State-of-the-Art Lecture: Updates on testosterone replacement therapy CUA 2025

madman · Sunday at 2:10 PM

Nelson's house.....you know where it's at!

Conclusions

madman · Sunday at 2:16 PM

Testosterone Diagnosis and Testing

Hypogonadism

madman · Sunday at 2:18 PM

Testosterone Distribution

madman · Sunday at 2:20 PM

Why 2 Tests are Needed?

Why Early Morning Testing?

madman · Sunday at 2:21 PM

Signs and Symptoms

madman · Sunday at 2:27 PM

Types of Hypogonadism

Hypogonadism

Specific/Unknown

madman · Sunday at 2:30 PM

Hypogonadism and the Metabolic syndrome

Bidirectional Relationship

madman · Sunday at 2:32 PM

TRT and Other Conditions

madman · Sunday at 2:48 PM

TRT & Prostate Cancer

Thread 'Testosterone Supplementation After Localized Prostate Cancer: The Current State of the Literature'

Jul 29, 2025

* For clinicians considering TTh in men after prostate cancer treatment, several considerations should guide decision-making. Patient selection is critical with regular monitoring, with close attention to PSA velocity and testosterone levels. The benefits of treating hypogonadism, including improvements in energy, sexual function, bone density, body composition, and potentially cardiovascular health, must be weighed against the theoretical risk of promoting occult cancer cells in each individual patient. The current literature suggests that TTh can be safely...

post #5/6 (Go nuts)!

Thread 'TRT and the Prostate'

Mar 4, 2022

Testosterone Treatment and the Risk of Prostate Adverse Events (2022)
Jason A. Levy, DO, MS, Arthur L. Burnett, MD, MBA, Adrian S. Dobs, MD, MHS

INTRODUCTION

Definition Hypogonadism is a clinical syndrome that results from failure of the testis to produce physiologic concentrations of testosterone (T).1 Various thresholds exist to define low total T ranging from 230 to 350 ng/dL. Peak T levels typically are measured between 3 and 8 AM with total T level decreasing during the first 30 minutes of waking.2Serum T decreases with age and has shown to have an...

madman · Sunday at 3:07 PM

TRT & Cardiovascular Disease

TRAVERSE Summary

FDA Label Change

Thread 'TRT and Cardiovascular Disease'

Feb 18, 2022

Testosterone replacement therapy and cardiovascular disease (2022)
Jeremy M. Auerbach and Mohit Khera

The use of testosterone therapy has a complex history of apprehension and questions regarding its safety. Despite an eventual consensus that testosterone therapy was safe and effective, several studies relating to cardiovascular risks emerged in the last decade, rekindling skepticism regarding the safety of testosterone therapy. Given the utility of testosterone therapy in treating the symptoms of hypogonadism, it remains crucial to closely examine the safety of testosterone...

madman · Sunday at 3:26 PM

Novel TRT Options

TRT Timeline

Canadian Market

Thread 'Bausch Health has discontinued production of Delatestryl® in Canada'

Apr 28, 2024

This is sad to hear!

Delatestryl has been in use since 1956!

*Clinical safety and efficacy of Testosterone Enanthate Injection, USP is supported by clinical use with Canadian patients since 1956 without incidence

Looks like we are stuck with the generic Testosterone Enanthate manufactured by Hikma.

At least we still have the option for big pharma Depo-testosterone manufactured by Pfizer Canada Inc. or the generic Testosterone Cypionate manufacture by Taro Pharmaceutical Inc.

Downfall here is the TC is only available in the 100mg/mL strength in Canada...

Thread 'Testosterone Products in Canada - (oral, nasal, transdermal, injectable)'

Oct 12, 2024

Big pharma transdermal T patch Androderm manufactured by Allergan Inc. was discontinued back in 2018!

Big pharma brand name Andriol (oral TU) manufactured by Merck was also discontinued back in 2018 and more recently 2024 our beloved Delatestryl (testosterone enanthate) manufactured by Valeant has been discontinued.

The only oral TU available is the generic PMS-Testosterone and Taro-Testosterone capsules.

Come 2025 we may have the option to use the newer versions of oral TU Kyzatrex or Tlando which are available in the US as Marius Pharmaceuticals and Verity Pharmaceuticals are...

