A pill that could outsell Viagra: New testosterone Rx drug

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Kyzatrex could be a potential blockbuster to treat testosterone deficiency, a severely undertreated disease.
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Testosterone has been historically perceived as a lifestyle issue for men who want to improve their sex lives or those avid gym-goers who want to experience massive muscle gains. There has been extensive research on hormonal imbalance and the significant downstream impact it has on human organs and processes.

Testosterone deficiency, or hypogonadism, is a disease where a man’s body does not produce sufficient testosterone levels. Usually, it is treated with testosterone replacement therapy, which replaces the testosterone that has been lost and returns levels to normal.

More than 20 million men in the United States are believed to suffer from hypogonadism. (Globally, more than 100 million men suffer from the disease.)
Additionally, more than a third of men over age 40 and about 40 percent of men over 45 are testosterone deficient and suffer from numerous symptoms, such as fatigue, inflammation, weight gain, low libido, depression, and poor cognition.

Now a new prescription drug, developed and manufactured by the Raleigh, NC, based Marius Pharmaceuticals, has been approved by the U.S. Food and Drug Administration to treat adult men who have low or no testosterone levels due to certain medical conditions. Marius, a specialty pharmaceutical company, is founded by Indian American Himanshu H. Shah.

Traditionally, testosterone replacement therapy consisted of testosterone patches, gels, pellets, and injections. The new drug, Kyzatrex, which received FDA approval in July 2022, is an oral medicine. It is found to be effective in treating men who are symptomatic and show low testosterone levels below 300 nanograms per deciliter (ng/dL). A nanogram is one-billionth of a gram and a deciliter is 1/10 of a liter. Testosterone is measured through blood tests. According to WebMD, “most doctors agree that a ‘normal’ reading falls anywhere between 300 to 1,000 nanograms per deciliter (ng/dL).


Kyzatrex, which comes in dosage strengths of 100 mg, 150 mg, and 200 mg, can be taken twice a day with food. It will be available in all states across the United States, beginning October 15, 2022.

In an interview with The American Bazaar last week, Shah, who is the Executive Chairman of Marius, cited several advantages of Kyzatrex. Since the capsule is absorbed via the lymphatic system, bypassing the liver, it avoids liver toxicity and liver damage, he said. “The oral delivery method eliminates the risk of application site reactions common with intramuscular injections,” Shah said. “Kyzatrex also eliminates any risk of transference to women or children that can occur with topical testosterone gels and creams. Kyzatrex’s daily dosing more closely mimics the daily rhythm of natural testosterone production compared to long-acting therapies.”

Shah, who is also the managing general partner of Shah Capital Opportunity Fund, spoke about the need to dispel misconceptions about testosterone and testosterone therapy. Even though it is a true medical blind spot — with its immense potential to reduce downstream diseases — many physicians are hesitant to prescribe testosterone therapy over debunked claims that it causes prostate cancer and cardiovascular risks, he said.

A number of massive observational studies in the last five years have evaluated testosterone therapy’s effect on prostate cancer and cardiovascular disease and have found that testosterone therapy is actually cardioprotective and does not cause prostate cancer.
One recent large observational study that analyzed data from over 143,000 US men over age 65 found that testosterone therapy was associated with a lower incidence of prostate and colorectal cancers.

Shah said Marius is focusing on “Adequate Testosterone Therapy (ATT), a trade-marked mantra to improve patient outcomes while concurrently reducing unnecessary healthcare spending. “There are studies that show that testosterone therapy produces reductions in weight in those who are overweight and obese,” he said. “Likewise, another study evaluating the impact of testosterone therapy on pre-diabetics and type 2 diabetics found that testosterone therapy resulted in 33 percent of pre-diabetic and type 2 diabetic patients going into remission. Testosterone levels should be checked by a routine blood test in comorbid patients that could benefit from ATT.”

Shah touted the huge potential for Kyzatrex in the market, given the size of the population affected by testosterone deficiency and the upside of the testosterone treatment. He said he expects the drug to outsell Viagra in the long term. “Viagra treats only one condition, while Kyzatrex could treat so many more,” he said.

