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Importance of hypogonadism and testosterone replacement therapy in current urologic practice: a review

  • Urology – Review
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Abstract

Evaluation of potential candidates for testosterone replacement therapy (TRT) includes a complete medical history, physical examination, and hormonal screening. The choice of testosterone assay is important in clinical decision making. TRT should, in theory, approximate natural endogenous production of the hormone. There is no apparent association between TRT and the development of prostate cancer. The administration of exogenous testosterone is not a means of reversing the aging process in men with normal testosterone levels, but it may offer considerable benefit for those with hypogonadism.

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References

  1. Corona G, Mannucci E, Ricca V et al (2009) The age related decline of testosterone is associated with different specific symptoms and signs in patients with sexual dysfunction. Int J Androl. doi:10.1111/j.1365-2605.2009.00952.x

  2. McMahon CG (2009) Screening for erectile dysfunction in men with lifelong premature ejaculation—is the sexual health inventory for men (SHIM) reliable? J Sex Med 6(2):567–573

    Article  PubMed  Google Scholar 

  3. Köhler TS, Kim J, Feia K et al (2008) Prevalence of androgen deficiency in men with erectile dysfunction. Urology 71(4):693–697

    Article  PubMed  Google Scholar 

  4. Yildiz O (2007) Vascular smooth muscle and endothelial functions in aging. Ann N Y Acad Sci 1100:353–360

    Article  PubMed  CAS  Google Scholar 

  5. Ferrer JE, Velez JD, Herrera AM (2009) Age-related morphological changes in smooth muscle and collagen content in human corpus cavernosum. J Sex Med. doi:10.1111/j.1743-6109.2009.01508.x

  6. Somani B, Khan S, Donat R (2010) Screening for metabolic syndrome and testosterone deficiency in patients with erectile dysfunction: results from the first UK prospective study. BJU Int. doi:10.1111/j.1464-410X.2009.09145.x

  7. Moreley JE, Perry HM, Kevorkian RT et al (2006) Comparison of screening questionnaire for the diagnosis of hypogonadism. Maturitas 53(4):424–429

    Article  Google Scholar 

  8. Wierman ME, Basson R, Davis SR et al (2006) Androgen therapy in women: an Endocrine Society Clinical Practice guideline. J Clin Endocrinol Metab 91(10):3697–3710

    Article  PubMed  CAS  Google Scholar 

  9. Moisey R, Swinburne J, Orme S (2008) Serum testosterone and bioavailable testosterone correlate with age and body size in hypogonadal men treated with testosterone undecanoate (1000 mg IM—Nebido). Clin Endocrinol (Oxf) 69(4):642–647

    Article  CAS  Google Scholar 

  10. Nieschlag E, Loriaux DL (1972) Radioimmunoassay for plasma testosterone. Z Klin Chem Klin Biochem 10(4):164–168

    PubMed  CAS  Google Scholar 

  11. Wang C et al (2004) Measurement of total serum testosterone in adult men: comparison of current laboratory methods versus liquid chromatography tandem mass spectrometry. J Clin Endocrinol Metab 89(2):534–543

    Article  PubMed  CAS  Google Scholar 

  12. Fears TR et al (2002) Reproducibility studies and interlaboratory concordance for androgen assays of male plasma hormone levels. Cancer Epidemiol Biomarkers Prev 11(8):785–789

    PubMed  CAS  Google Scholar 

  13. Vesper HW, Botelho JC (2010) Standardization of testosterone measurements in humans. J Steroid Biochem Mol Biol

  14. Vesper HW et al (2009) Interlaboratory comparison study of serum total testosterone [corrected] measurements performed by mass spectrometry methods. Steroids 74(6):498–503

    Article  PubMed  CAS  Google Scholar 

  15. Fears TR et al (2000) Reproducibility studies and interlaboratory concordance for androgen assays in female plasma. Cancer Epidemiol Biomarkers Prev 9(4):403–412

