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'''Testosterone therapy''' is a form of [[hormone therapy]] in which [[testosterone]] is administered to supplement existing low level of the [[hormone]]
  
'''Testosterone therapy''' is a form of [[hormone therapy]] in which [[testosterone]] is administered to supplement existing low level of the [[hormone]]
   
−
===Routes of administration===
 +
=== Routes of administration ===
  +
[[File:Depo-testosterone 200 mg ml crop.jpg|thumb|left|150px|Vial of testosterone for intramuscular injection]]
 
There are many [[routes of administration]] for testosterone. Forms of testosterone for human administration currently available include injectable (such as testosterone cypionate or testosterone enanthate in oil), oral,<ref>{{cite web
  
There are many [[routes of administration]] for testosterone. Forms of testosterone for human administration currently available include injectable (such as testosterone cypionate or testosterone enanthate in oil), oral,<ref>{{cite web
 
|url = http://google2.fda.gov/search?client=FDA&site=FDA&oe=&lr=&proxystylesheet=FDA&output=xml_no_dtd&getfields=*&q=Andriol&as=GO
  
|url = http://google2.fda.gov/search?client=FDA&site=FDA&oe=&lr=&proxystylesheet=FDA&output=xml_no_dtd&getfields=*&q=Andriol&as=GO
Line 11: Line 12:
 
|format=PDF|title=Androgel|publisher=Food and Drug Administration}} and {{cite web
  
|format=PDF|title=Androgel|publisher=Food and Drug Administration}} and {{cite web
 
|url = http://google2.fda.gov/search?client=FDA&site=FDA&oe=&lr=&proxystylesheet=FDA&output=xml_no_dtd&getfields=*&q=Testim.&as=GO
  
|url = http://google2.fda.gov/search?client=FDA&site=FDA&oe=&lr=&proxystylesheet=FDA&output=xml_no_dtd&getfields=*&q=Testim.&as=GO
−
|title=Testim|publisher=Food and Drug Administration}}</ref> In the pipeline are "roll on" methods and nasal sprays.
 +
|title=Testim|publisher=Food and Drug Administration}}</ref>
   
  +
In the pipeline are "roll on" methods and nasal sprays.
⚫
===Indications===
  
⚫
The original and primary use of testosterone is for the treatment of males who have too little or no natural endogenous testosterone production—males with [[hypogonadism]]. Appropriate use for this purpose is legitimate hormone replacement therapy (testosterone replacement therapy (TRT)), which maintains serum testosterone levels in the normal range.
  
   
  ⚫
=== Indications ===
−
However, over the years, as with every hormone, testosterone or other [[anabolic steroids]] has also been given for many other conditions and purposes besides replacement, with variable success but higher rates of side effects or problems. Examples of relence to psychologists include:
  
−
* [[Appetite stimulation]].
 
−
* [[Erectile dysfunction]]
  
−
* [[Fatigue]]
  
−
* [[Infertility]],
 
−
* [[Lack of libido]]
 
   
  ⚫
The original and primary use of testosterone is for the treatment of males who have too little or no natural endogenous testosterone production—males with [[hypogonadism]]. Appropriate use for this purpose is legitimate hormone replacement therapy (testosterone replacement therapy [TRT]), which maintains serum testosterone levels in the normal range.
−
By the late 1940s testosterone was being touted as an anti-aging wonder drug (e.g., see [[Paul de Kruif]]'s ''The Male Hormone''). Decline of testosterone production with age has led to a demand for [[Androgen Replacement Therapy]].{{Fact|date=November 2008}}
  
   
  +
However, over the years, as with every hormone, testosterone or other [[anabolic steroids]] has also been given for many other conditions and purposes besides replacement, with variable success but higher rates of side effects or problems. Examples include [[infertility]], lack of libido or erectile dysfunction, [[osteoporosis]], [[penis enlargement|penile enlargement]], height growth, [[bone marrow]] stimulation and reversal of [[anemia]], and even appetite stimulation. By the late 1940s testosterone was being touted as an anti-aging wonder drug (e.g., see [[Paul de Kruif]]'s ''The Male Hormone'').<ref name = "de Kruif_1945"/> Decline of testosterone production with age has led to interest in [[androgen replacement therapy]].<ref name="pmid16985841">{{cite journal | author = Myers JB, Meacham RB | title = Androgen replacement therapy in the aging male | journal = Rev Urol | volume = 5 | issue = 4 | pages = 216–26 | year = 2003 | pmid = 16985841 | pmc = 1508369 | doi = | url = | issn = }}</ref>
⚫
To take advantage of its [[virilizing]] effects, testosterone is often administered to [[transmen]] as part of the [[Hormone replacement therapy (female-to-male)|hormone replacement therapy]], with a "target level" of the normal male testosterone level. Like-wise, [[transwomen]] are sometimes prescribed [[antiandrogen|anti-androgens]] to decrease the level of testosterone in the body and allow for the effects of estrogen to develop.
  