The FDA approval for the drug came after 13 years of clinical studies, including the Phase 3 trials, conducted in 35 sites across the United States.
Men from various demographics, including African Americans, Asian Americans, and Hispanics, were part of the studies. In the first Phase 3 study, which lasted 12 months, there were 314 total subjects. The second Phase 3 study was approximately nine months in duration and had 155 subjects. The most common side effect of the drug in clinical trials was hypertension, which occurred in only 2.6 percent of subjects.

Patients can sign up for the medication by visiting the virtual health platform BaseHealthcare.com, which does comprehensive lab work and provides a telehealth visit with a clinician. Alternatively, Kyzatrex can be prescribed by an existing physician and ordered through the website www.Kyzatrexdirect.com with medication shipped directly to the patient’s home upon launch. “BaseHealthcare.com is a men’s virtual health platform focusing on foundational health and optimization using testosterone and patient-centered health coaching,” Shah said.
 
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*Kyzatrex, which comes in dosage strengths of 100 mg, 150 mg, and 200 mg, can be taken twice a day with food. It will be available in all states across the United States, beginning October 15, 2022
 
I hope these companies won't self-terminate by setting an insane price for their testosterone pills. They are expected to be less effective than the cheap injectable testosterone.

I also notice the cheap sales pitch implying that TRT is the ultimate solution for "fatigue, inflammation, weight gain, low libido, depression, and poor cognition", when this forum is full of threads on exactly these problems unresolved on TRT.
 
I hope these companies won't self-terminate by setting an insane price for their testosterone pills. They are expected to be less effective than the cheap injectable testosterone.

I also notice the cheap sales pitch implying that TRT is the ultimate solution for "fatigue, inflammation, weight gain, low libido, depression, and poor cognition", when this forum is full of threads on exactly these problems unresolved on TRT.

Two different animals.

You could never mimic the PK profile injecting esterified T.

Oral TU is dosed 2x daily which results in 2 daily peaks/troughs 24/7.

Top it off that T levels are maintained within the physiological range.

Although injectables are dirt cheap and you can easily achieve healthy let alone absurdly high levels well into the supraphysiological range with ease many get caught up on the more T is better mentality.

Many end up running absurdly high TT/FT levels and this is at the f**king trough let alone steady-state 24/7.

No wonder so many struggle with sides (blood markers/cosmetic).

Running too high an FT level can easily have a negative effect on mood/well-being, energy, libido, and erectile function let alone elevated RBCs/hemoglobin/hematocrit.

You remember this no?

Those beloved injectables!


My reply from a previous thread:

Unfortunately most caught up on that more T is better mentality will continue to struggle as they will always be searching for something that will never be there.

Many will refuse to settle for feeling NORMAL and be chasing that so-called OPTIMAL until the cows come home.

Never-ending merry-go-round.

You have people on the forums going on and on about so-called optimal let alone everything being in balance yet these same individuals are trying their damnedest to micro-manage estradiol/DHT/prolactin/DHEA and the laundry list goes on yet when it comes to T are running levels well beyond what their body could ever produce endogenously let alone what level they were genetically at in their PRIME (late teens/the early 20s).

No male in his prime (late teens/early 20s) was producing absurdly high peak or trough TT/FT levels let alone 24/7 (steady-state).

Top it all off that your HPGA is shut down and most are not replacing physiological levels of T they are FORCING levels upon THEMSELVES WELL BEYOND what one could endogenously ever produce.

Unfortunately too many want to be jacked up on T 24/7.

When it comes to building muscle high T levels steady-state is where it's at and there is no denying such.

The sad fact of the matter is many are brainwashed into thinking that more T is better.

For many years we have been stressing the point that many are overmedicated when it comes to testosterone therapy.

Too many caught up on that neanderthal mindset you know that more T is better mentality.

Unfortunately many are jacked up on T from the get-go let alone many are also dick riding that so-called OPTIMAL bulls**t!

Too many get caught up in expecting to feel great 24/7 once on trt as if testosterone is going to cure all that ails them.

So much misinformation spewed on the numerous forums/gootube.


*neanderthal mindset that more T is better

*HIGH T = raging libido/titanium erections

*HIGH T = OPTIMAL as in that fairytale everyone is chasing.....you know the one with raging libido/titanium erections 24/7, unlimited amounts of energy, stellar mood (Mr. Rogers neighborhood), packing on muscle like the hulk with the recovery abilities of wolverine



Never going to change especially when everyone keeps pushing the more T is better mentality on most of the other BUM ASS forums and it does not help when many are loaded with are beloved (LOL) blast n cruiserZZZ!
 