Thread 'Marius Pharmaceuticals Submits KYZATREX® (oral TU) CIII Capsules for Approval to Health Canada'

Jul 30, 2024

It was just a matter of time!

F**king A!

Looks like they may have beat out Verity Pharmaceuticals oral Tlando for dibs on the Canadian market!

RALEIGH, N.C., July 30, 2024 (GLOBE NEWSWIRE) -- Marius Pharmaceuticals, a patient-centric healthcare company focused on developing innovative therapies for Testosterone Deficiency, is pleased to announce the submission of its New Drug Submission (NDS) for KYZATREX® (testosterone undecanoate) CIII capsules to Health Canada for approval. This submission marks the company’s first international filing, with an anticipated...

Thread 'Lipocine Announces Filing of New Drug Submission for TLANDO® in Canada'

Jun 10, 2025

It's coming!

Lipocine Announces Filing of New Drug Submission for TLANDO® in Canada

New Drug Submission filed by Lipocine's licensing partner Verity Pharma Over 700,000 total prescriptions written annually for testosterone replacement therapy (TRT) in Canada, representing large...

ir.lipocine.com

New Drug Submission filed by Lipocine's licensing partner Verity Pharma
Over 700,000 total prescriptions written annually for testosterone replacement therapy (TRT) in Canada, representing large commercial opportunity

SALT LAKE CITY, June 9, 2025 /PRNewswire/ -- Lipocine Inc. (NASDAQ: LPCN), a biopharmaceutical company leveraging its proprietary technology platform to enable effective oral delivery of therapeutics, today announced...

madman · Sunday at 3:39 PM

Conclusions

madman · Sunday at 3:43 PM

Thread 'Canadian Urology Guideline on Testosterone Replacement'

Mar 5, 2021

Canadian Urological Association clinical practice guideline on testosterone deficiency in men: Evidence-based Q&A (2021)
Ethan D. Grober, MD; Yonah Krakowsky, MD; Mohit Khera, MD; Daniel T. Holmes, MD; Jay C. Lee, MD; John E. Grantmyre, MD; Premal Patel, MD; Richard A. Bebb, MD; Ryan Fitzpatrick, MD; Jeffrey D. Campbell, MD; Serge Carrier, MD; Abraham Morgentaler, MD

Introduction

As part of their ongoing commitment to education and best practice standards, the Canadian Urological Association (CUA) solicited the creation of a clinical practice guideline dedicated to...

Thread 'Testosterone Therapy in Canada'

Mar 25, 2023

@Marcel

THE DEA And ACCESS TO TRT TELEMEDICINE - Page 6 - Excel Male TRT Forum

COMMENTS DUE DATE: MARCH 31. THE DEA WANTS TO LIMIT YOUR ACCESS TO TELEMEDICINE EXECUTIVE SUMMARY: The DEA has proposed new rules to update the Ryan Haight Act, which could negatively affect telemedicine prescribing of non-narcotic medications in Schedules III, IV, and V. These rules would...

www.excelmale.com

We have always been far worse off than the US when it comes to the treatment of men for testosterone deficiency.

Although there has been some improvement in certain areas we are still lacking in many others.

*In 2013, a comprehensive Canada-wide needs assessment revealed that over 25% of Canadian physicians were uncomfortable with the diagnosis and treatment of TD and identified significant knowledge gaps related to patient management.4 To address...

Thread 'Practice-Changing Publications (PCP): Testosterone'

Dec 12, 2022

Practice Changing Publications (PCP): Testosterone | Canadian Urological Association

www.cua.org

Speakers: Ryan Flannigan & Premal Patel

Objectives:

Discuss cardiovascular considerations with Low Testosterone & Treatment
Review current evidence with Low Testosterone & Treatment in the context of Prostate Cancer
Identify strategies to treat older patients presenting with Low Testosterone
Identify strategies to treat young patients presenting with Low Testosterone

Thread 'CUA- Testosterone Deficiency & Therapy'

Dec 12, 2022

Thread 'Testosterone Products in Canada - (oral, nasal, transdermal, injectable)'

Oct 12, 2024

Big pharma transdermal T patch Androderm manufactured by Allergan Inc. was discontinued back in 2018!