   
  ⚫
To take advantage of its [[virilizing]] effects, testosterone is often administered to [[transsexual|transsexual men]] as part of the [[Hormone replacement therapy (female-to-male)|hormone replacement therapy]], with a "target level" of the normal male testosterone level. Like-wise, [[trans men|transsexual men]] are sometimes prescribed [[antiandrogen|anti-androgens]] to decrease the level of testosterone in the body and allow for the effects of estrogen to develop.
⚫
Testosterone patches are effective at treating low libido in post-menopausal women.<ref name="Davis2008">{{cite journal|author=Davis SR, Moreau M, Kroll R, ''et al.''|title=Testosterone for low libido in postmenopausal women not taking estrogen|journal=N Engl J Med|year=2008|volume=359|issue=19|pages=2005&ndash;2017|url=http://content.nejm.org/cgi/content/short/359/19/2005?query=TOC|doi=10.1056/NEJMoa0707302|pmid=18987368}}</ref> Low libido may also occur as a symptom or outcome of hormonal contraceptive use. Women may also use testosterone therapies to treat or prevent loss of bone density, muscle mass and to treat certain kinds of depression and low energy state. Women on testosterone therapies may experience an increase in ''weight'' without an increase in body fat due to changes in bone and muscle density. Most undesired effects of testosterone therapy in women may be controlled by hair-reduction strategies, acne prevention, etc. There is a theoretical risk that testosterone therapy may increase the risk of breast or gynaecological cancers, and further research is needed to define any such risks more clearly.<ref name="Davis2008"/>
  
   
  ⚫
Testosterone patches are effective at treating low libido in post-menopausal women.<ref name="Davis_2008">{{cite journal | author = Davis SR, Moreau M, Kroll R, Bouchard C, Panay N, Gass M, Braunstein GD, Hirschberg AL, Rodenberg C, Pack S, Koch H, Moufarege A, Studd J | title = Testosterone for low libido in postmenopausal women not taking estrogen | journal = N. Engl. J. Med. | volume = 359 | issue = 19 | pages = 2005–17 | year = 2008 | month = November | pmid = 18987368 | doi = 10.1056/NEJMoa0707302 | url = | issn = | last12 = Moufarege | first12 = A | last13 = Studd | first13 = J | last14 = Aphrodite Study | first14 = Team }}</ref> Low libido may also occur as a symptom or outcome of hormonal contraceptive use. Women may also use testosterone therapies to treat or prevent loss of bone density, muscle mass and to treat certain kinds of depression and low energy state. Women on testosterone therapies may experience an increase in ''weight'' without an increase in body fat due to changes in bone and muscle density. Most undesired effects of testosterone therapy in women may be controlled by hair-reduction strategies, acne prevention, etc. There is a theoretical risk that testosterone therapy may increase the risk of breast or gynaecological cancers, and further research is needed to define any such risks more clearly.<ref name="Davis_2008"/>
−
There is a myth that [[exogenous]] testosterone can more or less definitively be used for male birth control. However, the vast majority of physicians will agree that to prescribe exogenous testosterone for this purpose is inappropriate. But, perhaps more important, many men found this, in first-hand experience, to be untrue or at least, unreliable.
  
   
  +
=== Hormone replacement therapy ===
−
Testosterone strongly reduces [[insulin resistance]], therefore it can be used as anti-[[diabetes mellitus]] drug and improve associated symptoms such as fatigue and loss of concentration.
  