Two different animals.

You could never mimic the PK profile injecting esterified T.

Oral TU is dosed 2x daily which results in 2 daily peaks/troughs 24/7.

Top it off that T levels are maintained within the physiological range.

Although injectables are dirt cheap and you can easily achieve healthy let alone absurdly high levels well into the supraphysiological range with ease many get caught up on the more T is better mentality.

Many end up running absurdly high TT/FT levels and this is at the f**king trough let alone steady-state 24/7.

No wonder so many struggle with sides (blood markers/cosmetic).

Running too high an FT level can easily have a negative effect on mood/well-being, energy, libido, and erectile function let alone elevated RBCs/hemoglobin/hematocrit.

You remember this no?

Those beloved injectables!


My reply from a previous thread:

Unfortunately most caught up on that more T is better mentality will continue to struggle as they will always be searching for something that will never be there.

Many will refuse to settle for feeling NORMAL and be chasing that so-called OPTIMAL until the cows come home.

Never-ending merry-go-round.

You have people on the forums going on and on about so-called optimal let alone everything being in balance yet these same individuals are trying their damnedest to micro-manage estradiol/DHT/prolactin/DHEA and the laundry list goes on yet when it comes to T are running levels well beyond what their body could ever produce endogenously let alone what level they were genetically at in their PRIME (late teens/the early 20s).

No male in his prime (late teens/early 20s) was producing absurdly high peak or trough TT/FT levels let alone 24/7 (steady-state).

Top it all off that your HPGA is shut down and most are not replacing physiological levels of T they are FORCING levels upon THEMSELVES WELL BEYOND what one could endogenously ever produce.

Unfortunately too many want to be jacked up on T 24/7.

When it comes to building muscle high T levels steady-state is where it's at and there is no denying such.

The sad fact of the matter is many are brainwashed into thinking that more T is better.

For many years we have been stressing the point that many are overmedicated when it comes to testosterone therapy.

Too many caught up on that neanderthal mindset you know that more T is better mentality.

Unfortunately many are jacked up on T from the get-go let alone many are also dick riding that so-called OPTIMAL bulls**t!

Too many get caught up in expecting to feel great 24/7 once on trt as if testosterone is going to cure all that ails them.

So much misinformation spewed on the numerous forums/gootube.


*neanderthal mindset that more T is better

*HIGH T = raging libido/titanium erections

*HIGH T = OPTIMAL as in that fairytale everyone is chasing.....you know the one with raging libido/titanium erections 24/7, unlimited amounts of energy, stellar mood (Mr. Rogers neighborhood), packing on muscle like the hulk with the recovery abilities of wolverine



Never going to change especially when everyone keeps pushing the more T is better mentality on most of the other BUM ASS forums and it does not help when many are loaded with are beloved (LOL) blast n cruiserZZZ!

Great response. Too many are also going on an AI and HCG with the first injection. Then, if something is wrong, it is very difficult to figure out what is wrong, I am a patient at Men’s Health Boston, where Morgentaler’s starting protocol is 100 mg IM once per week, that’s it. Nothing else until there is an issue. I have been on for over six years and have had none of the issues that many here seem to have. I have nudged it up to 140 weekly, where it has been steady for two years and no issues.

I also agree with you that the expectations some guys have are unrealistic. TRT is not the cure, but is the catalyst for a lifestyle change that leads to desired results. Diet, sleep, exercise, and mental health are all part of that. A lot of guys are really dealing with minor mental health issues and think TRT is the cure and a lot of us have hang ups about ourselves that TRT alone can’t fix. I think younger guys starting too early in life is a mistake and that they should adjust their lifestyle and habits first. Most seem unwilling to do that and have a lot of lame excuses for not doing so and unrealistic expectations about what it is going to do for them and are too focused on being “dialed in.” You dial yourself in.

Keep it simple and do the work. Keep your expectations reasonable.
 
The oral testosterone pills have the opposite problem: the levels achieved are actually too low most of the time. For some, achieving an average level of 400 ng/dL is "in normal range" but doesn't cut it as TRT.