    PubMed  CAS  Google Scholar 

  16. Newman JD, Doery JC (2008) Assessing hypogonadism in men how helpful are current testosterone assays? Aust Fam Physician 37(8):670–671

    PubMed  Google Scholar 

  17. Bhasin S et al (2008) The impact of assay quality and reference ranges on clinical decision making in the diagnosis of androgen disorders. Steroids 73(13):1311–1317

    Article  PubMed  CAS  Google Scholar 

  18. Albrecht L, Styne D (2007) Laboratory testing of gonadal steroids in children. Pediatr Endocrinol Rev 5(Suppl 1):599–607

    PubMed  Google Scholar 

  19. Herzog AG, Levesque LA (1992) Testosterone, free testosterone, nonsex hormone binding globulin bound testosterone, and free androgen index: which testosterone measurement is most relevant to reproductive and sexual function in men with epilepsy? Arch Neurol 49(2):133–135

    Article  PubMed  CAS  Google Scholar 

  20. Mellstrom D et al (2006) Free testosterone is an independent predictor of BMD and prevalent fractures in elderly men: MrOS Sweden. J Bone Miner Res 21(4):529–535

    Article  PubMed  Google Scholar 

  21. Kley HK, Bartmann E, Kruskemper HL (1977) A simple and rapid method to measure nonproteinbound fractions of cortisol, testosterone and oestradiol by equilibrium dialysis: comparison with centrifugal filtration. Acta Endocrinol (Copenh) 85(1):209–219

    CAS  Google Scholar 

  22. Vlahos I et al (1982) An improved ultrafiltration method for determining free testosterone in serum. Clin Chem 28(11):2286–2291

    PubMed  CAS  Google Scholar 

  23. Chen Y et al (2010) Direct measurement of serum free testosterone by ultrafiltration followed by liquid chromatography tandem mass spectrometry. Clin Biochem 43(4‐5):490–496

    Article  PubMed  CAS  Google Scholar 

  24. Sartorius G et al (2009) Predictive accuracy and sources of variability in calculated free testosterone estimates. Ann Clin Biochem 46(Pt 2):137–143

    Article  PubMed  CAS  Google Scholar 

  25. Vermeulen A (2005) Hormonal cutoffs of partial androgen deficiency: a survey of androgen assays. J Endocrinol Invest 28(3 Suppl):28–31

    PubMed  CAS  Google Scholar 

  26. Vicente FB et al (2006) Measurement of serum testosterone using high performance liquid chromatography/tandem mass spectrometry. Clin Chem Lab Med 44(1):70–75

    Article  PubMed  CAS  Google Scholar 

  27. Thienpont LM et al (2008) State of the art of serum testosterone measurement by isotope dilution liquid chromatography tandem mass spectrometry. Clin Chem 54(8):1290

    Article  PubMed  CAS  Google Scholar 

  28. Bui HN et al (2010) Serum testosterone levels measured by isotope dilution liquid chromatography tandem mass spectrometry in postmenopausal women versus those in women who underwent bilateral oophorectomy. Ann Clin Biochem 47(Pt 3):248–252

    Article  PubMed  CAS  Google Scholar 

  29. Boyce MJ et al (2004) Are published normal ranges of serum testosterone too high? Results of a crosssectional survey of serum testosterone and luteinizing hormone in healthy men. BJU Int 94(6):881–885

    Article  PubMed  CAS  Google Scholar 

  30. Sikaris K et al (2005) Reproductive hormone reference intervals for healthy fertile young men: evaluation of automated platform assays. J Clin Endocrinol Metab 90(11):5928–5936

    Article  PubMed  CAS  Google Scholar 

  31. Leifke E, Korner HC, Link TM et al (2008) Effects of testosterone replacement therapy on cortical and trabecular bone mineral density, vertebral body area and paraspinal muscle area in hypogonadal men. Eur J Endocrinol 138(1):51–58