  +
{{Main|Androgen replacement therapy}}
  +
Testosterone levels decline gradually with age in human beings. The clinical significance of this decrease is debated (see [[andropause]]). There is disagreement about when to treat aging men with testosterone replacement therapy. The American Society of Andrology's position is that:<ref name="pmid16474019">{{cite journal | author = | title = Testosterone replacement therapy for male aging: ASA position statement | journal = J. Androl. | volume = 27 | issue = 2 | pages = 133–4 | year = 2006 | pmid = 16474019 | doi = | url = | issn = }}</ref>
  +
{{Quotation|"... testosterone replacement therapy in aging men is indicated when both clinical symptoms and signs suggestive of [[Hypogonadism|androgen deficiency]] and decreased testosterone levels are present."}}
   
  +
The American Association of Clinical Endocrinologists says:<ref name="pmid12917096">{{cite journal | author = Guay AT, Spark RF, Bansal S, Cunningham GR, Goodman NF, Nankin HR, Petak SM, Perez JB | title = American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of male sexual dysfunction: a couple's problem--2003 update | journal = Endocr Pract | volume = 9 | issue = 1 | pages = 77–95 | year = 2003 | pmid = 12917096 | doi = | url =http://www.aace.com/pub/pdf/guidelines/sexdysguid.pdf | issn = }}</ref>
−
==Cognitive function==
  
−
Testosterone supplementation had mixed effects on cognitive function (5 studies). Improvement was found on some measures: [[spatial memory|spatial]] and [[verbal memory]], [[spatial ability]] and spatial cognition improved in 2 studies, while [[working memory]] improved in 1 study. No improvement was found on other measures, i.e. [[memory recall]] and [[verbal fluency]] (1 study). In addition, verbal fluency failed to improve with practice (1 study).[http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=12003000307]
  
   
  +
{{Quotation|"[[Hypogonadism]] is defined as a free testosterone level that is below the lower limit of normal for young adult control subjects. Previously, age-related decreases in free testosterone were once accepted as normal. Currently, they are not considered normal. Patients with low-normal to subnormal range testosterone levels warrant a clinical trial of testosterone."}}
−
==Treatment of premature ejaculation==
  
   
  +
There is not total agreement on the threshold of testosterone value below which a man would be considered [[hypogonadal]]. (Currently there are no standards as to when to treat women.) Testosterone can be measured as "free" (that is, bioavailable and unbound) or more commonly, "total" (including the percentage which is chemically bound and unavailable). In the United States, male total testosterone levels below 300&nbsp;ng/dL from a morning serum sample are generally considered low.<ref name="urlMedlinePlus Medical Encyclopedia: Testosterone">{{cite web | url = http://www.nlm.nih.gov/MEDLINEPLUS/ency/article/003707.htm | title = Testosterone | author = Holt EH, Zieve D | authorlink = | coauthors = | date = 2008-03-18 | work = MedlinePlus Medical Encyclopedia | publisher = U.S. National Library of Medicine | pages = | language = | archiveurl = | archivedate = | quote = | accessdate = 2009-07-17}}</ref> However these numbers are typically not age-adjusted, but based on an average of a test group which includes elderly males with low testosterone levels.{{Citation needed|date=May 2008}} Therefore a value of 300&nbsp;ng/dL might be normal for a 65-year-old male, but not normal for a 30-year-old.{{Citation needed|date=May 2008}} Identification of inadequate testosterone in an aging male by symptoms alone can be difficult. The signs and symptoms are non-specific, and might be confused with normal aging characteristics, such as loss of muscle mass and bone density, decreased physical endurance, decreased memory ability{{Citation needed|date=May 2008}}, and loss of libido.
   
  +
Replacement therapy can take the form of injectable depots, transdermal patches and gels, subcutaneous pellets, and oral therapy. Adverse effects of testosterone supplementation include minor side effects such as acne and oily skin, and more significant complications such as increased [[hematocrit]] which can require [[venipuncture]] in order to treat, exacerbation of [[sleep apnea]] and acceleration of pre-existing [[prostate cancer]] growth in individuals who have undergone androgen deprivation. Exogenous testosterone also causes suppression of [[spermatogenesis]] and can lead to infertility.<ref name="pmid1977002">{{cite journal | author = | title = Contraceptive efficacy of testosterone-induced azoospermia in normal men. World Health Organization Task Force on methods for the regulation of male fertility | journal = Lancet | volume = 336 | issue = 8721 | pages = 955–9 | year = 1990 | month = October | pmid = 1977002 | doi = 10.1016/0140-6736(90)92416-F | url = | issn = }}</ref> It is recommended that physicians screen for prostate cancer with a digital rectal exam and PSA ([[prostate specific antigen]]) level before starting therapy, and monitor hematocrit and PSA levels closely during therapy.
−
===Other drugs===
  
−
Some drugs specifically target testosterone as a way of treating certain conditions. For example, [[finasteride]] inhibits the conversion of testosterone into [[dihydrotestosterone]] (DHT), a metabolite which is more potent than testosterone. By lowering the levels of dihydrotestosterone, finasteride may be used for various conditions associated with androgens, such as benign prostatic hyperplasia (BPH) and androgenetic alopecia (male-pattern baldness). That said there are many men who have complained of long lasting or permanent adverse effects resulting from the use of finasteride and Dr Eugene Shippen has spoken for many years of finasteride causing a difficult to treat form of [[hypogonadism]] in some men.).
  
