Category Archives: Testosterone

The most effective delivery method for Testosterone Replacement Therapy (or TRT) is Testosterone injections. Testosterone Replacement Therapy typically requires weekly Testosterone injections and ancillary medications, where necessary. These may include medications which allow the testes to continue its natural production of testosterone while on TRT, and an Aromatase Inhibitor, typically in pill form, to suppress the bodys conversion of Testosterone to Estrogen.

Every man has his own unique set of circumstances and must be treated as an individual. Therefore, EHormonesMD managed physicians perform physical examinations on every patient, in addition to using a combination of comprehensive, diagnostic lab work, feedback from the patient himself, as well as medical history and symptomology to determine the patients individual Testosterone Therapy regimen. However, it is important to note that not every adult male will be a candidate for Testosterone Replacement Therapy. This is why its very important that you speak with a doctor who specializes in treating Low Testosterone in adult men.

Ask yourself if you suffer from one or more of the following:

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Testosterone Replacement Therapy - Ehormones

Understand the potential risks and consider alternatives before boosting your hormones indefinitely.

Millions of American men use a prescription testosterone gel or injection to restore normal levels of the manly hormone. The ongoing pharmaceutical marketing blitz promises that treating "low T" this way can make men feel more alert, energetic, mentally sharp, and sexually functional. However, legitimate safety concerns linger. For example, some older men on testosterone could face higher cardiac risks.

"Because of the marketing, men have been flooded with information about the potential benefit of fixing low testosterone, but not with the potential costs," says Dr. Carl Pallais, an endocrinologist and assistant professor of medicine at Harvard Medical School. "Men should be much more mindful of the possible long-term complications."

MIND Depression Reduced self-confidence Difficulty concentrating Disturbed sleep

BODY Declining muscle and bone mass Increased body fat Fatigue Swollen or tender breasts Flushing or hot flashes

SEXUAL FUNCTION Lower sex drive Fewer spontaneous erections Difficulty sustaining erections

Images: Thinkstock

A loophole in FDA regulations allows pharmaceutical marketers to urge men to talk to their doctors if they have certain "possible signs" of testosterone deficiency. "Virtually everybody asks about this now because the direct-to-consumer marketing is so aggressive," says Dr. Michael O'Leary, a urologist at Harvard-affiliated Brigham and Women's Hospital. "Tons of men who would never have asked me about it before started to do so when they saw ads that say 'Do you feel tired?'"

Just being tired isn't enough to get a testosterone prescription. "General fatigue and malaise is pretty far down my list," Dr. O'Leary says. "But if they have significant symptoms, they'll need to have a lab test. In most men the testosterone level is normal."

If a man's testosterone looks below the normal range, there is a good chance he could end up on hormone supplementsoften indefinitely. "There is a bit of a testosterone trap," Dr. Pallais says. "Men get started on testosterone replacement and they feel better, but then it's hard to come off of it. On treatment, the body stops making testosterone. Men can often feel a big difference when they stop therapy because their body's testosterone production has not yet recovered."

This wouldn't matter so much if we were sure that long-term hormone therapy is safe, but some experts worry that low-T therapy is exposing men to small risks that could add up to harm over time.

A relatively small number of men experience immediate side effects of testosterone supplementation, such as acne, disturbed breathing while sleeping, breast swelling or tenderness, or swelling in the ankles. Doctors also watch out for high red blood cell counts, which could increase the risk of clotting.

The evidence for long-term risks is mixed. Some studies have found that men on testosterone have fewer cardiovascular problems, like heart attacks, strokes, and deaths from heart disease. Other studies have found a higher cardiac risk. For example, in 2010, researchers halted the Testosterone in Older Men study when early results showed that men on hormone treatments had noticeably more heart problems. "In older men, theoretical cardiac side effects become a little more immediate," Dr. Pallais says.

Some physicians also have a lingering concern that testosterone therapy could stimulate the growth of prostate cancer cells. As with the hypothetical cardiac risks, the evidence is mixed. But because prostate cancer is so common, doctors tend to be leery of prescribing testosterone to men who may be at risk.

