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Testosterone Replacement, Low T, HCG, & Beyond
Prostate Related Issues
What is best meds for BPH and how long do they take to work?
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<blockquote data-quote="madman" data-source="post: 232472" data-attributes="member: 13851"><p>[URL unfurl="true"]https://www.excelmale.com/forum/threads/canadian-urological-association-guideline-mluts-bph.25845/[/URL]</p><p></p><p></p><p>I would tread lightly when it comes to the use of 5-ARIs (finasteride/dutasteride)!</p><p></p><p></p><p><strong>2.3 <u>Medical therapy</u></strong></p><p><strong></strong></p><p><strong>2.3.1. Alpha-blockers</strong></p><p><em>We recommend alpha-blockers as an excellent first-line therapeutic option for men with symptomatic bother due to BPH who desire treatment <strong>(strong recommendation, evidence level A).</strong></em></p><p></p><p></p><p><strong>2.3.2. 5-ARIs</strong></p><p><em>We recommend 5-ARIs (dutasteride and finasteride) as an appropriate and effective treatment for patients with LUTS associated with a demonstrable prostatic enlargement<strong> (strong recommendation, evidence level A)</strong></em></p><p></p><p></p><p><strong>2.3.3. Combination therapy (alpha-blocker and 5-ARI)</strong></p><p><em>We recommend the combination of an alpha-adrenergic receptor blocker and a 5-ARI as an appropriate and effective treatment strategy for patients with symptomatic LUTS associated with prostatic enlargement (>30 ccs) <strong>(strong recommendation, evidence level B)</strong></em></p><p><em></em></p><p><em>It may be appropriate to consider discontinuing the alpha-blockers in patients successfully managed with combination therapy after 6–9 months of combination therapy.32,33</em></p><p><em></em></p><p><em>We suggest that patients successfully treated with combination therapy may be given the option of discontinuing the alpha-blocker. If symptoms recur, the alpha-blocker should be restarted <strong>(conditional recommendation, evidence level B).</strong></em></p><p></p><p></p><p><strong>2.3.4. Antimuscarinic and beta-3 agonist medications</strong></p><p><em>We suggest that antimuscarinics or beta-3 agonists may be useful in predominately storage symptoms and BPH, and used with caution in those with significant BOO and/or an elevated PVR <strong>(conditional recommendation, evidence level C).</strong></em></p><p></p><p></p><p><strong>2.3.5. Antimuscarinic or beta-3 agonists in combination with alpha-blockers</strong></p><p><em>We suggest that an alpha-blocker combined with an antimuscarinic or beta-3 agonist may be useful to treat LUTS/ BPH in men with both voiding and storage symptoms and failure of alpha-blocker monotherapy <strong>(conditional recommendation, evidence level B).</strong></em></p><p></p><p></p><p><strong>2.3.6. Phosphodiesterase inhibitors</strong></p><p><em>We recommend long-acting PDE5Is as monotherapy for men with LUTS/BPH, particularly in men with both LUTS and erectile dysfunction <strong>(strong recommendation, evidence level B).</strong></em></p><p></p><p></p><p><strong>2.3.7. Desmopressin</strong></p><p><em>We recommend desmopressin as a therapeutic option in men with LUTS/BPH with nocturia as a result of NP (conditional recommendation, evidence level B).</em></p><p></p><p></p><p><strong>2.3.8. Phytotherapies</strong></p><p><em>We do not recommend phytotherapies as standard treatment for MLUTS/BPH <strong>(strong recommendation, evidence level B).