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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Basics & Questions
so what *are* the possible causes of late-onset secondary hypogonadism?
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<blockquote data-quote="madman" data-source="post: 138178" data-attributes="member: 13851"><p><strong>ABSTRACT </strong></p><p></p><p><strong><span style="color: rgb(184, 49, 47)">Introduction: </span></strong>The frequency of late-onset hypogonadism (LOH) ranges between 2 and 15%. <strong><span style="color: rgb(184, 49, 47)">Up to 85% of LOH </span>is due to a functional impairment of the hypothalamus–pituitary–testicular axis, <span style="color: rgb(184, 49, 47)">mostly secondary to metabolic conditions.</span></strong></p><p></p><p><strong><span style="color: rgb(184, 49, 47)">Areas covered:</span></strong> This paper provides a comprehensive review of all the available medications for treating LOH, including antiestrogens, gonadotropins and testosterone therapy (TTh). In addition, the evidence on clinical outcomes of these treatments is provided by meta-analyzing the results from the available randomized clinical trials.</p><p></p><p><strong><span style="color: rgb(184, 49, 47)">Expert commentary: </span></strong>The present data indicate that antiestrogens are able to increase testosterone levels without changing gonadotropins or even increasing them. Therefore, they may maintain, and even to stimulate spermatogenesis. However, their efficacy in treating LOH-associated symptoms has been scarcely tested and their use in LOH is off-label. In contrast, gonadotropins are indicated for hypogonadism, in particular when fertility is required. Information on the effects of gonadotropins on LOH is scanty and the impractical administration limits their use. TTh can be administered with different modalities, making it a suitable option for LOH, when fertility is not desired. The available meta-analyses show that TTh is able to improve sexual function and body composition, with more evident results obtained with transdermal and injectable preparations.</p><p></p><p></p><p></p><p></p><p></p><p></p><p></p><p></p><p></p><p></p><p><strong>9. Five-year view</strong></p><p></p><p>LOH has confirmed as a <strong>frequent finding in both general and specific populations.</strong> <strong><span style="color: rgb(184, 49, 47)">Even though its pathogenesis and clinical meaning is still unclear, in the last years the urgency of recommendations on its clinical management has emerged.</span></strong> TTh represents the most classical therapeutic approach for treating LOH. In the last years, many efforts have been done for evaluating the benefits of TTh in the treatment of LOH and several RCTs have been published with different outcomes. The meta-analysis of the available RCTs confirms that TTh is able to improve sexual function, body composition and glycolipid metabolism. In contrast, data concerning the effect of TTh on osteoporosis and mood or cognition are still scanty with insufficient or inconclusive results. Since LOH has often a functional nature; in the last years a nonpharmacologic approach, based on lifestyle, has been encouraged. However, despite there is evidence for an increase in serum T levels after weight loss, there is still no data of an associated improvement in clinical features of LOH. In secondary HG, gonadotropins and antiestrogens represent other possible treatments for LOH. Despite their mechanism of action is more respectful of HPT axis physiology than TTh, also allowing preserving fertility, their use in LOH men has been scarcely studied, in particular concerning sexual outcomes. Although showing a nice increase in serum T, antiestrogens carry the potential––and still not extensively studied––risk of worsening sexual function and osteoporosis. However, the need of acquiring more information on these medications for LOH has been apparently received by researchers, since several clinical trials are now ongoing.</p><p></p><p>At present, TTh seems to be the most reasonable treatment for LOH, because it is the most studied in terms of both advantages and disadvantages. However, it is conceivable that in the next few years further information will be available on these new options, which will make them more realistic alternatives to TTh.</p><p></p><p></p><p></p><p></p><p></p><p></p><p></p><p><strong><span style="color: rgb(184, 49, 47)">Key issues </span></strong></p><p></p><p>●<strong> LOH is the most frequent form of hypogonadism (HG) and it is characterized by low serum testosterone (T) together with symptoms consistent with HG. <span style="color: rgb(184, 49, 47)">It often results from a mixed disruption of the HPT axis at central or peripheral level, without a clear structural lesion at either these levels. </span>Thus, it is considered functional in about 85% of cases.</strong></p><p></p><p>● A non-pharmacological approach with lifestyle improvements is the most rationale treatment because it removes the causing conditions, resulting in serum T increase. However, compliance is an issue. In addition, there is still limited evidence of its efficacy in improving the LOHrelated symptoms.</p><p></p><p>● Estrogens can inhibit HPT axis and, despite conflicting evidence have been reported, they are deemed to have a role in pathogenesis of obesity-related HG. Antiestrogens (SERMs or aromatase inhibitors) can decrease estrogen activity on hypothalamus and pituitary, thus being an option for LOH therapy. Indeed, this treatment––used offlabel for HG––is associated with a considerable increase in serum T. However, the improvement in LOH clinical features has been scarcely investigated. Due to the possible role of estrogens in physiology of sexual function and bone, concerns exist on the possibility that antiestrogens could have a deleterious, rather than beneficial, effect on sexual complaints and osteoporosis.</p><p></p><p>● Gonadotropins are on label treatments for HG and they are mainly used for improvement of fertility. They could represent an option in LOH for the increasingly later search of paternity during life. However, they have not been specifically studied in LOH and their advantages on its clinical features are largely speculative.</p><p></p><p>● T therapy (TTh) is available with a number of possible formulations, which can be tailored in the patient needs. In the last years, several randomized clinical trials have assessed its efficacy in improving clinical features of LOH. These have shown that TTh can ameliorate sexual symptoms, body composition and glycolipid levels. Uncertainness still exists on its role in improving mood and cognition as well as the risk of fractures.</p></blockquote><p></p>