   
−
===Adverse effects===
 +
=== Benefits ===
⚫
Exogenous testosterone supplementation comes with a number of health risks. [[Fluoxymesterone]] and [[methyltestosterone]] are synthetic derivatives of testosterone. In 2006 it was reported that women taking [[Estratest]], a combination pill including estrogen and methyltestosterone, were at considerably heightened risk of [[breast cancer]].{{Fact|date=February 2007}} That said methyltestosterone and Fluoxymesterone are no longer prescribed by physicians given their poor safety record, and testosterone replacement in men does have a very good safety record as evidenced by over sixty years of medical use in hypogonadal men.
  
   
  +
Appropriate testosterone therapy can prevent or reduce the likelihood of [[osteoporosis]], [[type 2 diabetes]],<ref name="pmid18772488">{{cite journal | author = Traish AM, Saad F, Guay A | title = The dark side of testosterone deficiency: II. Type 2 diabetes and insulin resistance | journal = J. Androl. | volume = 30 | issue = 1 | pages = 23–32 | year = 2009 | pmid = 18772488 | doi = 10.2164/jandrol.108.005751 | url = | issn = }}</ref> [[cardio-vascular disease]] (CVD), [[obesity]], [[Major depressive episode|depression]] and anxiety and the statistical risk of early mortality. Low testosterone also brings with it an increased risk for the development of [[Alzheimer’s Disease]].<ref name="pmid16785599"/><ref name="pmid15383512"/>
⚫
One adverse effect that many men complain of is that of the development of [[gynecomastia]] (breasts), but this is something that can be prevented by appropriate choice and dosing of medication, and, in required cases, the use of ancillary medications that help lower [[SHBG]] or [[estradiol]]. Another side-effect is having difficulty urinating.
  
   
  +
A small trial in 2005 showed mixed results.<ref name="pmid18167405">{{cite journal | author = Emmelot-Vonk MH, Verhaar HJ, Nakhai Pour HR, Aleman A, Lock TM, Bosch JL, Grobbee DE, van der Schouw YT | title = Effect of testosterone supplementation on functional mobility, cognition, and other parameters in older men: a randomized controlled trial | journal = JAMA | volume = 299 | issue = 1 | pages = 39–52 | year = 2008 | month = January | pmid = 18167405 | doi = 10.1001/jama.2007.51 | url = | issn = }}</ref>
⚫
===Athletic use===
  
⚫
Testosterone may be administered to an athlete in order to improve performance, and is considered to be a form of doping in most sports. There are several application methods for testosterone, including [[intramuscular injection]]s, [[transdermal|transdermal gels and patches]], and implantable pellets.
  
   
  +
Large scale trials to assess the efficiency and long-term safety of testosterone are still lacking.<ref name="url_ Cunningham">{{cite web | url = http://www.endocrinetoday.com/view.aspx?rid=29171 | title = Testosterone treatment in aging men | author = Cunningham GR | authorlink = | coauthors = | date = 2008-06-25 | format = | work = | publisher = EndocrineToday.com | pages = | language = | archiveurl = | archivedate = | quote = | accessdate = 2009-07-17}}</ref>
⚫
[[Anabolic steroids]] (including testosterone) have also been taken to enhance muscle development, [[strength]], or [[endurance]]. They do so directly by increasing the muscles' protein synthesis. As a result, muscle fibers become larger and repair faster than the average person's.
  