Remember, oral testosterone was taken in huge doses in 1970s and it was discontinued exactly because of too low average levels achieved, compared to injectable or transdermal. These new companies pushing overpriced testosterone pills are not actually inventing the wheel and the hot water.

It's fine if they release it at prices matching injectable testosterone but it seems that will not be the case and for people without insurance, which is willing to be milked in that blatant way, the injectable or transdermal testosterone will remain the only feasable options, which will lead to a waning hype for the testosterone pills.
 
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The oral testosterone pills have the opposite problem: the levels achieved are actually too low most of the time.
The same can be said about the natural T production, peaking high in the morning and declining in the midday and evening.

I'm peaking at around 1000 ng/dL and at 4 hours after morning dose, 772 ng/dL (12.p.m.) and don't drop below 500 until about 5 p.m and dose a second time a few hours later.
 
With a single 237mg dose of Jatenzo, you will be in the hypogonadal state most of the 24h dosing interval.

The solution is to either increase the dose, in which case your peak testosterone will be several times above upper normal, or as in your case to take doses separated by 12hours.

This illustrates exactly the weakness of the delivery method - you either have to take too much of it and be hyper-gonadal, or dose it several times daily to avoid being hypo-gonadal most of the time, which is not the normal testosterone variation cycle.
 
With a single 237mg dose of Jatenzo, you will be in the hypogonadal state most of the 24h dosing interval.
Jatenzo dosing is twice daily, no one is going to dose Jatenzo once daily, so your argument is nonsense.

You're overthinking it.

The solution is to either increase the dose, in which case your peak testosterone will be several times above upper normal
More nonsense. You're basing all of this off of a hypothetical situation that doesn't exist.

This illustrates exactly the weakness of the delivery method - you either have to take too much of it and be hyper-gonadal, or dose it several times daily to avoid being hypo-gonadal most of the time
I take it you missed the efficiency rating on Jatenzo in the clinical trial data provided in my thread.

It was noted that men going from injections to Jatenzo didn't notice a better or worse response in regards to the side effect profile.

You keep creating hypothetical situations that don't exist. I never feel hypogonadal on Jatenzo, I feel the same 24/7.
 
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you either have to take too much of it and be hyper-gonadal, or dose it several times daily to avoid being hypo-gonadal most of the time, which is not the normal testosterone variation cycle.
I don't have to take too much of Jatenzo or overshoot my levels above normal to show a very strong response to therapy.

According to my endocrinologist, he says I'm over-responding to Jatenzo. Maybe this statement is misguided and I'm just responding very strongly to Jatenzo rather than over-responding.
 
The oral testosterone pills have the opposite problem: the levels achieved are actually too low most of the time. For some, achieving an average level of 400 ng/dL is "in normal range" but doesn't cut it as TRT.

Remember, oral testosterone was taken in huge doses in 1970s and it was discontinued exactly because of too low average levels achieved, compared to injectable or transdermal. These new companies pushing overpriced testosterone pills are not actually inventing the wheel and the hot water.

It's fine if they release it at prices matching injectable testosterone but it seems that will not be the case and for people without insurance, which is willing to be milked in that blatant way, the injectable or transdermal testosterone will remain the only feasable options, which will lead to a waning hype for the testosterone pills.

The oral testosterone pills have the opposite problem: the levels achieved are actually too low most of the time. For some, achieving an average level of 400 ng/dL is "in normal range" but doesn't cut it as TRT.

Boo hoo!

Might wanna throw that SD in there while you are at it.

Even then it is dosed twice daily (12 hrs apart) which results in 2 peaks/troughs over 24 hrs.

Many will do just fine!


post #9

Kyzatrex

*The average daily NaF/EDTA plasma testosterone concentration was 393.3 (±113.6) ng/dL after 90 days of treatment

Tlando

*The average serum testosterone concentration over 24 hours (Cavg0-24h) observed following TLANDO administration was 476 ng/dL.

Jatenzo


The average daily NaF-EDTA plasma testosterone concentration was 403 (± 128) ng/dL at the end of the treatment








Remember, oral testosterone was taken in huge doses in 1970s and it was discontinued exactly because of too low average levels achieved, compared to injectable or transdermal. These new companies pushing overpriced testosterone pills are not actually inventing the wheel and the hot water.

