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Testosterone Replacement, Low T, HCG, & Beyond
Prostate Related Issues
Pharmacological treatment of LUTS in BPH:
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<blockquote data-quote="madman" data-source="post: 186726" data-attributes="member: 13851"><p><strong>Pharmacological treatment of lower urinary tract symptoms in benign prostatic hyperplasia: <span style="color: rgb(184, 49, 47)">consequences on sexual function and possible endocrine effects </span></strong></p><p></p><p></p><p></p><p><span style="color: rgb(184, 49, 47)"><strong>ABSTRACT</strong> </span></p><p></p><p><strong>Introduction:</strong> Benign prostate hyperplasia (BPH) is one of the most prevalent diseases in aging men. It may adversely affect quality-of-life due to the presence of low urinary tract symptoms (LUTS) and its effects on sexuality.</p><p></p><p><strong>Areas covered:</strong> The impact of α1-blockers, 5α-reductase inhibitors (5-ARI), and phosphodiesterase 5 inhibitors (PDE-5i) on erectile and ejaculatory functions in men with BPH are covered. Endocrinological aspects have also been addressed, including the management of hypogonadism, which affects many patients with BPH, and the impact of the use of 5-ARI use on bone health.</p><p></p><p><strong>Expert opinion:</strong> <em><span style="color: rgb(184, 49, 47)">The adverse-event profile of α1-blockers depends on their affinity for the α1-adrenoceptors rather than selectivity. The probability of ejaculatory dysfunction is highest with silodosin than other nonselective drugs (tamsulosin, alfuzosin, doxazosin, and terazosin). </span></em><span style="color: rgb(44, 130, 201)"><em>Concerning the impact of finasteride and dutasteride on sexual desire, erectile function, and ejaculation, the vast majority of the studies have shown a low prevalence of treatment-related adverse events.</em></span> <em><span style="color: rgb(26, 188, 156)">Due to the benefits of erection, PDE5i represents the perfect class of drugs for the treatment of LUTS-BPH in patients with erectile dysfunction. </span></em><span style="color: rgb(243, 121, 52)">Testosterone replacement therapy could be considered in some hypogonadal patients with BPH. Finally, current evidence supports the safety of 5-ARI on bone tissue.</span></p><p></p><p></p><p></p><p></p><p></p><p></p><p></p><p><strong>8. Expert opinion </strong></p><p></p><p><em><strong><span style="color: rgb(184, 49, 47)">First-line therapy for BPH/LUTS syndrome is represented by α1-adrenoreceptor blockers. The adverse-event profile of these drugs depends on the affinity rather than selectivity for the α1Aadrenoceptor. Hence, the probability of ejaculatory dysfunctions is highest with silodosin than with other drugs with lower affinity for this receptor subtype (tamsulosin, alfuzosin, doxazosin, and terazosin).</span></strong></em> <span style="color: rgb(44, 130, 201)"><em><strong>However, classifying these patients by age (older vs. younger) and sexual activity (present or not), the use of PDE5is should be considered even if this is more expensive especially when BPH/LUTS coexists with ED. <u>Indeed, due to the benefits of erection, PDE5i represents the most advantageous class of drugs for the treatment of LUTS-BPH in patients with ED</u>. Interestingly, the remarkable effects of daily PDE5is on body composition and endothelial function other than sexual improvements are reported [121] and suggest a pleiotropic beneficial effect of these drugs. LUTS-BPH often associates with metabolic syndrome, although the exact mechanism has not been clarified yet. Molecular studies address insulin as a role in prostatic hyperplasia and inflammation [122].</strong></em></span> Also, insulin-resistance is a predictive factor of LUTS development, likely due to the close association between the hyperactivity of the autonomous nervous system (which involves the α-adrenergic pathway) and hyperinsulinemia [123]. Data coming out from the Third National Health and Nutrition Examination Survey (NHANES III), involving 2,372 patients, also reveal the association between hypertension and LUTS-BPH [124]. BMI has been demonstrated as a predictor of LUTS development, as confirmed by an analysis of 21,694 patients [125]. In addition, the second Nord-Trondelag Health Study, involving 21,694 patients, showed a higher risk for LUTS in patients with diabetes mellitus than in non-diabetic men [125], being the risk of BPH even fourfold higher in diabetic patients with high LDL cholesterol serum levels [126]. Taken together, these data strongly highlight the close association between LUTS-BPH with metabolic abnormalities and cardiovascular risk factors which has been ascribed by some authors to the male equivalent of polycystic ovarian syndrome (PCOS) occurring in these men [127–129]. In this view, the role of PDE-5i on metabolism and endothelial dysfunction deserves to be promoted and further addressed by focused studies.