  +
⚫
After a series of scandals and publicity in the 1980s (such as sprinter Ben Johnson's improved performance at the 1988 Summer Olympics), prohibitions of anabolic steroid use were renewed or strengthened by many sports organizations. Testosterone and other anabolic steroids were designated a "[[controlled substance]]" by the United States Congress in 1990, with the [[Anabolic Steroid Control Act]].<ref>{{cite web
  
  +
=== Adverse effects ===
  ⚫
Exogenous testosterone supplementation comes with a number of health risks. [[Fluoxymesterone]] and [[methyltestosterone]] are synthetic derivatives of testosterone. In 2006 it was reported that women taking [[Estratest]], a combination pill including estrogen and methyltestosterone, were at considerably heightened risk of [[breast cancer]].{{Citation needed|date=February 2007}} That said, methyltestosterone and Fluoxymesterone are no longer prescribed by physicians given their poor safety record, and testosterone replacement in men does have a very good safety record as evidenced by over sixty years of medical use in hypogonadal men.
  +
  ⚫
One adverse effect that many men complain of is that of the development of [[gynecomastia]] (breasts), {{Citation needed|date=January 2010}} but this is something that can be prevented by appropriate choice and dosing of medication, and, in required cases, the use of ancillary medications that help lower [[SHBG]] or [[estradiol]]. Another side-effect is having difficulty urinating. {{Citation needed|date=January 2010}}
  +
  ⚫
=== Athletic use ===
  ⚫
Testosterone may be administered to an [[sportsperson|athlete]] in order to improve performance, and is considered to be a form of [[Doping (sport)|doping]] in most sports. There are several application methods for testosterone, including [[intramuscular injection]]s, [[transdermal|transdermal gels and patches]], and implantable pellets.
  +
  ⚫
[[Anabolic steroids]] (including testosterone) have also been taken to enhance muscle development, strength, or endurance. They do so directly by increasing the muscles' protein synthesis. As a result, muscle fibers become larger and repair faster than the average person's.
  ⚫
After a series of scandals and publicity in the 1980s (such as [[Ben Johnson (sprinter)|Ben Johnson's]] improved performance at the [[1988 Summer Olympics]]), [[prohibition]]s of anabolic steroid use were renewed or strengthened by many sports organizations. Testosterone and other anabolic steroids were designated a "[[controlled substance]]" by the [[United States Congress]] in 1990, with the ''Anabolic Steroid Control Act''.<ref>{{cite web
 
|url = http://www.ussc.gov/USSCsteroidsreport-0306.pdf#search=%22Anabolic%20Steroid%20Control%20Act%20of%201990%22
  
|url = http://www.ussc.gov/USSCsteroidsreport-0306.pdf#search=%22Anabolic%20Steroid%20Control%20Act%20of%201990%22
−
|title = Anabolic Steroid Control Act| publisher = United States Sentencing Commission|year = 1990}}</ref> The levels of testosterone abused in sport greatly exceed the quantities of the steroid that are prescribed for medical use in hypogonadism. It is the supraphysiological doses and ultra high levels of testosterone that bring with it many undesirable effects and potential long term adverse health effects.
+
|title = Anabolic Steroid Control Act| publisher = United States Sentencing Commission|year = 1990}}</ref> The levels of testosterone abused in sport greatly exceed the quantities of the steroid that are prescribed for medical use in hypogonadism.{{Citation needed|date=January 2010}} It is the supraphysiological doses and ultra high levels of testosterone that bring with it many undesirable effects and potential long term adverse health effects.{{Citation needed|date=January 2010}} Coupled with the nature of cheating in sport, this is seen as being a seriously problematic issue in modern sport, particularly given the lengths to which athletes and professional laboratories go to in trying to conceal such abuse from sports regulators. Steroid abuse once again came into the spotlight recently as a result of the [[Chris Benoit]] double murder-suicide in 2007, and the media frenzy surrounding it - however, there has been no evidence indicating steroid use as a contributing factor.
   
 
==References==
  
==References==
Line 125: Line 130:
 
*Wylie, K., & Davies-South, D. (2004). A study of treatment choices in men with erectile dysfunction and reduced androgen levels. Journal of Sex & Marital Therapy, 30(2), 107-144.
  
*Wylie, K., & Davies-South, D. (2004). A study of treatment choices in men with erectile dysfunction and reduced androgen levels. Journal of Sex & Marital Therapy, 30(2), 107-144.
 
*Yates, W. R., Perry, P. J., MacIndoe, J., Holman, T., & Ellingrod, V. (1999). Psychosexual effects of three doses of testosterone cycling in normal men. Biological Psychiatry, 45(3), 254-260.
  
