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Effect of 12 months of testosterone replacement therapy on metabolic syndrome components in hypogonadal men: data from the Testim Registry in the US (TRiUS)
Rajib K Bhattacharya, Mohit Khera, Gary Blick, Harvey Kushner, Dat Nguyen, Martin M Miner
BMC Endocrine Disorders , 2011, DOI: 10.1186/1472-6823-11-18
Abstract: Data were obtained from TRiUS (Testim? Registry in the United States), a 12-month, multicenter, prospective observational registry (N = 849) of hypogonadal men prescribed Testim 1% testosterone gel (5-10 g/day). Data analyzed included age, total testosterone (TT), free testosterone (FT), sex hormone-binding globulin (SHBG), and MetS components: waist circumference, blood pressure, fasting blood glucose, plasma triglycerides, and HDL cholesterol.Of evaluable patients (581/849) at baseline, 37% were MetS+ (n = 213) and 63% were MetS- (n = 368). MetS+ patients had significantly lower TT (p < 0.0001) and SHBG (p = 0.01) levels. Patients with the lowest quartile TT levels (<206 ng/dL [<7.1 nmol/L]) had a significantly increased risk of MetS+ classification vs those with highest quartile TT levels (≥331 ng/dL [≥11.5 nmol/L]) (odds ratio 2.66; 95% CI, 1.60 to 4.43). After 12 months of TRT, TT levels significantly increased in all patients (p < 0.005). Despite having similar TT levels after TRT, only MetS+ patients demonstrated significant decreases in waist circumference, fasting blood glucose levels, and blood pressure; lowest TT quartile patients demonstrated significant decreases in waist circumference and fasting blood glucose. Neither HDL cholesterol nor triglyceride levels changed significantly in either patient population.Hypogonadal MetS+ patients were more likely than their MetS- counterparts to have lower baseline TT levels and present with more comorbid conditions. MetS+ patients and those in the lowest TT quartile showed improvement in some metabolic syndrome components after 12 months of TRT. While it is currently unclear if further cardiometabolic benefit can be seen with longer TRT use in this population, testing for low testosterone may be warranted in MetS+ men with hypogonadal symptoms.Hypogonadism is commonly found in middle-aged and older men [1]; symptoms may include decreased muscle mass and strength, increased abdominal fat, decreased sexual interest
Short term testosterone replacement therapy improves libido and body composition
Andrade Júnior, Edésio Seara de;Clapauch, Ruth;Buksman, Salo;
Arquivos Brasileiros de Endocrinologia & Metabologia , 2009, DOI: 10.1590/S0004-27302009000800014
Abstract: objective: to assess the efficacy and safety of testosterone replacement in males with late-onset hypogonadism compared to hypogonadal men without replacement, and controls, during six months. methods: we assessed, through adam, ams, iief-5 and sf-36 questionnaires, and through clinical and laboratorial examinations, 62 patients divided into three groups: 17 hypogonadal males (hr) used intramuscular testosterone every three weeks; 14 hypogonadal males (hv) and 31 non-hypogonadal males (cv) used oral vitamins daily. results: when compared to others, hr group obtained libido improvement assessed by adam 1 (p = 0.004), and borderline sexual potency improvement assessed by iief-5 (p = 0.053), besides a decrease in waist circumference after eight weeks (p = 0.018). the remaining parameters did not differ between the groups. psa and hematocrit remained stable in those using testosterone. conclusion: six months of testosterone replacement improved sexuality and body composition, with prostatic and hematological safety.