"Like any treatment, there is risk," Dr. O'Leary says. "I would not give it to a man who is being treated for active prostate cancer, but it's pretty safe under careful supervision for those who need it."

For the time being, the long-term risks of testosterone therapy are "known unknowns." It offers men who feel lousy a chance to feel better, but that quick fix could distract attention from unknown long-term hazards. "I can't tell you for certain that this raises the risk of heart problems and prostate cancer, or that it doesn't," Dr. Pallais says. "We need a large study with multiple thousands of people followed for many years to figure it out."

So, keep risks in mind when considering testosterone therapy. "I frequently discourage it, particularly if the man has borderline levels," Dr. Pallais says.

These steps can help you feel more energetic today without drugs or dietary supplements:

Pace yourself: Spread out activities throughout the day.

Take a walk: It gives you a lift when you feel pooped out.

Snack smart: Have a snack with fiber and some protein between meals.

A large, definitive trial for hormone treatment of men is still to come. Until then, here is how to take a cautious approach to testosterone therapy.

Have you considered other reasons why you may be experiencing fatigue, low sex drive, and other symptoms attributable to low testosterone? For example, do you eat a balanced, nutritious diet? Do you exercise regularly? Do you sleep well? Address these factors before turning to hormone therapy.

If your sex life is not what it used to be, have you ruled out relationship or psychological issues that could be contributing?

If erectile dysfunction has caused you to suspect "low T" as the culprit, consider that cardiovascular disease can also cause erectile dysfunction.

Inaccurate or misinterpreted test results can either falsely diagnose or miss a case of testosterone deficiency. Your testosterone level should be measured between 7 am and 10 am, when it's at its peak. Confirm a low reading with a second test on a different day. It may require multiple measurements and careful interpretation to establish bioavailable testosterone, or the amount of the hormone that is able to have effects on the body. Consider getting a second opinion from an endocrinologist.

After starting therapy, follow-up with your physician periodically to have testosterone checks and other lab tests to make sure the therapy is not causing any problems with your prostate or blood chemistry.

Approach testosterone therapy with caution if you are at high risk for prostate cancer; have severe urinary symptoms from prostate enlargement; or have diagnosed heart disease, a previous heart attack, or multiple risk factors for heart problems.

Ask your doctor to explain the various side effects for the differentformulations of testosterone, such as gels, patches, and injections. Know what to look for if something goes wrong.

Testosterone therapy is not a fountain of youth. There is no proof that it will restore you to the level of physical fitness or sexual function of your youth, make you live longer, prevent heart disease or prostate cancer, or improve your memory or mental sharpness. Do not seek therapy with these expectations in mind.

If erectile function has been a problem, testosterone therapy might not fix it. In fact, it might increase your sex drive but not allow you to act on it. You may also need medication or other therapy for difficulty getting or maintaining erections.

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Is testosterone therapy safe? Take a breath before you ...

Many things only occur in September. The school year gets into full swing as does football season. Gardens are nearing the end of their life spans . One of the most important events that happens every September is the Niobrara Health Fair Blood Draw. It will be held from 6 am to 9am Thursday September 14 and Friday September 15 at the Niobrara County Fairgrounds Auditorium meeting rooms. A team of skilled phlebotomists has been assembled to .expertly draw your blood and prepare it for shipment to Quest Diagnostics Labs in Denver for analyzing If you have limited funds for health care, this is the perfect way to gather a large amount of information about your body and health for a minimal investment. Most doctors readily accept the results of this blood testing and it is a bargain compared to the same tests done at a hospital lab.

A list of the screenings available and the associated prices follows:

The most basic and popular test is the HealthScreen/TSH/Direct LDL Measurement (previously known as the Chemistry Panel) which will give information on cholesterol levels, triglycerides, liver function, kidney function, thyroid function, and shows the presence of a gout indicator. This test is $35. A twelve hour fast is recommended.

A complete blood count (CBC) is available for $17.00 and will give information about the presence of infection, anemia, and early signs of leukemia.

The PSA or Prostate Specific Antigen Test is available for $27.00 and is used to detect possible prostate cancer. It is recommended for men over the age of 50.