*Yates, W. R., Perry, P. J., MacIndoe, J., Holman, T., & Ellingrod, V. (1999). Psychosexual effects of three doses of testosterone cycling in normal men. Biological Psychiatry, 45(3), 254-260.
−  
 
[[Category:Hormone therapy]]
  
[[Category:Hormone therapy]]
 
[[Category:Testosterone]]
  
[[Category:Testosterone]]

Revision as of 12:25, 3 September 2010

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Testosterone therapy is a form of hormone therapy in which testosterone is administered to supplement existing low level of the hormone

Routes of administration

File:Depo-testosterone 200 mg ml crop.jpg

Vial of testosterone for intramuscular injection

There are many routes of administration for testosterone. Forms of testosterone for human administration currently available include injectable (such as testosterone cypionate or testosterone enanthate in oil), oral,[1] buccal,[2] transdermal skin patches, and transdermal creams or gels.[3]

In the pipeline are "roll on" methods and nasal sprays.

Indications

The original and primary use of testosterone is for the treatment of males who have too little or no natural endogenous testosterone production—males with hypogonadism. Appropriate use for this purpose is legitimate hormone replacement therapy (testosterone replacement therapy [TRT]), which maintains serum testosterone levels in the normal range.

However, over the years, as with every hormone, testosterone or other anabolic steroids has also been given for many other conditions and purposes besides replacement, with variable success but higher rates of side effects or problems. Examples include infertility, lack of libido or erectile dysfunction, osteoporosis, penile enlargement, height growth, bone marrow stimulation and reversal of anemia, and even appetite stimulation. By the late 1940s testosterone was being touted as an anti-aging wonder drug (e.g., see Paul de Kruif's The Male Hormone).[4] Decline of testosterone production with age has led to interest in androgen replacement therapy.[5]

To take advantage of its virilizing effects, testosterone is often administered to transsexual men as part of the hormone replacement therapy, with a "target level" of the normal male testosterone level. Like-wise, transsexual men are sometimes prescribed anti-androgens to decrease the level of testosterone in the body and allow for the effects of estrogen to develop.

Testosterone patches are effective at treating low libido in post-menopausal women.[6] Low libido may also occur as a symptom or outcome of hormonal contraceptive use. Women may also use testosterone therapies to treat or prevent loss of bone density, muscle mass and to treat certain kinds of depression and low energy state. Women on testosterone therapies may experience an increase in weight without an increase in body fat due to changes in bone and muscle density. Most undesired effects of testosterone therapy in women may be controlled by hair-reduction strategies, acne prevention, etc. There is a theoretical risk that testosterone therapy may increase the risk of breast or gynaecological cancers, and further research is needed to define any such risks more clearly.[6]

Hormone replacement therapy

Main article: Androgen replacement therapy

Testosterone levels decline gradually with age in human beings. The clinical significance of this decrease is debated (see andropause). There is disagreement about when to treat aging men with testosterone replacement therapy. The American Society of Andrology's position is that:[7]

"... testosterone replacement therapy in aging men is indicated when both clinical symptoms and signs suggestive of androgen deficiency and decreased testosterone levels are present."


The American Association of Clinical Endocrinologists says:[8]

"Hypogonadism is defined as a free testosterone level that is below the lower limit of normal for young adult control subjects. Previously, age-related decreases in free testosterone were once accepted as normal. Currently, they are not considered normal. Patients with low-normal to subnormal range testosterone levels warrant a clinical trial of testosterone."


There is not total agreement on the threshold of testosterone value below which a man would be considered hypogonadal. (Currently there are no standards as to when to treat women.) Testosterone can be measured as "free" (that is, bioavailable and unbound) or more commonly, "total" (including the percentage which is chemically bound and unavailable). In the United States, male total testosterone levels below 300 ng/dL from a morning serum sample are generally considered low.[9] However these numbers are typically not age-adjusted, but based on an average of a test group which includes elderly males with low testosterone levels.[citation needed] Therefore a value of 300 ng/dL might be normal for a 65-year-old male, but not normal for a 30-year-old.[citation needed] Identification of inadequate testosterone in an aging male by symptoms alone can be difficult. The signs and symptoms are non-specific, and might be confused with normal aging characteristics, such as loss of muscle mass and bone density, decreased physical endurance, decreased memory ability[citation needed], and loss of libido.

Replacement therapy can take the form of injectable depots, transdermal patches and gels, subcutaneous pellets, and oral therapy. Adverse effects of testosterone supplementation include minor side effects such as acne and oily skin, and more significant complications such as increased hematocrit which can require venipuncture in order to treat, exacerbation of sleep apnea and acceleration of pre-existing prostate cancer growth in individuals who have undergone androgen deprivation. Exogenous testosterone also causes suppression of spermatogenesis and can lead to infertility.[10] It is recommended that physicians screen for prostate cancer with a digital rectal exam and PSA (prostate specific antigen) level before starting therapy, and monitor hematocrit and PSA levels closely during therapy.