[QUOTE="madman, post: 138178, member: 13851"] [B]ABSTRACT [/B] [B][COLOR=rgb(184, 49, 47)]Introduction: [/COLOR][/B]The frequency of late-onset hypogonadism (LOH) ranges between 2 and 15%. [B][COLOR=rgb(184, 49, 47)]Up to 85% of LOH [/COLOR]is due to a functional impairment of the hypothalamus–pituitary–testicular axis, [COLOR=rgb(184, 49, 47)]mostly secondary to metabolic conditions.[/COLOR][/B] [B][COLOR=rgb(184, 49, 47)]Areas covered:[/COLOR][/B] This paper provides a comprehensive review of all the available medications for treating LOH, including antiestrogens, gonadotropins and testosterone therapy (TTh). In addition, the evidence on clinical outcomes of these treatments is provided by meta-analyzing the results from the available randomized clinical trials. [B][COLOR=rgb(184, 49, 47)]Expert commentary: [/COLOR][/B]The present data indicate that antiestrogens are able to increase testosterone levels without changing gonadotropins or even increasing them. Therefore, they may maintain, and even to stimulate spermatogenesis. However, their efficacy in treating LOH-associated symptoms has been scarcely tested and their use in LOH is off-label. In contrast, gonadotropins are indicated for hypogonadism, in particular when fertility is required. Information on the effects of gonadotropins on LOH is scanty and the impractical administration limits their use. TTh can be administered with different modalities, making it a suitable option for LOH, when fertility is not desired. The available meta-analyses show that TTh is able to improve sexual function and body composition, with more evident results obtained with transdermal and injectable preparations. [B]9. Five-year view[/B] LOH has confirmed as a [B]frequent finding in both general and specific populations.[/B] [B][COLOR=rgb(184, 49, 47)]Even though its pathogenesis and clinical meaning is still unclear, in the last years the urgency of recommendations on its clinical management has emerged.[/COLOR][/B] TTh represents the most classical therapeutic approach for treating LOH. In the last years, many efforts have been done for evaluating the benefits of TTh in the treatment of LOH and several RCTs have been published with different outcomes. The meta-analysis of the available RCTs confirms that TTh is able to improve sexual function, body composition and glycolipid metabolism. In contrast, data concerning the effect of TTh on osteoporosis and mood or cognition are still scanty with insufficient or inconclusive results. Since LOH has often a functional nature; in the last years a nonpharmacologic approach, based on lifestyle, has been encouraged. However, despite there is evidence for an increase in serum T levels after weight loss, there is still no data of an associated improvement in clinical features of LOH. In secondary HG, gonadotropins and antiestrogens represent other possible treatments for LOH. Despite their mechanism of action is more respectful of HPT axis physiology than TTh, also allowing preserving fertility, their use in LOH men has been scarcely studied, in particular concerning sexual outcomes. Although showing a nice increase in serum T, antiestrogens carry the potential––and still not extensively studied––risk of worsening sexual function and osteoporosis. However, the need of acquiring more information on these medications for LOH has been apparently received by researchers, since several clinical trials are now ongoing. At present, TTh seems to be the most reasonable treatment for LOH, because it is the most studied in terms of both advantages and disadvantages. However, it is conceivable that in the next few years further information will be available on these new options, which will make them more realistic alternatives to TTh. [B][COLOR=rgb(184, 49, 47)]Key issues [/COLOR][/B] ●[B] LOH is the most frequent form of hypogonadism (HG) and it is characterized by low serum testosterone (T) together with symptoms consistent with HG. [COLOR=rgb(184, 49, 47)]It often results from a mixed disruption of the HPT axis at central or peripheral level, without a clear structural lesion at either these levels. [/COLOR]Thus, it is considered functional in about 85% of cases.[/B] ● A non-pharmacological approach with lifestyle improvements is the most rationale treatment because it removes the causing conditions, resulting in serum T increase. However, compliance is an issue. In addition, there is still limited evidence of its efficacy in improving the LOHrelated symptoms. ● Estrogens can inhibit HPT axis and, despite conflicting evidence have been reported, they are deemed to have a role in pathogenesis of obesity-related HG. Antiestrogens (SERMs or aromatase inhibitors) can decrease estrogen activity on hypothalamus and pituitary, thus being an option for LOH therapy. Indeed, this treatment––used offlabel for HG––is associated with a considerable increase in serum T. However, the improvement in LOH clinical features has been scarcely investigated. Due to the possible role of estrogens in physiology of sexual function and bone, concerns exist on the possibility that antiestrogens could have a deleterious, rather than beneficial, effect on sexual complaints and osteoporosis. ● Gonadotropins are on label treatments for HG and they are mainly used for improvement of fertility. They could represent an option in LOH for the increasingly later search of paternity during life. However, they have not been specifically studied in LOH and their advantages on its clinical features are largely speculative. ● T therapy (TTh) is available with a number of possible formulations, which can be tailored in the patient needs. In the last years, several randomized clinical trials have assessed its efficacy in improving clinical features of LOH. These have shown that TTh can ameliorate sexual symptoms, body composition and glycolipid levels. Uncertainness still exists on its role in improving mood and cognition as well as the risk of fractures. [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Basics & Questions
so what *are* the possible causes of late-onset secondary hypogonadism?
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