The Hemoglobin A1C test priced at $27.00 is available for diabetics to check their average blood sugar levels and help determine if their medication is working properly. It is also recommended for anyone with a family history of diabetes.

Vitamin D screening is available for $42.00 It has been recently determined that low levels of vitamin D may be the cause of many aches and pains. Vitamin D deficiency may also be related to other health issues.

The Cardio CRP test is $32.00 and screens for high levels of a protein that indicates inflammation in the body, especially in arteries. Arterial inflammation may cause cholesterol deposits to break away and clog an artery leading to a heart attack or stroke.

The Cardio IQ+HealthScreen test is also available for $92. This test is generally only recommended for those people with known cholesterol issues and provides a much more detailed cholesterol analysis. It also includes a basic blood chemistry test to check kidney, thyroid, liver and bone functions. A twelve hour fast is recommended. This test is not done if the regular chemistry test for $35 is chosen.

A Gluten Intolerance/Celiac Screen test is available for $42. This test will indicate the presence of celiac disease and help individuals determine if they should avoid foods containing gluten.

Vitamin B12 and Folate testing is also available for $42. This test will determine if you have abnormal levels of vitamin B12 or of folate, another B vitamin.

Female and Male Testosterone testing is priced at $42. This test will indicate abnormal levels of this hormone. It is a great way to determine if you many need testosterone replacement therapy.

An InSure FIT Colon Screening Kit is also available for $25.00. This is a take home kit that checks for colorectal cancer.

Dont pass up this economical opportunity to get more information about your health. Be sure to attend the Niobrara Health Fair Blood Draw on Thursday September 15 or Friday September 16 from 6 am to 9 am at the Niobrara County Fairgrounds Auditorium. If you participated in the past, you should have received, or will be receivingsoon, a post card reminder in the mail. For additional information or questions, please contact Randi Ross at 307 334-0107 or 307 216-0073

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Health Fair blood draw - Lusk Herald

In June of 2014, the U.S. Judicial Panel on Multidistrict Litigation (JPML) consolidated all federally filed testosterone-replacement therapy (TRT) lawsuits into one court in the Northern District of Illinois. District Judge Matthew Kelley decided early on that trials would be scheduled based on the type of TRT product used. Since AbbVies product AndroGel leads the market in testosterone-replacement products, the first bellwether trials each involve AndroGel.

In the second case to be tried, a Chicago jury determined that manufacturer AbbVie should pay $150 million to an Oregon man who suffered a heart attack after taking the drug.

The plaintiff first started taking AndroGel in 2008, and used it through 2012. He suffered a heart attack that year, at 49 years old. He claimed that AbbVie failed to warn of the risks associated with their drug, which he claims include blood clots, heart attacks, and strokes. He also claimed that the company misled consumers when they aggressively advertised the drug as a solution for age-related low-T.

The jury came back with a split verdict. They awarded the plaintiff $150 in punitive damages, stating that AbbVie was liable for false marketing and fraudulent misrepresentation. At the same time, however, they concluded that the plaintiffs heart attack was not caused by AbbVies negligence, and did not award him any compensatory damages.

AbbVie blamed the plaintiffs heart attack on other risk factors, including high blood pressure and cholesterol, obesity, and smoking. The company is expected to appeal the verdict.

This is only the second of seven planned bellwether trials to go to a jury. (An earlier trial ended in a mistrial, and is expected to begin again in September.) The consolidated litigation includes about 4,000 lawsuits, with all plaintiffs claiming that the manufacturers failed to warn of cardiovascular and blood-clot-related risks.

Even if the verdict doesnt stand, it sends a powerful message to AbbVie, and shows that juries will likely react unfavorably to AbbVies aggressive million-dollar advertising campaign. The company marketed the drug as an effective treatment for low-T, which it described as a condition with the same symptoms of normal male aging, like fatigue, muscle loss, and drop in libido.

The FDA, however, approved testosterone replacement only for medically diagnosed low testosterone, or hypogonadism. Studies have shown that many of the men who were convinced to take the drug never had a single testosterone test to diagnose any medical condition.

In 2014, for example, researchers reported that 40.2 percent of U.S. men did not have a testosterone test in the 180 days before beginning therapy, and 50 percent had only one test (doctors usually conduct at least two to get an average reading).