Benefits

Appropriate testosterone therapy can prevent or reduce the likelihood of osteoporosis, type 2 diabetes,[11] cardio-vascular disease (CVD), obesity, depression and anxiety and the statistical risk of early mortality. Low testosterone also brings with it an increased risk for the development of Alzheimer’s Disease.[12][13]

A small trial in 2005 showed mixed results.[14]

Large scale trials to assess the efficiency and long-term safety of testosterone are still lacking.[15]

Adverse effects

Exogenous testosterone supplementation comes with a number of health risks. Fluoxymesterone and methyltestosterone are synthetic derivatives of testosterone. In 2006 it was reported that women taking Estratest, a combination pill including estrogen and methyltestosterone, were at considerably heightened risk of breast cancer.[citation needed] That said, methyltestosterone and Fluoxymesterone are no longer prescribed by physicians given their poor safety record, and testosterone replacement in men does have a very good safety record as evidenced by over sixty years of medical use in hypogonadal men.

One adverse effect that many men complain of is that of the development of gynecomastia (breasts), [citation needed] but this is something that can be prevented by appropriate choice and dosing of medication, and, in required cases, the use of ancillary medications that help lower SHBG or estradiol. Another side-effect is having difficulty urinating. [citation needed]

Athletic use

Testosterone may be administered to an athlete in order to improve performance, and is considered to be a form of doping in most sports. There are several application methods for testosterone, including intramuscular injections, transdermal gels and patches, and implantable pellets.

Anabolic steroids (including testosterone) have also been taken to enhance muscle development, strength, or endurance. They do so directly by increasing the muscles' protein synthesis. As a result, muscle fibers become larger and repair faster than the average person's. After a series of scandals and publicity in the 1980s (such as Ben Johnson's improved performance at the 1988 Summer Olympics), prohibitions of anabolic steroid use were renewed or strengthened by many sports organizations. Testosterone and other anabolic steroids were designated a "controlled substance" by the United States Congress in 1990, with the Anabolic Steroid Control Act.[16] The levels of testosterone abused in sport greatly exceed the quantities of the steroid that are prescribed for medical use in hypogonadism.[citation needed] It is the supraphysiological doses and ultra high levels of testosterone that bring with it many undesirable effects and potential long term adverse health effects.[citation needed] Coupled with the nature of cheating in sport, this is seen as being a seriously problematic issue in modern sport, particularly given the lengths to which athletes and professional laboratories go to in trying to conceal such abuse from sports regulators. Steroid abuse once again came into the spotlight recently as a result of the Chris Benoit double murder-suicide in 2007, and the media frenzy surrounding it - however, there has been no evidence indicating steroid use as a contributing factor.

References

  1. ↑ Andriol. Food and Drug Administration.
  2. ↑ Striant. Food and Drug Administration.
  3. ↑ Androgel. (PDF) Food and Drug Administration. and Testim. Food and Drug Administration.
  4. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named de Kruif_1945
  5. ↑ Myers JB, Meacham RB (2003). Androgen replacement therapy in the aging male. Rev Urol 5 (4): 216–26.
  6. ↑ 6.0 6.1 Davis SR, Moreau M, Kroll R, Bouchard C, Panay N, Gass M, Braunstein GD, Hirschberg AL, Rodenberg C, Pack S, Koch H, Moufarege A, Studd J (November 2008). Testosterone for low libido in postmenopausal women not taking estrogen. N. Engl. J. Med. 359 (19): 2005–17.
  7. ↑ (2006) Testosterone replacement therapy for male aging: ASA position statement. J. Androl. 27 (2): 133–4.
  8. ↑ Guay AT, Spark RF, Bansal S, Cunningham GR, Goodman NF, Nankin HR, Petak SM, Perez JB (2003). American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of male sexual dysfunction: a couple's problem--2003 update. Endocr Pract 9 (1): 77–95.
  9. ↑ Holt EH, Zieve D. Testosterone. MedlinePlus Medical Encyclopedia. U.S. National Library of Medicine. URL accessed on 2009-07-17.
  10. ↑ (October 1990) Contraceptive efficacy of testosterone-induced azoospermia in normal men. World Health Organization Task Force on methods for the regulation of male fertility. Lancet 336 (8721): 955–9.
  11. ↑ Traish AM, Saad F, Guay A (2009). The dark side of testosterone deficiency: II. Type 2 diabetes and insulin resistance. J. Androl. 30 (1): 23–32.
  12. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named pmid16785599
  13. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named pmid15383512
  14. ↑ Emmelot-Vonk MH, Verhaar HJ, Nakhai Pour HR, Aleman A, Lock TM, Bosch JL, Grobbee DE, van der Schouw YT (January 2008). Effect of testosterone supplementation on functional mobility, cognition, and other parameters in older men: a randomized controlled trial. JAMA 299 (1): 39–52.
  15. ↑ Cunningham GR. Testosterone treatment in aging men. EndocrineToday.com. URL accessed on 2009-07-17.
  16. ↑ (1990). Anabolic Steroid Control Act. United States Sentencing Commission.

