Category Archives: Testosterone Replacement Therapy

Introduction

Hypogonadism (HG), or testosterone (T) deficiency, is referred to as the syndrome of symptoms resulting from insufficient serum levels of testosterone, which results in inadequate action in sensitive tissues. Its role has been investigated for thousands of years, and the Romans are reported to have observed its impact on energy, erectile function, and urination.1 The causes are several, but they can be categorized into two primary groups: primary hypogonadism or testicular failure, acquired or congenital and secondary hypogonadism, which implies the origin of the syndrome is found in the hypothalamus or the pituitary gland including complex mechanisms.2 Klinefelter syndrome (KS) represents one of the commonest, congenital causes of primary hypogonadism.3 Conversely, the aging of the testicles seems to be a natural phenomenon as men will experience roughly a 12% per year reduction of their circulating testosterone levels starting at the beginning of fifth decade, which eventually results in the development of the late-onset hypogonadism (LOH).4 The timing of the manifestations varies according to the cause as congenital causes will manifest primarily as incomplete or delayed sexual development at childhood whereas late-onset or acquired hypogonadism will present more frequently as loss of libido, fatigue, mood disorders, and erectile dysfunction in older age.5,6

Hypogonadism presents as a clinical syndrome. This includes a combination of a variety of nonspecific signs and symptoms is present in addition to the hormonal imbalance. Incomplete sexual development, erectile and sexual dysfunction, decreased energy, mood disorders, muscle weakness, fatigue, sleeping difficulties, infertility, and chronic pain are the main manifestations of testosterone deficiency, which alone or in combination will affect significantly the quality of life of affected men.710 In aged males, the condition warrants high suspicion as symptoms are not specific. A combination of low energy, sleep disturbances, loss of libido, underperformed sexual activity, and emotional stress should trigger screening for hypogonadism in men above (but not limited to) the age of 40.7,11

Testosterone replacement therapy (TRT) or supplementation therapy (TST) has positive effects on body weight and metabolism, bone and liver health, cardiovascular status, sexual, and micturition health, and sarcopenia.12 It has been offered in multiple pharmacological forms (oral administration, injections gel, transdermal patches, etc) for the restoration of normal testosterone levels in cases of both primary and secondary hypogonadism when clinically appropriate.1 When hypogonadism is complicated by infertility, special hormonal manipulations are needed as low testosterone interferes with the spermatogenesis, but pure TRT may negatively affect the reproductive axis.13,14 Testosterone replacement differs to treatment with human chorionic gonadotropin (HCG), which is used to treat secondary hypogonadism and improve spermatogenesis by stimulating the Leydig cells without the side effects on fertility seen in TRT.15 Apart from the beneficial effect on the hormonal status, TRT has been found efficient to improve the quality of life in hypogonadic men as part of a multidisciplinary team approach as illustrated in subjective tools and metrics.1618 Various questionnaires and scoring systems have been proposed as assessors for the standardized evaluation of the effect on quality of life (QoL) along with the measurement of clinical parameters and should comprise the routine approach as QoL endpoints might elude.19,20 Specific questionnaires such as the widespread used aging males symptom rating scale (AMS) have been well-established as they assess several views of quality of life including sexual, somatic, and psychological aspects.18 However, a more delicate and thorough tool might be needed in men where the chief complaint comes from the mental sphere, sexuality, or chronic pain.21,22 Moreover, lower urinary tract symptoms are quite common in aging men with hypogonadism, affecting quality of life warranting follow-up.23 However, a standard regime for monitoring the QoL in men on TRT is unknown and the optimal tools are yet to be established. So far, no specific tools affecting QoL in men on TRT has been suggested or included in international guidelines.24 In this paper, we review the indications and the rationality of the available tools monitoring QoL in adult men with LOH on TRT, and we provide the evidence for their usage.