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Jury Punishes AbbVie for False Advertising in First MDL Verdict - Legal Examiner

Global Testosterone Replacement Therapy Market to Witness Sizeable Decline in Revenues

By type, the global TRT products market was dominated by creams and gels in 2015, which accounted for nearly 66% of the market worldwide. The fastest growth will be observed in the injections product segment through the forecast period of TMRs study.

View Full Report: http://www.transparencymarketresearch.com/testosterone-replacement-therapy.html

Among all the major active ingredients available on the market, testosterone in its native form was observed to be the leading segment with over 68% of the global TRT market. Likewise, the North America TRT market stood as the largest worldwide in 2015 with an 84.7% share.

It was trailed by Europe and Asia Pacific, in that order.

Increased Prevalence of Testosterone Deficiency will Augur well for TRT Market

Testosterone deficiency, also referred to as hypogonadism, is a common problem among men aged between 40 and 79 years, with some studies stating that nearly 30% of all men worldwide are affected by hypogonadism. As the incidence of testosterone deficiency increases, it is expected that the demand for TRT will also show a simultaneous increase.

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At the same time, the report states that the geriatric population, which is rising at a steady pace worldwide, represents a massive target demographic for companies in the TRT market. The number of men reporting a deficiency in testosterone levels is likely to rise as the number of aged individuals soars worldwide.

Overall, the effect of these two drivers will be compounded by an overall increase in the awareness levels about testosterone replacement therapy (TRT).

Perceived Risk of TRT Side Effects to Weaken Efforts of Key Players

The perceived risk of cardiovascular or metabolic disease associated with treating testosterone deficiency has hampered the consumption of TRT products. Moreover, with numerous studies evidencing the adverse effects, the FDA has issued adequate warnings pertaining to these risks, causing many patients to view TRT in a negative light.

Although these risks are associated only with certain TRT products, this is perhaps the greatest challenge that companies in the TRT market will have to overcome, opines a TMR analyst.

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According to TMR, the other challenge that stands in the way of the markets growth is the expiry of key TRT products, which will clear the path for the entry of generics. The three top performers in the testosterone replacement therapy market currently are AbbVie, Inc.s AndroGel, Eli Lilly and Companys Axiron, and Endo Pharmaceuticals, Inc.s Nebido.

While AndroGels patent expired in 2015, Axiron and Nebido are heading toward a patent expiry, which will deal a blow to the revenues of the top market players.

AbbVie, Inc. emerged the undisputed leader in a highly consolidated global testosterone replacement therapy (TRT) market in 2015 thanks to its star performer TRT product, AndroGel, finds Transparency Market Research (TMR) in a new study. Endo Pharmaceuticals, Inc., Eli Lilly and Company, Allergan plc, and Bayer AG are the other strong contenders in this space.

The top five players together held sway over 80% of the market in the same year, finds TMR.

GlobalTestosterone Replacement Therapy MarketReport

Although in the short term, the advent of innovative testosterone replacement therapy technology such as spray-on and unmodified testosterone will give the testosterone market a shot in the arm, the market is nearing a patent cliff. As a result of these imminent patent expirations, the market will witness a decline in revenues.

Yet, its a not entirely a bleak picture. With several drivers acting upon the market, slow albeit steady growth will be possible.

There is a rising demand for advanced TRT products as consumers become more aware about the options available to them, says a TMR analyst.

Continued here:
Testosterone replacement therapy market is exhibiting a (-4.2)% CAGR by 2024 according to new research report - WhaTech

Adam Jacobs (Aladdin) and Isabelle McCalla (Jasmine) star in the national touring production of Aladdin. Photo by Deen van Meer.How many people does it take to put on a national tour of a Broadway show? If the show isAladdin, the answer is 75...if you only count the people who show

The Catalyst Quartet rehearsing.It was the first of August. Dr. Deborah Justice was settling in for a month of fiddling around musically speaking when the email arrived. "Im afraid I have some sad news from Caracas," it began. "Venezuela at this moment is now a war zone."At that