Further reading

  • Andrew, R. J., & Jones, R. (1992). Increased distractibility in capons: An adult parallel to androgen-induced effects in the domestic chick. Behavioural Processes, 26(2-3), 201-209.
  • Bain, J., Brock, G., & Kuzmarov, I. (2007). Canadian Society for the Study of the Aging Male: Response to health Canada's position paper on testosterone treatment. Journal of Sexual Medicine, 4(3), 558-566.
  • Basson, R. (2007). Hormones and sexuality: Current complexities and future directions. Maturitas, 57(1), 66-70.
  • Burris, A. S., Gracely, R. H., Carter, C., Sherins, R. J., & et al. (1991). Testosterone therapy is associated with reduced tactile sensitivity in males. Hormones and Behavior, 25(2), 195-205.
  • Buvat, J. (2006). It is time for a large trial of testosterone therapy for older men. Journal of Men's Health & Gender, 3(2), 169-171.
  • Carlson, N., Brenner, L., Wierman, M., Harrison-Felix, C., Morey, C., Gallagher, S., et al. (2009). Hypogonadism on admission to acute rehabilitation is correlated with lower functional status at admission and discharge. Brain Injury, 23(4), 336-344.
  • Chaudhry, M. (2003). A 60-year-old man with progressive malaise, fatigue and decreased libido. Canadian Medical Association Journal, 169(5), 445.
  • Cherry, J. A., & Lepri, J. J. (1986). Sexual dimorphism and gonadal control of ultrasonic vocalizations in adult pine voles, Microtus pinetorum. Hormones and Behavior, 20(1), 34-48.
  • Crenshaw, T. L. (1985). Transsexual problem. Medical Aspects of Human Sexuality, 19(12), 53-56.
  • Daly, R. C., Schmidt, P. J., Roca, C. A., & Rubinow, D. R. (2001). Testosterone's effects not limited to mood. Archives of General Psychiatry, 58(4), 403.
  • Davis, S. (2000). Testosterone and sexual desire in women. Journal of Sex Education & Therapy, 25(1), 25-32.
  • Davis, S. R., Wolfe, R., Farrugia, H., Ferdinand, A., & Bell, R. J. (2009). The incidence of invasive breast cancer among women prescribed testosterone for low libido. Journal of Sexual Medicine, 6(7), 1850-1856.
  • Davis, S. R., Wolfe, R., Farrugia, H., Ferdinand, A., & Bell, R. J. (2010). "Testosterone and breast cancer": Author response. Journal of Sexual Medicine, 7(2, Pt 2), 1036-1037.
  • Emmelot-Vonk, M. H., Verhaar, H. J., & van der Schouw, Y. T. (2008). Effects of testosterone therapy in older men: Reply. JAMA: Journal of the American Medical Association, 299(16), 1900-1901.
  • Freeman, M. P., & Freeman, S. A. (2003). Treatment of leuprolide-induced depression with intramuscular testosterone: A case report. Journal of Clinical Psychiatry, 64(3), 341-343.
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  • Goldstein, S. W. (2009). My turn... finally. Journal of Sexual Medicine, 6(2), 301-302.
  • Guay, A. T., Smith, T. M., & Offutt, L. A. (2009). Absorption of testosterone gel 1% (Testim) from three different application sites. Journal of Sexual Medicine, 6(9), 2601-2610.
  • Hall, S. A., Araujo, A. B., Kupelian, V., Maserejian, N. N., & Travison, T. G. (2010). Testosterone and breast cancer. Journal of Sexual Medicine, 7(2, Pt 2), 1035-1036.
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