Hate to burst your bubble but I reside in Canada and no one is even prescribing the older outdated oral TU (Andriol) anymore.

Once some of the newer oral TU formulations are approved by Health Canada they will be offered to any hypogonadal patient who wants to trial it!





*(Andriol®) was highly influenced by dietary fat, thus leading to significant intra- and inter-patient variability in T response and questionable clinical utility.7,8 Reformulation of this product to reduce the effect of dietary fat did not address the low TU content of the capsules, thus resulting in the need to dose hypogonadal men with several capsules three or more times daily. Even then, reported serum T response would not result in average serum T levels in the normal range



A new oral testosterone undecanoate therapy comes of age for the treatment of hypogonadal men (2020)


*Historically, efforts to administer oral T have taken two primary paths: alkylation of T at the C-17 position to create T analogs that are resistant to first-pass hepatic metabolism (exemplified by methyltestosterone);2 or fatty-acid esterification of T to create a T-ester (exemplified by TU) that is absorbed via the intestinal lymphatic system thus bypassing the portal circulation.3 Oral methyltestosterone, originally discovered and used clinically in the mid-1930s,1 is the only oral TRT ever approved for use in the US, but has been associated with serious hepatotoxicity such as cholestasis, peliosis hepatis, and hepatic adenocarcinoma4–6 and therefore is not recommended for clinical management of male hypogonadism. Conversely, while oral TU has not been associated with liver toxicity, an early oral TU formulation approved for use in many countries but never in the US (Andriol®) was highly influenced by dietary fat, thus leading to significant intra- and inter-patient variability in T response and questionable clinical utility.7,8 Reformulation of this product to reduce the effect of dietary fat did not address the low TU content of the capsules, thus resulting in the need to dose hypogonadal men with several capsules three or more times daily. Even then, reported serum T response would not result in average serum T levels in the normal range9 and therefore would not pass current-day regulatory scrutiny for efficacy. Consequently, these oral TU formulations have never been widely used to treat T deficiency although they remain available in many countries.







 
With a single 237mg dose of Jatenzo, you will be in the hypogonadal state most of the 24h dosing interval.

The solution is to either increase the dose, in which case your peak testosterone will be several times above upper normal, or as in your case to take doses separated by 12hours.

This illustrates exactly the weakness of the delivery method - you either have to take too much of it and be hyper-gonadal, or dose it several times daily to avoid being hypo-gonadal most of the time, which is not the normal testosterone variation cycle.

Who the f**k in their right mind would dose it once daily!

This is ridiculous.

Give your head a shake son!

All of the oral TU therapies available are meant to be taken twice daily due to the PK.
 
My point was that these oral testosterone pills are not feasible: daily injectable or daily transdermal testosterone have better and more natural PK and are cheaper for the masses.

The second point is that the oral pills Jatenzo come with the insane price of $1000/month. Most insurances don't and won't cover it, because there are way cheaper alternatives with equal or better effectiveness.

The bottom line is that price gouging shemes like Jatenzo are not going to pick up unless they reduce the price to $30-50 monthly. There are already signs of the logical decline of Jatenzo and it will be the same for anyone else trying the same scheme:

https://www.fiercepharma.com/pharma...nch-jatenzo-falters-triggering-layoffs-and-rd
 
equal or better effectiveness.
You're making claims without any evidence that Jatenzo is less effective than injections, gel and creams.

Even then it is dosed twice daily (12 hrs apart) which results in 2 peaks/troughs over 24 hrs.

Many will do just fine!

I take it you missed the efficiency rating on Jatenzo in the clinical trial data provided in my thread.
Clearly this went way over your head.
 
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Actually the maker of Jatenzo is already bankrupt, not because their pills do not work but because they do not understand what would be a reasonable market price for their pills:

Clarus Therapeutics Holdings, Inc. Announces Plan for Near-Term Sale of JATENZO® Using Structured Process Through Chapter 11 of the U.S. Bankruptcy Code

The same fate awaits any other drug maker that tries to repackage something that already exists at a 100 times higher price. The female drugs for libido will fail for exactly the same reason.
 
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