The late J. Otis Powell.Poet, playwright, and overall multi-talented artist J. Otis Powell died on Monday, August 28. Powell was 61 years' old, and had been awarded a Sally Ordway Irvine Award for Commitment just five days prior. He had struggled with ill health, and received a kidney transplant several

A bar chart showing historical box office totals for the Minnesota Fringe Festival.The Minnesota Fringe Festival announced the final statistics today for the 2017 Minnesota Fringe Festival. The 11-day festival brought in 46,076 butts-in-seats, spread across 860 performances of 167 shows at 17 venues in Minneapolis.Why Count Butts-in-Seats?Since 2016, the

The Ordway Center for the Performing Arts announced today the recipients of the 25th annual Sally Ordway Irvine Awards. These awards were given in five categories to recipients from across the State of Minnesota. This year's recipients are all based in the Twin Cities metro area: Hunter Gullickson (Arts Access)

Actors Gary Briggle (left) and Wendy Lehr (right). Photo by Keith Bridges.The playwright A.R. Gurney passed away two months ago. Many of the various eulogies and obituaries cited his 1988 playLove Letters, a tale of charmed correspondence that was nominated for a Pulitzer Prize.Love Letters encapsulated many of the themes

Lady Gaga rocked the Xcel Energy Center with her trademark costume-heavy, immersive performance. Here's the set list from the concert:Act I "Video Intro" "Diamond Heart" "A-Yo" "Poker Face" "Perfect Illusion"Act II "John Wayne" "Scheie" "Alejandro"Act III "Horns" "Just Dance" "LoveGame" "Telephone"Act IV "Claws" "Applause" "Come to Mama" "The Edge of

A mosaic of different graphs of Fringe Festival sold-out attendance data.It's been one week since the 2017 Minnesota Fringe Festival closed its doors and the Fringe staff are still tallying and double-checking festival data. While a fuller report on the festival box office is still forthcoming, here are six figures

Women dancing inArabian Nights.Photo by Dan Van Meer.The Orpheum Theatre is getting a magic lamp. Starting September 15, the Orpheum will host the Broadway touring production of Aladdin for three and a half weeks (closing October 8). This touring production stars Adam Jacobs, who originated the title role of Aladdin

Actress-musician-songwriter Claire Wellin. Photo by Tiffany Topol.This Friday, Claire Wellin is bringing her band Youth in a Roman Field to Icehouse in Minneapolis. Youth in a Roman Field's "ghost folk" sound emphasizes haunting strings, acoustic instruments, and multipart vocal writing. The MSU-Mankato graduate spoke with the Arts Reader'sBasil Considine about

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Does propecia work in owmen - How long before propecia works - Testosterone replacement therapy and propecia - Twin Cities Arts Reader

Reprinted with the kind permission of Life Extension.

August 23 2017.An article appearing on July 18, 2017 in theJournal of Urologydocuments improvements in sexual function, urinary function and quality of life among men who receivedtestosterone replacement therapy.

The prospective registry study involved 656 men with low testosterone levels and symptoms of testosterone deficiency, among whom 360 were regularly treated with parenteral testosterone undecanoate for up to 10 years. The remainder of the subjects, who chose not to be treated with testosterone, received biannual routine clinic visits.

The researchers, from Boston University School of Medicine and School of Public Health in collaboration with German urologists, found that men who received testosterone therapy experienced significant decreases in their International Prostate Symptom Score, post-voiding bladder volume and Aging Males Symptoms scale, which assesses health-related quality of life. The percentage of patients without erectile dysfunction significantly improved in the testosterone treated group, from 17.1% at the beginning of the study, to 74.4% of the study at the last visit. In contrast, subjects who did not receive the hormone experienced deterioration in erectile function as well as in voiding functions. Prostate specific antigen (PSA), a marker which, when elevated, is associated with an increased risk of prostate cancer, remained unchanged in both groups over the course of the study.

While there were five deaths, 8 nonfatal strokes and 8 nonfatal heart attacks over the 8-month median follow-up period in the untreated group, none of these events occurred among those who received testosterone.