</strong></em></p><p></p><p></p><p></p><p><strong><em>post #10</em></strong></p><p>[URL unfurl="true"]https://www.excelmale.com/forum/threads/low-testosterone-in-men-recommendations-on-the-diagnosis-treatment-and-monitoring.23933/#post-206877[/URL]</p><p></p><p></p><p><strong><u>BPH/LUTS</u></strong></p><p><strong></strong></p><p><strong><em>*There is no evidence that TTh either increases the risk of BPH or contributes to the worsening of LUTS</em></strong></p><p></p><p><em><strong>*At present, there is no evidence that TTh either increases the risk of BPH or contributes to the worsening of LUTS</strong></em></p><p></p><p></p><p></p><p></p><p></p><p>[URL unfurl="true"]https://www.excelmale.com/forum/threads/is-dihydrotestosterone-dht-good-or-bad-for-men.21071/[/URL]</p><p></p><p><em>In this issue of Endocrine Reviews, Swerdloff et al. (<a href="https://www.excelmale.com/forum/javascript%3A;" target="_blank">5</a>) review the human and animal data regarding the physiological and clinical implications of elevated blood concentrations of DHT in men and women. <strong>All exogenous testosterone formulations increase serum DHT concentrations above physiologically normal serum concentrations. </strong>Because testosterone therapy is commonly prescribed to men, understanding the physiological effects (beneficial and adverse) of supranormal DHT concentrations is clinically important (<a href="https://www.excelmale.com/forum/javascript%3A;" target="_blank">6</a>, <a href="https://www.excelmale.com/forum/javascript%3A;" target="_blank">7</a>). Although the focus of their review is on the physiological and clinical effects of supraphysiological serum DHT concentrations, they also review the effects of pharmacological suppression of DHT</em></p><p><em></em></p><p><em><strong>*</strong>Collectively, these data indicate that the<strong> prostate self-regulates DHT concentrations independently of serum DHT concentrations.</strong> <strong>Within a broad range from low to high-normal serum testosterone concentrations, <u>prostatic DHT concentrations remain stable</u></strong></em></p><p><em><strong></strong></em></p><p><em><strong>* DHT acts as a paracrine independently of circulating DHT concentrations</strong> for the two principal target organs in adults: <strong>prostate and skin</strong></em></p><p><em><strong></strong></em></p><p><em><strong>*</strong>The review by Swerdloff et al. (<a href="https://www.excelmale.com/forum/javascript%3A;" target="_blank">5</a>) demonstrates that <strong>DHT is principally a paracrine hormone. Circulating DHT concentrations have little relationship to prostatic and skin DHT concentrations. </strong></em><strong><em>In addition, within a broad range of serum testosterone concentrations, <u>raising or lowering serum testosterone concentrations has little effect on prostatic DHT concentrations</u></em></strong></p></blockquote><p></p>
[QUOTE="madman, post: 232472, member: 13851"] [URL unfurl="true"]https://www.excelmale.com/forum/threads/canadian-urological-association-guideline-mluts-bph.25845/[/URL] I would tread lightly when it comes to the use of 5-ARIs (finasteride/dutasteride)! [B]2.3 [U]Medical therapy[/U] 2.3.1. Alpha-blockers[/B] [I]We recommend alpha-blockers as an excellent first-line therapeutic option for men with symptomatic bother due to BPH who desire treatment [B](strong recommendation, evidence level A).[/B][/I] [B]2.3.2. 5-ARIs[/B] [I]We recommend 5-ARIs (dutasteride and finasteride) as an appropriate and effective treatment for patients with LUTS associated with a demonstrable prostatic enlargement[B] (strong recommendation, evidence level A)[/B][/I] [B]2.3.3. Combination therapy (alpha-blocker and 5-ARI)[/B] [I]We recommend the combination of an alpha-adrenergic receptor blocker and a 5-ARI as an appropriate and effective treatment strategy for patients with symptomatic LUTS associated with prostatic enlargement (>30 ccs) [B](strong recommendation, evidence level B)[/B] It may be appropriate to consider discontinuing the alpha-blockers in patients successfully managed with combination therapy after 6–9 months of combination therapy.32,33 We suggest that patients successfully treated with combination therapy may be given the option of discontinuing the alpha-blocker. If symptoms recur, the alpha-blocker should be restarted [B](conditional recommendation, evidence level B).