</p><p></p><p><span style="color: rgb(184, 49, 47)"><strong><em>According to guidelines, 5-ARI treatment (alone or in combination with α1-blockers) should be considered in older patients with prostate volume greater than 50 mL where a significant reduction of the prostate volume is expected after long-term use. Concerning the impact of finasteride and dutasteride on sexual desire, erectile function, and ejaculation, the vast majority of the studies have shown a low prevalence of treatment-related adverse events, being both almost well tolerated. However, they should be used cautiously because of their possible metabolic and reproductive adverse events, i.e. hypogonadism, that may be reverted by appropriate hormonal-specific treatments. Finally, few reported have been reported so far on the effects of these drugs on bone metabolism, the majority of these supporting the safety of 5-ARI on the bone tissue. This issue deserves to be further investigated in order to better assess the 5-ARIrelated adverse events. </em></strong></span></p><p></p><p></p><p></p><p></p><p></p><p></p><p><strong>The article highlights </strong></p><p></p><p>● <span style="color: rgb(184, 49, 47)"><u>The probability of ejaculatory dysfunction is highest with silodosin</u> than other non-selective drugs (tamsulosin, alfuzosin, doxazosin, and terazosin). </span></p><p></p><p>● <span style="color: rgb(184, 49, 47)">Finasteride and dutasteride are well tolerated. </span></p><p></p><p>● <span style="color: rgb(184, 49, 47)">Phosphodiesterase 5 inhibitors (PDE5i) are effective for the treatment of LUTS-BPH in patients with erectile dysfunction. </span></p><p></p><p>● <span style="color: rgb(184, 49, 47)">Testosterone replacement therapy (TRT) can be considered in hypogonadal patients with non-obstructive BPH. </span></p><p></p><p>● <span style="color: rgb(184, 49, 47)">5α-reductase inhibitors (5-ARI) are not harmful to bone tissue.</span></p><p></p><p>● <span style="color: rgb(184, 49, 47)">This box summarizes the key points contained in the article </span></p></blockquote><p></p>
[QUOTE="madman, post: 186726, member: 13851"] [B]Pharmacological treatment of lower urinary tract symptoms in benign prostatic hyperplasia: [COLOR=rgb(184, 49, 47)]consequences on sexual function and possible endocrine effects [/COLOR][/B] [COLOR=rgb(184, 49, 47)][B]ABSTRACT[/B] [/COLOR] [B]Introduction:[/B] Benign prostate hyperplasia (BPH) is one of the most prevalent diseases in aging men. It may adversely affect quality-of-life due to the presence of low urinary tract symptoms (LUTS) and its effects on sexuality. [B]Areas covered:[/B] The impact of α1-blockers, 5α-reductase inhibitors (5-ARI), and phosphodiesterase 5 inhibitors (PDE-5i) on erectile and ejaculatory functions in men with BPH are covered. Endocrinological aspects have also been addressed, including the management of hypogonadism, which affects many patients with BPH, and the impact of the use of 5-ARI use on bone health. [B]Expert opinion:[/B] [I][COLOR=rgb(184, 49, 47)]The adverse-event profile of α1-blockers depends on their affinity for the α1-adrenoceptors rather than selectivity. The probability of ejaculatory dysfunction is highest with silodosin than other nonselective drugs (tamsulosin, alfuzosin, doxazosin, and terazosin). [/COLOR][/I][COLOR=rgb(44, 130, 201)][I]Concerning the impact of finasteride and dutasteride on sexual desire, erectile function, and ejaculation, the vast majority of the studies have shown a low prevalence of treatment-related adverse events.[/I][/COLOR] [I][COLOR=rgb(26, 188, 156)]Due to the benefits of erection, PDE5i represents the perfect class of drugs for the treatment of LUTS-BPH in patients with erectile dysfunction. [/COLOR][/I][COLOR=rgb(243, 121, 52)]Testosterone replacement therapy could be considered in some hypogonadal patients with BPH. Finally, current evidence supports the safety of 5-ARI on bone tissue.