Long-term testosterone therapy, in men with testosterone deficiency, was well tolerated with excellent adherence suggesting a high level of patient satisfaction, authors Karim Sultan Haider and colleagues conclude. A progressive and sustained improvement in urinary and sexual function was recorded in men receiving long-term testosterone therapy, contributing to overall improvement in quality of life.

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Testosterone replacement therapy associated with improved urinary, sexual function - ProHealth

Global Testosterone Replacement Therapy Market Research Report 2017 to 2022 provides a unique tool for evaluating the market, highlighting opportunities, and supporting strategic and tactical decision-making. This report recognizes that in this rapidly-evolving and competitive environment, up-to-date marketing information is essential to monitor performance and make critical decisions for growth and profitability. It provides information on trends and developments, and focuses on markets and materials, capacities and technologies, and on the changing structure of the Testosterone Replacement Therapy Market.

Companies Mentioned are AbbVie, Pfizer, Eli Lilly, Teva Pharmaceuticals, Mylan, Bayer HealthCare Pharmaceuticals, Antares Pharma, Ferring Pharmaceuticals, Allergan, Antares Pharma, Sandoz, Clarus Therapeutics, Juniper Pharmaceuticals, Endo International, Acerus Pharmaceuticals, Forendo Pharma, MetP Pharma, Repros Therapeutics

The Global Testosterone Replacement Therapy market consists of different international, regional, and local vendors. The market competition is foreseen to grow higher with the rise in technological innovation and M&A activities in the future. Moreover, many local and regional vendors are offering specific application products for varied end-users. The new vendor entrants in the market are finding it hard to compete with the international vendors based on quality, reliability, and innovations in technology.

This report segments the Global Testosterone Replacement Therapy market on the basis of types, Gels, Injectables, Patches, Other On the basis of application, the Global Testosterone Replacement Therapy market is segmented into Hospitals, Clinics, Other

Browse full report at: https://www.marketinsightsreports.com/reports/090117112/global-testosterone-replacement-therapy-market-professional-survey-report-2017

This independent 112 page report guarantees you will remain better informed than your competition. With over 165 tables and figures examining the Testosterone Replacement Therapy market, the report gives you a visual, one-stop breakdown of the leading products, submarkets and market leaders market revenue forecasts as well as analysis to 2022.

Geographically, this report is segmented into several key Regions, with production, consumption, revenue (million USD), and market share and growth rate of Testosterone Replacement Therapy in these regions, from 2012 to 2022 (forecast), covering Global, Europe, Japan, China, India , Southeast Asia, Other.

The report provides a basic overview of the Testosterone Replacement Therapy industry including definitions, classifications, applications and industry chain structure. And development policies and plans are discussed as well as manufacturing processes and cost structures.

Then, the report focuses on Global major leading industry players with information such as company profiles, product picture and specifications, sales, market share and contact information. Whats more, the Testosterone Replacement Therapy industry development trends and marketing channels are analyzed.

The research includes historic data from 2012 to 2016 and forecasts until 2022 which makes the reports an invaluable resource for industry executives, marketing, sales and product managers, consultants, analysts, and other people looking for key industry data in readily accessible documents with clearly presented tables and graphs. The report will make detailed analysis mainly on above questions and in-depth research on the development environment, market size, development trend, operation situation and future development trend of Testosterone Replacement Therapy on the basis of stating current situation of the industry in 2017 so as to make comprehensive organization and judgment on the competition situation and development trend of Testosterone Replacement Therapy Market and assist manufacturers and investment organization to better grasp the development course of Testosterone Replacement Therapy Market.

Inquire for sample copy at: https://www.marketinsightsreports.com/reports/090117112/global-testosterone-replacement-therapy-market-professional-survey-report-2017/inquiry

The study was conducted using an objective combination of primary and secondary information including inputs from key participants in the industry. The report contains a comprehensive market and vendor landscape in addition to a SWOT analysis of the key vendors.

There are 15 Chapters to deeply display the Global Testosterone Replacement Therapy market.