[/B][/I] [B]2.3.4. Antimuscarinic and beta-3 agonist medications[/B] [I]We suggest that antimuscarinics or beta-3 agonists may be useful in predominately storage symptoms and BPH, and used with caution in those with significant BOO and/or an elevated PVR [B](conditional recommendation, evidence level C).[/B][/I] [B]2.3.5. Antimuscarinic or beta-3 agonists in combination with alpha-blockers[/B] [I]We suggest that an alpha-blocker combined with an antimuscarinic or beta-3 agonist may be useful to treat LUTS/ BPH in men with both voiding and storage symptoms and failure of alpha-blocker monotherapy [B](conditional recommendation, evidence level B).[/B][/I] [B]2.3.6. Phosphodiesterase inhibitors[/B] [I]We recommend long-acting PDE5Is as monotherapy for men with LUTS/BPH, particularly in men with both LUTS and erectile dysfunction [B](strong recommendation, evidence level B).[/B][/I] [B]2.3.7. Desmopressin[/B] [I]We recommend desmopressin as a therapeutic option in men with LUTS/BPH with nocturia as a result of NP (conditional recommendation, evidence level B).[/I] [B]2.3.8. Phytotherapies[/B] [I]We do not recommend phytotherapies as standard treatment for MLUTS/BPH [B](strong recommendation, evidence level B).[/B][/I] [B][I]post #10[/I][/B] [URL unfurl="true"]https://www.excelmale.com/forum/threads/low-testosterone-in-men-recommendations-on-the-diagnosis-treatment-and-monitoring.23933/#post-206877[/URL] [B][U]BPH/LUTS[/U] [I]*There is no evidence that TTh either increases the risk of BPH or contributes to the worsening of LUTS[/I][/B] [I][B]*At present, there is no evidence that TTh either increases the risk of BPH or contributes to the worsening of LUTS[/B][/I] [URL unfurl="true"]https://www.excelmale.com/forum/threads/is-dihydrotestosterone-dht-good-or-bad-for-men.21071/[/URL] [I]In this issue of Endocrine Reviews, Swerdloff et al. ([URL='https://www.excelmale.com/forum/javascript%3A;']5[/URL]) review the human and animal data regarding the physiological and clinical implications of elevated blood concentrations of DHT in men and women. [B]All exogenous testosterone formulations increase serum DHT concentrations above physiologically normal serum concentrations. [/B]Because testosterone therapy is commonly prescribed to men, understanding the physiological effects (beneficial and adverse) of supranormal DHT concentrations is clinically important ([URL='https://www.excelmale.com/forum/javascript%3A;']6[/URL], [URL='https://www.excelmale.com/forum/javascript%3A;']7[/URL]). Although the focus of their review is on the physiological and clinical effects of supraphysiological serum DHT concentrations, they also review the effects of pharmacological suppression of DHT [B]*[/B]Collectively, these data indicate that the[B] prostate self-regulates DHT concentrations independently of serum DHT concentrations.[/B] [B]Within a broad range from low to high-normal serum testosterone concentrations, [U]prostatic DHT concentrations remain stable[/U] * DHT acts as a paracrine independently of circulating DHT concentrations[/B] for the two principal target organs in adults: [B]prostate and skin *[/B]The review by Swerdloff et al. ([URL='https://www.excelmale.com/forum/javascript%3A;']5[/URL]) demonstrates that [B]DHT is principally a paracrine hormone. Circulating DHT concentrations have little relationship to prostatic and skin DHT concentrations. [/B][/I][B][I]In addition, within a broad range of serum testosterone concentrations, [U]raising or lowering serum testosterone concentrations has little effect on prostatic DHT concentrations[/U][/I][/B] [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Prostate Related Issues
What is best meds for BPH and how long do they take to work?
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