Testosterone and the Metabolic Syndrome in Men: Current Knowledge  [PDF]
Nieschlag E,Zitzmann M
Journal für Reproduktionsmedizin und Endokrinologie , 2006,
Abstract: Circumstances of life and food supply have changed in developed countries, resulting in an increasing prevalence of overweight. As a consequence, a complex disorder consisting of visceral obesity, dyslipidemia, insulin resistance and hypertension emerges: the so-called metabolic syndrome leads to the manifestation of diabetes type 2 and cardiovascular disease. In men, testosterone deficiency contributes to the generation of the metabolic syndrome, as demonstrated by epidemiological and interventional approaches. Correspondingly, testosterone substitution in hypogonadal men is able to invalidate the mechanisms of the metabolic syndrome by various pathways. It has reciprocal effects on the generation of muscle and visceral fat tissue by exerting influence on the commitment of pluripotent stem cells. In addition, testosterone inhibits further development of pre-adipocytes. It also enhances insulin sensitivity of muscle cells by augmenting mitochondrial capacity and fostering expression of oxidative phosphorylation genes. Testosterone is also able to break the vicious circle of leptin resistance and generation of new adipose tissue. These effects are exerted by androgen receptor-mediated mechanisms. As epidemiological studies indicate, testosterone substitution is especially helpful in preventing or attenuating the metabolic syndrome in aging men with late-onset hypogonadism and in Klinefelter patients.
The role of testosterone in type 2 diabetes and metabolic syndrome in men
Saad, Farid;
Arquivos Brasileiros de Endocrinologia & Metabologia , 2009, DOI: 10.1590/S0004-27302009000800002
Abstract: over the last three decades, it has become apparent that testosterone plays a significant role in glucose homeostasis and lipid metabolism. the metabolic syndrome is a clustering of risk factors predisposing to diabetes mellitus type 2, atherosclerosis and cardiovascular morbidity and mortality. the main components of the syndrome are visceral obesity, insulin resistance, glucose intolerance, raised blood pressure and dyslipidemia (elevated triglycerides, low levels of high-density lipoprotein cholesterol), and a pro-inflammatory and thrombogenic state. cross-sectional epidemiological studies have reported a direct correlation between plasma testosterone and insulin sensitivity, and low testosterone levels are associated with an increased risk of type 2 diabetes mellitus, dramatically illustrated by androgen deprivation in men with prostate carcinoma. lower total testosterone and sex hormone-binding globulin (shbg) predict a higher incidence of the metabolic syndrome. there is evidence that hypotestosteronemia should be an element in the definition of the metabolic syndrome since low levels of testosterone are associated with or predict the development of the metabolic syndrome and of diabetes mellitus. administration of testosterone to hypogonadal men reverses part of the unfavorable risk profile for the development of diabetes and atherosclerosis. so far, studies on the effects of normalization of testosterone in hypogonadal men on glucose homeostasis are limited, but convincing, and if diabetes mellitus is viewed in the context of the metabolic syndrome, the present results of testosterone treatment are very encouraging.
Testosterone and Depression  [PDF]
?ükrü Kartalc?
Psikiyatride Guncel Yaklasimlar , 2010,
Abstract: Androgens have various effects on human body and mood. Testosterone, a hormone mainly secreted from testes and adrenals, is one of the most potent androgens. Multiple studies have found that testosterone plays a role in regulating sexual activity, libido, social behaviors, aggression, cognitive functions, sleep control and well-being in men and women. Testosterone deficiency in hypogonadic or elderly men leads to neuropsychiatric problems, such as fatigue, loss of libido, irritability, insomnia and depressive mood. Testosterone replacement therapy consistently reverses these sequel in men. On the other hand, hyperandrogenic states in women are related to aggression and antisocial behavior, which might lead to depressive mood. Low testosterone levels may also result in depression among oophorectomized women. Because of such effects, a relationship between testosterone and depression has long been an issue of speculation, but yet very few studies have addressed this relation. Along with clinical studies, experimental and epidemiological studies show that testosterone is related to depression in men and women. But studies of testosterone concentrations in depression have yielded inconsistent results reporting low as well as high testosterone levels associated with depression. In this article, the physiological and psychological effects of testosterone and evidence regarding its relationship to depressive disorders and possible gender differences have been reviewed.