A nonsystematic search in PubMed/Medline, Google Scholar, Web of Science, and Embase was performed using the terms testosterone replacement therapy and quality of life, chronic pain, lower urinary tract symptoms, general health, well-being, sexual health, questionnaire. Outstanding studies escaped from engine search were selected through the full texts of the reviewed papers. Exclusion criteria were non-English, animal, and retracted studies. We select the evidence related to the specialism of tools in the below domains: general health assessment, lower urinary tract symptoms, sexual health assessment, mental health, in men treated with TRT for LOH.

The aging males symptoms (AMS) scale was developed in 1999 as a tool to aid assessment of andropause including evaluation of symptoms, severity, and response to TRT. It consists of 17 questions of somatic, psychological, and sexual symptoms and the score varies from 17 (minimal significance) to 85 (severe symptoms consistent to TD).25 It has been one of the most extensively used assessors of quality of life in men treated with hypogonadism and reduction of the score indicates treatment success in terms of quality of life improvements.26 Domains of the questionnaires can also be used separately for the assessment of the chief complaint such as sleep disturbance/apnoea which is not an uncommon manifestation of HG.7 Furthermore, it seems that the tool follows reliably the severity of the symptoms and the complexity of HG. Jeong et al reported that men with metabolic syndrome showed less improvement in the AMS scale reflecting directly the effect of the complications on quality of life.27 Similarly, the androgen deficiency in the aging male (ADAM) questionnaire is another used tool initially designed for the screening of low testosterone. This questionnaire is shorter and consists of 10 questions with a binary response (yes/no) assessing sexual life, energy levels, mood, and activities performance. It has been used, but less frequently compared to AMS, for the assessment of the response to TRT and reduction in the score indicates improvement in quality of life.28 Similarly to AMS, the questionnaire can be used for the assessment of single complaints such as the psychological aspects and for the monitoring of men with chronic pain.22,29 Short-form health survey (SF) questionnaires have been developed for monitoring the QoL in patients with chronic conditions and other stressful circumstances.30 They assess aspects of general health, physical functioning, role physical, bodily pain, vitality, social functioning, mental health, and emotional status.31 The original questionnaire consisted of 36 questions (SF36) has been used in young male cancer survivors treated for hypogonadism. This study did not reveal any changes in QoL but the outcome might be the result of selection bias.32 A shorter version of eight questions, the SF-8 has also been reported to assess the response to individual symptoms and the treatment effect of testosterone.19

Evaluation of the QoL related to lower urinary tract symptoms (LUTS) in men treated for HG is clinically relevant as there is a theoretical effect of testosterone on prostate growth. A 12% significant increase on prostate volume in hypogonadic men (with no bothering urinary tract symptoms) treated with TRT has been reported.33 Moreover, LUTS are reported quite common in aging men treated for hypogonadism, likely the result of concurrent BPH.23 Although the association of hypogonadism and LUTS is weak, men with obstructive symptoms due for surgery and international prostate symptoms score IPSS >19 have been reported with higher testosterone concentrations compared with men with lower score.34 In contrast, a meta-analysis has reported that alterations in IPSS for an average follow-up of three years were similar between men who received TRT versus those not treated. As a result and compared to the previous dogma, TRT should not be regarded an absolute, but rather a relative, contraindication in men with severe BPH.23,35 However, a critical view in studies showing no deterioration in IPSS with TRT may reveal that relevant information regarding the anatomical risk factors (eg, prostate volume) were unreported, whereas in others, men with high IPSS were excluded.35 Therefore, it is advisable that assessment of urinary tract symptoms be included in the follow-up of hypogonadic men treated with testosterone replacement. In that regard, the IPSS represents a well-reported, reliable tool in monitoring and can facilitate as an indirect measure of quality of life.35 Using IPSS, changes in both voiding and storage type of symptoms can be detected promptly in men on moderate to severe scale, in the very early follow-up of treatment at three months and even if TRT is used as monotherapy without addition of BPH drugs.3638 Furthermore and of interest, alterations in urinary symptoms have been reported not to be linked with similar effects of testosterone on general body health such as weight loss and sexual health; thus, IPSS looks sensible to remain during follow-up and not to be substituted by other markers of clinical response.39