Big pharma brand name Andriol (oral TU) manufactured by Merck was also discontinued back in 2018 and more recently 2024 our beloved Delatestryl (testosterone enanthate) manufactured by Valeant has been discontinued.

The only oral TU available is the generic PMS-Testosterone and Taro-Testosterone capsules.

Come 2025 we may have the option to use the newer versions of oral TU Kyzatrex or Tlando which are available in the US as Marius Pharmaceuticals and Verity Pharmaceuticals are...

madman · Sunday at 7:42 PM

For all the GPs, endocrinologists, urologists and T-clinics it needs to be stressed to your patients that in Canada we use/rely upon the linear law-of-mass action Vermeulen (cFTV) for testing free testosterone as it replaced the known to be inaccurate direct immunoassays yet many are still not aware that the cFTV tends to overestimate free testosterone!

Thread 'Use of calculated FT in men: advantages and limitations'

Nov 6, 2024

Use of calculated free testosterone in men: advantages and... : Current Opinion in Endocrinology, Diabetes and Obesity

hting its relevance in preventing misdiagnosis and overtreatment of male hypogonadism. Recent findings While there is consensus on measuring total T – comprising sex hormone-binding globulin (SHBG)-bound, albumin-bound, and free T – as a first step in diagnosing male hypogonadism, evidence...

journals.lww.com

INTRODUCTION

Clinical practice guidelines on the diagnosis of male hypogonadism focus on clinical signs and symptoms of androgen deficiency, as well as biochemical assessment of low circulating testosterone (T). However, there is a longstanding debate, as well as a persisting controversy concerning biochemical assessment of serum T and in particular the use (and misuse) of free T. Free T, as advocated by the free hormone hypothesis, represents...

Free & Bioavailable Testosterone calculator

Unfortunately we do not have easy access to the most accurate assay for testing free testosterone the gold standard Equilibrium Dialysis and even then as of now there is no standardized ED assay let alone harmonized reference range for free testosterone.

The CDC has been working hard behind the scenes over the years on developing a standardized FT assay (ED-LC/MS/MS) and harmonized reference range for free testosterone.

Similar to what was done for harmonized TT.

* Assays that are standardized are designed to provide accurate results, traceable to “true” value-assigned certified reference materials and gold-standard reference methods.

Soon enough we will have a CDC Hormone Standardization Program (CDC HoSt) Certified Free Testosterone Procedure and a harmonized reference range for free testosterone!

Just a matter of time as this has been a painstaking wait!

We need this!

Thread 'CDC STANDARDIZED TOTAL T and ESTRADIOL ASSAYS and soon to be FREE TESTOSTERONE!'

Jan 5, 2019

How the CDC Clinical Standardization Programs Are Improving Hormone Tests - AACC.org

WHAT PROGRESS HAS CDC MADE WITH STANDARDIZING TOTAL TESTOSTERONE AND ESTRADIOL TESTS?

Since HoSt began in 2010, CDC has had more than 350 participants in 15 countries. Participants have shown measurable improvements for both total testosterone (TT) and estradiol (E2). Specifically, the among-laboratory bias has decreased from 16.5% in 2007 to 2.8% in 2017 for TT and from 54.8% in 2012 to 13.9% in 2017 for E2. Not only has bias improved, but data...

Thread 'CDC's Clinical Standardization Programs: Free Testosterone soon to be!'

Apr 17, 2021

Thread 'CDC’s Clinical Standardization Programs (CDC CSP): Ensuring the Accuracy and Reliability of Chronic Disease Biomarker Tests'

Apr 7, 2024

Thread 'Importance of free testosterone measurement in assesssing androgen disorders'

Jun 15, 2025

As usual Nelson's house is where it's at!

Importance of free testosterone measurement in assessing androgen disorders

Thursday, March 27, 2025 at 1:00 PM Eastern Daylight Time.

event.on24.com

Testosterone imbalances affect men, women, and children differently. In males, testosterone deficiency (hypogonadism) can lead to low libido, fatigue, and muscle loss, while excess may contribute to aggression and cardiovascular risks. In females, testosterone excess (hyperandrogenism), often associated with polycystic ovary syndrome (PCOS) or adrenal disorders, can cause excess hair growth, weight gain, and menstrual irregularities. In children...