Testosterone replacement therapy for older men  [cached]
Stephen E Borst,Thomas Mulligan
Clinical Interventions in Aging , 2007,
Abstract: Stephen E Borst, Thomas MulliganGeriatrics Research, Education, and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL, USAAbstract: Despite intensive research on testosterone therapy for older men, important questions remain unanswered. The evidence clearly indicates that many older men display a partial androgen deficiency. In older men, low circulating testosterone is correlated with low muscle strength, with high adiposity, with insulin resistance and with poor cognitive performance. Testosterone replacement in older men has produced benefits, but not consistently so. The inconsistency may arise from differences in the dose and duration of testosterone treatment, as well as selection of the target population. Generally, studies reporting anabolic responses to testosterone have employed higher doses of testosterone for longer treatment periods and have targeted older men whose baseline circulating bioavailable testosterone levels were low. Most studies of testosterone replacement have reported anabolic that are modest compared to what can be achieved with resistance exercise training. However, several strategies currently under evaluation have the potential to produce greater anabolic effects and to do so in a safe manner. At this time, testosterone therapy can not be recommended for the general population of older men. Older men who are hypogonadal are at greater risk for the catabolic effects associated with a number of acute and chronic medical conditions. Future research is likely to reveal benefits of testosterone therapy for some of these special populations. Testosterone therapy produces a number of adverse effects, including worsening of sleep apnea, gynecomastia, polycythemia and elevation of PSA. Efficacy and adverse effects should be assessed frequently throughout the course of therapy.Keywords: aging, testosterone, hypogonadism, physical function
Testosterone Administration Reduces Lying in Men  [PDF]
Matthias Wibral, Thomas Dohmen, Dietrich Klingmüller, Bernd Weber, Armin Falk
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0046774
Abstract: Lying is a pervasive phenomenon with important social and economic implications. However, despite substantial interest in the prevalence and determinants of lying, little is known about its biological foundations. Here we study a potential hormonal influence, focusing on the steroid hormone testosterone, which has been shown to play an important role in social behavior. In a double-blind placebo-controlled study, 91 healthy men (24.32±2.73 years) received a transdermal administration of 50 mg of testosterone (n = 46) or a placebo (n = 45). Subsequently, subjects participated in a simple task, in which their payoff depended on the self-reported outcome of a die-roll. Subjects could increase their payoff by lying without fear of being caught. Our results show that testosterone administration substantially decreases lying in men. Self-serving lying occurred in both groups, however, reported payoffs were significantly lower in the testosterone group (p<0.01). Our results contribute to the recent debate on the effect of testosterone on prosocial behavior and its underlying channels.
Improvement of the diabetic foot upon testosterone administration to hypogonadal men with peripheral arterial disease. Report of three cases
Svetlana Kalinchenko, Alexandr Zemlyanoy, Louis J Gooren
Cardiovascular Diabetology , 2009, DOI: 10.1186/1475-2840-8-19
Abstract: We report the beneficial effects of administration of testosterone to three men with a diabetic foot whose serum testosterone was subnormal.Upon normalization of serum testosterone there was an improvement of hyperglycemia, a decrease of leukocytes and of fibrinogen levels, an increase of antithrombin III activity and of tissue oxygen pressure. The wound showed granulation.Beneficial effects of administration of testosterone to hypogonadal with a diabetic foot may be due to improved vascularization and to anti-inflammatory action.Lower extremity complications are common in patients with diabetes and include neuropathy, ulceration, infection, and peripheral arterial disease. Foot infections represent the single most common cause of hospitalization and lower extremity amputation in persons with diabetes. Foot ulceration as a result of diabetic peripheral sensory neuropathy, rigid osseous deformities and soft-tissue contractures, repetitive trauma from unprotected ambulation, and peripheral vascular disease can all lead to a limb- or even