Chapter 1, to describe Testosterone Replacement Therapy Introduction, product scope, market overview, market opportunities, market risk, market driving force;

Chapter 2, to analyze the top manufacturers of Testosterone Replacement Therapy, with sales, revenue, and price of Testosterone Replacement Therapy, in 2016 and 2017;

Chapter 3, to display the competitive situation among the top manufacturers, with sales, revenue and market share in 2016and 2017;

Chapter 4, to show the Global market by regions, with sales, revenue and market share of Testosterone Replacement Therapy, for each region, from 2012to 2017;

Chapter 5, 6, 7, 8 and 9, to analyze the key regions, with sales, revenue and market share by key countries in these regions;

Chapter 10 and 11, to show the market by type and application, with sales market share and growth rate by type, application, from 2012 to 2017;

Chapter 12, Testosterone Replacement Therapy market forecast, by regions, type and application, with sales and revenue, from 2017to 2022;

Chapter 13, 14 and 15, to describe Testosterone Replacement Therapy sales channel, distributors, traders, dealers, Research Findings and Conclusion, appendix and data source.

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Can i get a prescription for propecia online - Propecia with testosterone replacement - Forward Florida

As one of those whose passions were aroused by testosterone replacement therapy (TRT) in men, I am delighted that Clinical Pharmacist has provided Geoff Hackett with a platform to clarify the current clinical position (Clinical Pharmacist 2017;9:195). Hackett rightly points out that we should have no truck with those who have preconceived views on testosterone and interpret studies based on these preconceptions.

Indeed, with the feel of his erudite hand firmly on my collar, I confess that my own comments on this matter which used the inflammatory term male menopause (The Pharmaceutical Journal 2017;298;100) did not have the benefit of more recent studies quoted in this excellent article and I apologise if I appeared trite, cynical or indifferent. It is good to have a dispassionate, objective review of this subject focused on the facts.

My initial concerns about safety and efficacy of TRT were based on a letter from my colleague Sid Dajani (The Pharmaceutical Journal 2016;297:364) who appeared to me to be promoting the medicalisation of the ageing male population a population I am now part of and hope to be for some time by screening for low testosterone levels and, where identified, treating. In fact, I believe they should first stop smoking, reduce their drinking, take more exercise and relax. These steps would reduce their risk of cardiovascular disease and diabetes yet, I admit, they may not enjoy an early morning erection. Dajani was defiant about my concerns (The Pharmaceutical Journal 2017;298:235) over efficacy and I now know that I was wrong. There is good evidence for efficacy across a number of clear clinical outcomes. Hackett has convinced me of this.

But what about safety? Hackett attempts to convince me (and it may be just my stupidity so forgive me) but he seems to find studies that disagree with his case methodologically flawed whereas supportive studies do not attract such censure. I know that by saying that I risk being called out as one of the biased evangelical healthcare professionals dispensing their own standards of social justice. I hope not.

For example, he severely criticises the methodology in a paper published by Vigen et al[1]. The conclusion of this paper states: Long-term exposure to testosterone replacement therapy was associated with reduced risks of mortality, cardiovascular events, and prostate cancer. However, testosterone replacement therapy increased the risk of mortality and cardiovascular events with short durations of therapy. In view of the limitations of observational data and the potential for selection bias, these results warrant confirmation in a randomised trial.

I seem to understand what these authors are saying as; if the treatment does not kill you in the first few months then it might save your life. Very Nietzsche indeed.

I bow to Hacketts expertise on methodology. However, he also quotes a paper by Wallis et al[2] and without any criticisms of its methodology, quotes this study as supporting a decreased risk in all-cause mortality from TRT making no reference to the authors safety concerns: Use of testosterone therapy in this cohort of veterans with significant medical comorbidities was associated with increased risk of mortality, myocardial infarction, or ischaemic stroke. These findings were not modified by the presence of coronary artery disease. Future studies including randomised controlled trials are needed to properly characterise the potential risks of testosterone therapy in men with comorbidities.

This is clearly a complex clinical area. I would respectfully suggest that, accepting that TRT has an important clinical role when in the hands of experts such as Hackett, wider use of TRT is not a risk free-panacea for the ills of the ageing baby boomers.

Terry Maguire

Belfast

Citation: Clinical Pharmacist, CP August 2017 online, online | DOI: 10.1211/CP.2017.20203367

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Wider use of testosterone therapy is not risk free - The Pharmaceutical Journal