[/COLOR] [B]8. Expert opinion [/B] [I][B][COLOR=rgb(184, 49, 47)]First-line therapy for BPH/LUTS syndrome is represented by α1-adrenoreceptor blockers. The adverse-event profile of these drugs depends on the affinity rather than selectivity for the α1Aadrenoceptor. Hence, the probability of ejaculatory dysfunctions is highest with silodosin than with other drugs with lower affinity for this receptor subtype (tamsulosin, alfuzosin, doxazosin, and terazosin).[/COLOR][/B][/I] [COLOR=rgb(44, 130, 201)][I][B]However, classifying these patients by age (older vs. younger) and sexual activity (present or not), the use of PDE5is should be considered even if this is more expensive especially when BPH/LUTS coexists with ED. [U]Indeed, due to the benefits of erection, PDE5i represents the most advantageous class of drugs for the treatment of LUTS-BPH in patients with ED[/U]. Interestingly, the remarkable effects of daily PDE5is on body composition and endothelial function other than sexual improvements are reported [121] and suggest a pleiotropic beneficial effect of these drugs. LUTS-BPH often associates with metabolic syndrome, although the exact mechanism has not been clarified yet. Molecular studies address insulin as a role in prostatic hyperplasia and inflammation [122].[/B][/I][/COLOR] Also, insulin-resistance is a predictive factor of LUTS development, likely due to the close association between the hyperactivity of the autonomous nervous system (which involves the α-adrenergic pathway) and hyperinsulinemia [123]. Data coming out from the Third National Health and Nutrition Examination Survey (NHANES III), involving 2,372 patients, also reveal the association between hypertension and LUTS-BPH [124]. BMI has been demonstrated as a predictor of LUTS development, as confirmed by an analysis of 21,694 patients [125]. In addition, the second Nord-Trondelag Health Study, involving 21,694 patients, showed a higher risk for LUTS in patients with diabetes mellitus than in non-diabetic men [125], being the risk of BPH even fourfold higher in diabetic patients with high LDL cholesterol serum levels [126]. Taken together, these data strongly highlight the close association between LUTS-BPH with metabolic abnormalities and cardiovascular risk factors which has been ascribed by some authors to the male equivalent of polycystic ovarian syndrome (PCOS) occurring in these men [127–129]. In this view, the role of PDE-5i on metabolism and endothelial dysfunction deserves to be promoted and further addressed by focused studies. [COLOR=rgb(184, 49, 47)][B][I]According to guidelines, 5-ARI treatment (alone or in combination with α1-blockers) should be considered in older patients with prostate volume greater than 50 mL where a significant reduction of the prostate volume is expected after long-term use. Concerning the impact of finasteride and dutasteride on sexual desire, erectile function, and ejaculation, the vast majority of the studies have shown a low prevalence of treatment-related adverse events, being both almost well tolerated. However, they should be used cautiously because of their possible metabolic and reproductive adverse events, i.e. hypogonadism, that may be reverted by appropriate hormonal-specific treatments. Finally, few reported have been reported so far on the effects of these drugs on bone metabolism, the majority of these supporting the safety of 5-ARI on the bone tissue. This issue deserves to be further investigated in order to better assess the 5-ARIrelated adverse events. [/I][/B][/COLOR] [B]The article highlights [/B] ● [COLOR=rgb(184, 49, 47)][U]The probability of ejaculatory dysfunction is highest with silodosin[/U] than other non-selective drugs (tamsulosin, alfuzosin, doxazosin, and terazosin). [/COLOR] ● [COLOR=rgb(184, 49, 47)]Finasteride and dutasteride are well tolerated. [/COLOR] ● [COLOR=rgb(184, 49, 47)]Phosphodiesterase 5 inhibitors (PDE5i) are effective for the treatment of LUTS-BPH in patients with erectile dysfunction. [/COLOR] ● [COLOR=rgb(184, 49, 47)]Testosterone replacement therapy (TRT) can be considered in hypogonadal patients with non-obstructive BPH. [/COLOR] ● [COLOR=rgb(184, 49, 47)]5α-reductase inhibitors (5-ARI) are not harmful to bone tissue.[/COLOR] ● [COLOR=rgb(184, 49, 47)]This box summarizes the key points contained in the article [/COLOR] [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
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Pharmacological treatment of LUTS in BPH:
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