Can TRT Cause Urinary Tract and Prostate Problems?
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It's a well-known fact that Testosterone Replacement Therapy (TRT) does have accompanying side effects--fluid retention, breast enlargement, acne, oily skin, stimulation of prostate tissue, and so on. Now, concerns have been raised regarding the effect of TRT on both urinary tract infections and prostate health.
The good news is that there is no evidence linking hormone therapy to either Benign Prostate Hyperplasia (enlarged prostate) or Lower Urinary Tract Symptoms (LUTS). The concerns were raised due to the link between metabolic syndrome and LUTS.
However, the fact that TRT can improve metabolic syndrome means that there is potential for improvements in LUTS. At the same time, TRT has also been known to reduce prostatic inflammation, another contributing factor to LUTS.
What data there is points to the fact that TRT will NOT worsen urinary tract problems. In many cases, there is change in the LUTS at all, though in some few cases, TRT helped to improve LUTS.
[style=font-style:italic;](DeLay KJ, Kohler TS. Urol Clin North Am. 2016 Aug; p 43)[/style]
[style=font-weight:bold;]Can TRT Make Prostate Cancer Worse?
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Prostate cancer is among one of the most common types of cancer in men. Men with a history of prostate cancer are often recommended against undergoing TRT. The use of hormone therapy for hypogonadism among men with a history of this cancer is still a highly controversial subject. Recent findings have linked androgens (including testosterone) with the growth of prostate cancer.
However, a recent review of the studies examining the effects of testosterone on the male prostate has discovered that it may be safer to undergo TRT despite prostate cancer risk than was previously believed. Among cases of men with non-high-risk prostate cancer, there is no evidence to support the belief that TRT can raise the risk, promote the growth, or increase progression of cancer cells.
[style=font-weight:bold;]Note:[/style]Among men with high-risk prostate cancer, the evidence is still unclear.
Men with a family history of non-high-risk prostate cancer may be able to undergo TRT safely as a means of treating their hypogonadism, without fear of developing prostate cancer. Further research on the matter is warranted.
[style=font-style:italic;](Guyen TM, Pastuszak AW., Sex Med Rev. 2016 Jul 27)[/style]
[style=font-weight:bold;]Are American Guidelines for "Infertility" Correct for the World?
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The American Society for Reproductive Medicine has established clear guidelines and recommendations for male infertility, but are these guidelines applicable around the world? This study examined the validity of the guidelines specifically for European males.
Over 1,000 infertile men were examined, and underwent tests to measure:
Testicular volume
Serum hormones
The current Endocrine Society guidelines for hypogonadism in Europe defines it as less than 3 ng of testosterone per ml of blood. This was established according to the World Health Organization's reference criteria.
Of the men tested, a staggering 63.4% of the men would be considered "hypogonadal" or "infertile" according to the ASRM standards, but only 17.8% according to Endocrine Society guidelines. 23.7% of infertile men would have been overlooked according to ASRM standards. The specificity, accuracy, and sensitivity of the ASRM infertility tests were much lower than desirable, while the Endocrine Society tests had a better success rate.
As this study proves, the ASRM guidelines for infertility may work for American men, but may be less effective than the European Endocrine Society. ASRM methods of diagnosis may be unsuitable for European men.
[style=font-style:italic;](Ventimiglia E, et al. Fertil Steril. 2016 Jul 26)[/style]
[style=font-weight:bold;]Is Testosterone the Only Measure of Hypogonadism?
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Most people equate low testosterone levels with hypogonadism. However, what few people realize is that the testes produce four different hormones:
Testosterone
INSL3
AMH
InhB
Both InhB and Testosterone have dynamic regulation, while there is only limited information for the other two hormones. It is believed that in order to measure true gonadal function, all FOUR must be measured.
To test this hypothesis, researchers studied 210 men between the ages of 19 and 90, measuring the circulating levels of these four testicular hormones. The study found that all four hormones circulated mostly or entirely independent of each other. Some men had deficiencies in specific hormones, while others had deficiencies in all four. The testicular hormone profiles ranged from man to man.
This proves that testosterone is not the only accurate reflector of gonadal function. In order to truly measure gonadal states, it's essential to measure all four testicular hormones. The dynamic regulation of the hormones means that the hormone profile will be different for each person. Only be measuring all four can endocrinologists obtain a clear picture of true gonadal activity.
[style=font-style:italic;](Chong YH, Pankhurst MW, McLennan IS. J Gerontol A Biol Sci Med Sci. 2016 Jul 28)[/style]
[style=font-weight:bold;]How Hormones Affect the Heart Rate
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QT interval is defined as "the measure of the time between the start of the Q wave and the end of the T wave in the heart's electrical cycle." It's a measure used to monitor cardiac activity.
A prolonged QT interval can be dangerous, leading to torsades de pointes, an abnormal rhythm of the heart. In some cases, it can be fatal, causing cardiac death.
Men have a shorter QT interval than women, which means women have a higher risk of heart problems--particularly during their follicular phase (prior to ovulation) and after pregnancy. However, men suffering from peripheral hypogonadism also have a prolonged QT interval.
Progesterone and testosterone help to shorten the QT interval, while estradiol prolongs it. This means that both men and women undergoing estrogen therapy are at a higher risk of heart problems. Hypogonadism can also contribute to the problem, leading to abnormal cardiac rhythms. Just a bit more proof that treating hypogonadism is important!
[style=font-style:italic;](Salem JE, Alexandre J, Bachelot A, Funck-Brentano C. Pharmacol Ther. 2016 Jul 22.)[/style]