life-threatening infection.Men with type 2 diabetes have a lower serum testosterone concentration compared to men without a history of diabetes, and there is an inverse association between testosterone levels and HbA1c concentrations[1]. A recent systematic review and meta-analysis of cross-sectional studies indicated that testosterone levels were significantly lower in men with type 2 diabetes[2]. Further, in men with low plasma testosterone the risk of diabetes mellitus is increased[3]. One third to one half of men with type 2 diabetes mellitus are now recognized as testosterone deficient. Emerging evidence suggests that testosterone therapy may be able to reverse some aspects of metabolic syndrome[4].Further, a low plasma testosterone level appeared to be associated with endothelial dysfunction in men independent of other risk factors, suggesting a protective effect of endogenous testosterone on the endothelium[5]. In addition, ser
Apelin and Testosterone Levels in Men with Metabolic Syndrome  [PDF]
Petya Angelova, Zdravko Kamenov, Adelina Tsakova
Open Journal of Endocrine and Metabolic Diseases (OJEMD) , 2014, DOI: 10.4236/ojemd.2014.42004

Apelin is a new adipokine associated with obesity. Data about the relationship of apelin to the metabolic syndrome (MS) are still scarce. Late-onset hypogonadism (LOH) is common in men with MS, but we did not find data about the levels of apelin in men with LOH. The aim of this study is to determine the levels of apelin in men with MS with or without LOH. Patients and Methods: 99 men are included in the study. Of them 65 have MS (IDF 2005) and they are divided according to their morning total testosterone (TT) level (cutoff 10.4 nmol/l) into two groups: MS-low T (N = 21) and MS-normal T (N = 44). The control group consists of 34 men without MS and with normal T. Apelin is determined in serum using enzyme linked immunosorbent assay. Some of the men were additionally assigned to testosterone treatment and monitored. Results: MS men are at mean age (±SD) = 50.4 ± 9.6 years and TT = 13.6 ± 5.4 nmol/l. The control group is at age = 51.5 ± 6.4 years (NS) and TT = 17.9 ± 5.6 nmol/l (p < 0.001). The levels of apelin are higher in the MS group—1.61 ±

Double blind randomized placebo-controlled trial on the effects of testosterone supplementation in elderly men with moderate to low testosterone levels: design and baseline characteristics [ISRCTN23688581]
Hamid Reza Nakhai Pour, Marielle H Emmelot-Vonk, Marja Sukel-Helleman, Harald JJ Verhaar, Diederick E Grobbee, Yvonne T van der Schouw
Trials , 2006, DOI: 10.1186/1745-6215-7-24
Abstract: We recruited 237 men with serum testosterone levels below 13.7 nmol/L and ages 60–80 years. They were randomized to either four capsules of 40 mg testosterone undecanoate (TU) or placebo daily for 26 weeks. Primary endpoints are functional mobility and quality of life. Secondary endpoints are body composition, cognitive function, aortic stiffness and cardiovascular risk factors and bone mineral density. Effects on prostate, liver and hematological parameters will be studied with respect to safety.Measure of effect will be the difference in change from baseline visit to final visit between TU and placebo. We will study whether the effect of TU differs across subgroups of baseline waist girth (< 100 cm vs. ≥ 100 cm; testosterone level (<12 versus ≥ 12 nmol/L), age (< median versus ≥ median), and level of outcome under study (< median versus ≥ median).At baseline, mean age, BMI and testosterone levels were 67 years, 27 kg/m2 and 10.72 nmol/L, respectively.In men after the age of 30–40, testosterone production gradually declines which continuously persists into old age [1,2]. Ageing in men is accompanied by a decrease in muscle and bone mass, cognitive changes and decreased libido and sexual activity, all of which have been suggested to be related to the decrease in testosterone production [3]. Recent research has provided evidence that androgens play distinct roles in aspects of bone metabolism[4], body composition such as muscle and fat mass distribution [5,6], cognitive functioning [7], well-being [8], cardiovascular diseases [9], prostate hyperplasia [10,11]and in aspects of sexual behavior [12]. Since androgens are associated with muscle function and with cognitive functioning, it is reasonable to expect androgens to be related to activities of daily living (ADL) as well [13]. The association of lower testosterone levels with age-related conditions and the steady androgen levels decline with aging stimulated further investigations to test usefulness and safety of a
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