Hypogonadism has been a well-documented cause of loss of libido and reduction of sexual activity affecting the quality of life significantly and independently.40,41 TRT compared with placebo has been shown to achieve a significant improvement in sexual health in men with no comorbidities treated for over 30 weeks.42 For the assessment of the response and monitoring of QoL several questionnaires have been proposed. The International Index of Erectile Function (IIEF) is a validated assessment tool for the evaluation of the severity of sexual illness in the concept of hypogonadic men under treatment. It is the more widespread used tool for the assessment of sexual health outcomes.42 It is a self-reported questionnaire of 15 questions, which in its original form assess erectile function, orgasm, desire, intercourse satisfaction, and overall satisfaction. The lower the score, the higher the severity of the symptoms.43 A shorter version (IIEF-5) includes a series of five questions which has been used for the assessment of sexual health in men treated with TRT.20 Replacement therapy has been found to improve all domains of IEFF over a timespan of several weeks following improvements in quality of life.44 Derogatis interview for sexual functioning (DISF-SRII) - scored to 100, where 100 indicates better sexual function is a self-reporting tool which can also be used as an alternative for men in TRT.45 The psychosexual daily questionnaire (PDQ) is a six-question tool providing a useful aspect of the psychosexuality of men with hypogonadism.46 The limitation of the tool is the need of daily completion for a standard period of time, which may vary but should reflect the past period. However, the domains of the questionnaire (desire, pleasure, mood etc) can be used for the assessment of the response to TRT with adequate reproducibility.45 The brief male Sexual function inventory (BMSFI) is a similar questionnaire of 11 questions which include erectile function, ejaculation, personal view of the sexual problem, and overall satisfaction. It has been reported useful for the monitoring of QoL in terms of sexual health in men undergoing TRT.47 Other validated tools such as the mens sexual health questionnaire score could be potentially used, but they are infrequently reported in men on TRT. One study has assessed the usage of the tool in men with testosterone deficiency and profound ejaculatory dysfunction.48

Mental health disorders such as depression or mood fluctuations are one of the principal manifestations of hypogonadism.49 Older and andropause men may see their QoL decline as part of the syndrome.50 Younger men with congenital HG may experience more severe mental disorders (eg, alienation, shame) due to disrupted puberty, infertility issues, or delay to the final diagnosis.51 Much of this dysfunction in hypogonadism can be reversed or improved when appropriate with TRT.52 The domains from the short-form health survey (SF) questionnaires can be used for monitoring mental health in men under treatment.9 The symptom checklist 90 revised (SCL-90-R) is a sum of 90 questions which is used for the assessment of psychological well-being in patients with mental diseases or coming from traumatic situations.53 The questionnaire is quite analytic including questions related to feeling of guilt, agoraphobia, anger, etc. It has been used to assess the magnitude of psychological distress in men with Klinefelter syndrome. Fabrazzo et al reported that men with KS at their 40s experience significantly higher presence of obsessions, compulsions phobias and psychoticism compared to healthy controls based on the analysis by SCL-90-R.16 Domains of the AMS questionnaire (No. 4) can also be used for the assessment of mental health in periodical visits,54 whereas QoL associated with mental health has been found to remain significantly impaired in those with a high AMS score.19 When the chief complaint is depression, questionnaires such as the Hamilton depression rating scale (HAM-D) and the Endicott quality of life enjoyment and satisfaction scale (Q-LES-Q) can be used at diagnosis, follow-up and to alert for relapse.21 The first one assesses the short-term (past three days) anxiety and tension, fears, muscular tension and difficulty in concentration.55 Q-LES-Q comes in a long a short form; the latter one consists of 16 questions assessing the level of satisfaction of the past week related to general activities, feeling of strength and sociality, sexual drive, and others similar parameters. It has been reported to carry the highest specificity.56 It also exists in a pediatric form, which might make it attractive in young-onset hypogonadic patients for the assessment of depressive disorders.57 Finally, AMS and SF questionnaires include questions assessing mental health and well-being.32,58

Quality of life and the entity of hypogonadism are strongly related. Regardless of age of presentation and exact cause, hypogonadic men experience significant deterioration in their well-being. Therefore, both the assessment of the QoL at diagnosis and the re-evaluation during treatment should be regarded integral part of the management. Although all aspects of HG may affect QoL by causing disease-related symptoms, in this paper we focused on the four main domains.

