6/abstract?cc=y=

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Symptomatic response to testosterone treatment in dieting obese men with low testosterone levels in a randomized, placebo-controlled clinical trial

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Background:

Obese men commonly have reductions in circulating testosterone and report symptoms consistent with androgen deficiency. We hypothesized that testosterone treatment improves constitutional and sexual symptoms over and above the effects of weight loss alone.

Methods:

We conducted a pre-specified analysis of a randomized double-blind, placebo-controlled trial at a tertiary referral center. About 100 obese men (body mass index (BMI)greater than or equal to30kgm2) with a repeated total testosterone level less than or equal to12nmoll−1 and a median age of 53 years (interquartile range 47–60) receiving 10 weeks of a very-low-energy diet (VLED) followed by 46 weeks of weight maintenance were randomly assigned at baseline to 56 weeks of intramuscular testosterone undecanoate (n=49, cases) or matching placebo (n=51, controls). Pre-specified outcomes were the between-group differences in Aging Male Symptoms scale (AMS) and international index of erectile function (IIEF-5) questionnaires.

Results:

Eighty-two men completed the study. At study end, cases showed significant symptomatic improvement in AMS score, compared with controls, and improvement was more marked in men with more severe baseline symptoms (mean adjusted difference (MAD) per unit of change in AMS score −0.34 (95% confidence interval (CI) −0.65, −0.02), P=0.04). This corresponds to improvements of 11%and 20% from baseline scores of 40 and 60, respectively, with higher scores denoting more severe symptoms. Men with erectile dysfunction (IIEF-5less than or equal to20) had improved erectile function with testosterone treatment. Cases and controls lost the same weight after VLED (testosterone −12.0kg; placebo −13.5kg, P=0.40) and maintained this at study end (testosterone −11.4kg; placebo −10.9kg, P=0.80). The improvement in AMS following VLED was not different between the groups (−0.05 (95% CI −0.28, 0.17), P=0.65).

Conclusions:

In otherwise healthy obese men with mild to moderate symptoms and modest reductions in testosterone levels, testosterone treatment improved androgen deficiency symptoms over and above the improvement associated with weight loss alone, and more severely symptomatic men achieved a greater benefit.

 Article Source: http://www.nature.com/ijo/journal/v41/n3/full/ijo2016242a.html?WT.ec_id=IJO-201703

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Testosterone Replacement May Lower Cardiovascular Risks

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Testosterone replacement therapy (TRT) is associated with a lower risk of adverse cardiovascular (CV) events among men with testosterone deficiency, according to a new study.

Researchers led by T. Craig Cheetham, PharmD, MS, of the Southern California Permanente Medical Group, identified a retrospective cohort of 44,335 men aged 40 years and older with evidence of testosterone deficiency. The cohort included 8808 men who had ever been dispensed testosterone (ever-TRT group) and 35,527 men never dispensed testosterone (never-TRT group). The primary outcome was a composite of cardiovascular endpoints that included acute myocardial infarction (AMI), coronary revascularization, unstable angina, stroke, transient ischemic attack (TIA), and sudden cardiac death (SCD).

After a median follow-up of 3.2 years in the never-TRT group and 4.2 years in the ever-TRT group, the rates of the composite endpoint were significantly higher in the never-TRT than ever-TRT group (23.9 vs 16.9 per 1000 person-years), Dr Cheetham and colleagues reported online ahead of print in JAMA Internal Medicine. After adjusting for potential confounders, the ever-TRT group had a significant 33% lower risk of the primary outcome compared with the never-TRT group. The investigators found similar results when looking separately at combined cardiac events (AMI, SCD, unstable angina, coronary revascularization) and combined stroke events (stroke and TIA). The ever-TRT group had a significant 34% and 28% lower risk of cardiac events and stroke events compared with the never-TRT group, respectively.

“While these findings differ from those of recently published observational studies of TRT, they are consistent with other evidence of CV risk and the benefits of TRT in androgen-deficient men,” the investigators wrote.

Previous studies have found an association between low serum testosterone levels in aging men and an increased risk of coronary artery disease as well as an inverse relationship between serum testosterone and carotid intima thickness, Dr Cheetham’s team pointed out.

The never-TRT and ever TRT groups had a mean age of 59.8 and 58.4 years, respectively. In the never-TRT group, 13,824 men (38.9%) were aged 40 to 55 years, 10,902 (30.7%) were aged 56 to 65 years, and 10,801 (30.4%) were older than 65 years. In the ever-TRT group, 3746 men (42.5%) were aged 40 to 55, 2899 (32.9%) were aged 56 to 65 years, and 2163 (24.6%) were older than 65 years. The groups were similar with respect to race and ethnicity composition.

The researchers defined testosterone deficiency as a coded diagnosis and/or a morning serum total testosterone level below 300 ng/dL.

With regard to study limitations, the investigators noted that their criterion for identifying men with testosterone deficiency (a diagnosis or at least 1 morning testosterone measurement) does not meet the strict criteria established by the Endocrine Society. “Therefore some individuals in the study could be misclassified as being androgen-deficient.” In addition, as the study was observational in design, “unmeasured confounding may have had an influence on the results; unmeasured confounders could possibly influence clinicians to selectively use testosterone in healthier patients.”

In an accompanying editorial, Eric Orwoll, MD, of Oregon Health & Sciences University in Portland, commented that while the study by Dr Cheetham’s group “provides reassuring data concerning the effects of testosterone on cardiovascular health, convincing answers about this question—and other safety issues like prostate health—remain elusive and will require large, prospective randomized trials.

“At this point, clinicians and their patients should remain aware that the cardiovascular risks and benefits of testosterone replacement in older hypogonadal men have not been adequately resolved.”

Reference

1. Cheetham TC, An JJ, Jacobsen SJ et al. Assocation of testosterone replacement therapy with cardiovascular outcomes among men with androgen deficiency. JAMA Intern Med 2017; published online ahead of print. doi: 10.1001/jamainternmed.2016.9546

Jody A. Charnow, Editor

Article Source: http://www.renalandurologynews.com/hypogonadism/testosterone-deficiency-treated-trt-may-reduce-cardiovascular-events/article/639486/

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