Androgen deprivation can cause a symptomatic state, which can be easily reversed with carefully supervised TRT. However, one of the controversies has been whether symptoms are indeed related to hypogonadal states. Clinical depression, pathological states such as anemia, hypothyroidism as well as psychological states can easily confound the diagnosis. The current screening tools including the Androgen Decline in Aging Males (ADAM) questionnaire as well as the Heinemann scale can be sensitive but lack specificity in clinical use. Another controversy hovers around the best “gold standard” test to use. While total testosterone is easily available and more affordable, it is less explicit than other tests such as free testosterone by dialysis equilibrium and bioavialable testosterone.
Epidemiological studies point toward an association with increased morbidity and mortality with low testosterone states in aging males. For example, there is a higher prevalence of depression, coronary heart disease, osteoporosis, fracture rates, frailty and even dementia with low testosterone states. Short-term studies have shown improvements in many of these parameters upon testosterone replacement. However, it is more difficult to prove that testosterone improves these outcomes in the long run. Part of this is because of lack of funding to do properly designed long term clinical trials.
There had been some concerns about the long-term safety of testosterone replacement and prostate cancer. Current evidence suggests no causal relationship between prostate cancer and physiological dosing of testosterone, especially with careful selection and monitoring of patients. In clinical trials it has observed that a few men have developed prostate cancer while on testosterone. However, there is an argument that they may have developed the cancer even if they were not on hormone replacement as the rates are no different than comparable observed groups not on treatment.
Cardiovascular risks like heart attacks and strokes have been plaguing the media recently, following some controversial reports which was soon challenged by other studies proving safety instead. In any event, the FDA is asking for more prospective data to confirm risks. At the present moment, careful monitoring is suggested. Truly, mild eythrocytosis is a common side effect on testosterone replacement, but thromboembolic events have rarely been reported in the literature. Many endocrine studies have shown positive changes in lean body mass and bone integrity, but positive functional outcomes are by and large lacking at this point in time. There has been demonstration of testosterone positive influence on amyloid tissue in the brain. The reduction of this is believed to slow the progress of Alzheimer’s disease, but long-term data is not available. Data also suggests that testosterone may be an adjunctive treatment for depressed hypogonadal males.
If you need further information, please contact us at (713) 401 9396 or visit our web site www.opalmedical.com We have many years of experience of treating patients with low testosterone and are experts in this field.