    Article  Google Scholar 

  32. Zacharin MR, Pua J, Kanumakala S (2003) Bone mineral density following long-treatment with subcutaneous testosterone pellets implants in male hypogonadism. Clin Endocrinol 58(6):691–695

    Article  CAS  Google Scholar 

  33. Hak AE, Whitteman JC, deJong FH et al (2002) Low levels of endogenous androgens increase the risk of atherosclerosis in elderly men: the Rotterdam study. J Clin Endocrinol Metab 87:3632

    Article  PubMed  CAS  Google Scholar 

  34. English KM, Steeds RP, Jones TH et al (2000) Low-dose transdermal testosterone therapy improves angina threshold in men with chronic stable angina: a randomized, double-blind, placebo-controlled study. Circulation 102:1906

    PubMed  CAS  Google Scholar 

  35. Laughlin GA, Barrett-Connnor E, Bergstrom J (2008) Low serum testosterone, mortality in older men. J Clin Endocrinol Metab 93:68

    Article  PubMed  CAS  Google Scholar 

  36. Kapoor D, Goodwin E, Channer KS et al (2006) Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hypercholesterolaemia in hypogonadal men with type 2 diabetes. Eur J Endocrinol 154(6):899–906

    Article  PubMed  CAS  Google Scholar 

  37. D’Amico AV, Denham JW, Crook J et al (2007) Influence of androgen suppression therapy for prostate cancer on the frequency, timing of fatal myocardial infarctions. J Clin Oncol 25:2420

    Article  PubMed  Google Scholar 

  38. Rayanaud JP (2006) Prostate cancer risk in testosteronetreated men. J Steroid Biochem Mol Biol 102(1–5):261–266

    Article  Google Scholar 

  39. Marks LS, Mazer NA, Mostaghel E et al (2006) Effect of testosterone replacement therapy on prostate tissue in men with late-onset hypogonadism: a randomized controlled trial. JAMA 296:2351

    Article  PubMed  CAS  Google Scholar 

  40. Wang C, Nieschlag E, Swerdloff R et al (2008) Investigation, treatment, monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA, ASA recommendations. Eur J Endocrinol 159(5):507–514

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Urology, Tulane University, Health Sciences Center, 1430 Tulane Avenue, SL-42, New Orleans, LA, 70112, USA

    Wayne J. G. Hellstrom

  2. Department of Urology and Reproductive Medicine, Weill Cornell Medical College, New York, NY, USA

    Darius Paduch

  3. Department of Surgery, Division of Urology, Duke University Mecical Center, Durham, NC, USA

    Craig F. Donatucci

Authors
  1. Wayne J. G. Hellstrom
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  2. Darius Paduch
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  3. Craig F. Donatucci
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Corresponding author

Correspondence to Wayne J. G. Hellstrom.

Appendices

Appendix 1

Primary hypogonadism

(↓ T and ↑ LH)

  • Klinefelter’s syndrome

  • Mumps orchitis

  • Autoimmune orchitis

  • Trauma

  • Testicular irradiation or surgery

Secondary hypogonadism

(↓ T and ↓ ↔LH)

  • Acquired idiopathic

  • Pituitary tumors

  • Uremia

  • Systemic illness

  • Cranial irradiation

  • Hyperprolactinemia

  • Hemochromatosis

  • Cushing’s syndrome

  • Cirrhosis

  • Morbid obesity

  • Metabolic syndrome

  • Diabetes mellitus

Appendix 2

Testosterone preparations

  • Oral agents

  • Pellet implants

  • Scrotal patches

  • Intramuscular preparations

    • Short acting

    • Long acting

  • Transdermal patches

  • Transdermal gels

  • Buccal tablets

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Hellstrom, W.J.G., Paduch, D. & Donatucci, C.F. Importance of hypogonadism and testosterone replacement therapy in current urologic practice: a review. Int Urol Nephrol 44, 61–70 (2012). https://doi.org/10.1007/s11255-010-9879-4

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  • DOI: https://doi.org/10.1007/s11255-010-9879-4

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