The questionnaires are the cornerstone of the assessment of HG and response to TRT in terms of QoL as holding several advantages. They can be conducted quickly, with low-cost, can be easily repeated and can facilitate research. In contrast, it should be noted that they carry the risk of reporting bias, which may occur due to defensiveness, education, feeling of guilt, and may range from the underreporting edge up to the extreme response bias.59 Also, they lack specificity for HG and therefore, should be utilized after the diagnosis of HG through measurement of testosterone has been established.8 In that regard, if symptoms persist during follow-up other pathologies must be evaluated.

The optimal tool for the assessment of QoL is unknown as no comparison has been reported amongst questionnaires. The sum of the fundamental tools per domain is illustrated in Table 1. The AMS scale and the short-form health survey questionnaires look a wise choice for monitoring as they assess general, social, and mental health; AMS also assess sexual health, but SF does not. The AMS scale can provide rapidly the magnitude and the extent of the effects of HG and the course of TRT.60 Further on, specific tools could be selected according to patients main complaint. In men with profound erectile dysfunction, IIEF score should be used for the assessment of sexual health and repeated during treatment.20 If mental health is mostly impaired, the likelihood of a severe underlying mental condition should be considered. Questionnaires such as the HAM-D scale should be used to assess the possibility of depressive disorder within or additional to the spectrum of HG.21 Although the usage of such questionnaires is quite useful to the urologist, a referral to a specialized clinician should be considered prudent if any signs of mental illness. It is of outmost importance that an indisputable linkage of mental illness to HG be avoided and rather, further investigated. Finally, the presence of LUTS in men with HG is not uncommon, especially in older men. As aforesaid, the old dogma that TRT is contraindicated in men with BPH has been revoked. However, possible selection bias in the reported studies warrants a close follow-up in men with BPH until the safety of TRT is confirmed.35 In that regard, the IPSS should be regarded a great tool for the risk stratification of men on TRT. Furthermore, clinical assessment through biochemical markers (eg, serum testosterone, lipid markers, hematocrit, etc) should also be considered as indirect prognostic assessors of QoL as disease-related symptoms from untreatable disease may affect well-being significantly.61 The optimal schedule of re-evaluating QoL endpoints is not defined, but it would be sensible to be re-evaluated every 36 months as the routine assessment for men on TRT.24

Table 1 Tools for Monitoring QoL

Moreover, a special mention should be made regarding the association between TRT and prostate cancer. That diagnosis of prostatic malignancy is frequent in the male population might be a significant reason for QoL changes.62 It has been reported TRT may neither have an impact on decision-making nor undermine early diagnosis of prostate cancer as the effect on prostate specific antigen (PSA) readings is minimal.63 No effect on overall and specific mortality, and eventually in QoL is expected in selected men having received successful surgical treatment for prostate cancer who receive TRT.64 The findings are consistent with the so-called saturation model which supports that in normal and high testosterone levels prostate growth is insensitive; however, other authors advise that the available evidence should be critically reviewed and any decision-making in that concept should not be based on the model alone.65 Specific guidelines for the management of these patients are still under consideration.66 Given the limitations of our study, a suggested algorithm is illustrated in Table 2. Finally, the peculiarities regarding administration methods (gel, injections, patches, etc) needs to be appreciated as they may be related to patient experience, but the actual effect is unclear as recommendations may be guided by the clinicians.67 Cost and convenience may have an impact on choice, but satisfaction has been reported similar among gels, injections, and implantable pellets.67

Table 2 Suggestion for Monitoring QoL in Men on TRT

We appreciate some limitations in our study. We performed a narrative review, not a systematic one, and the selection of the discussed score systems and questionnaires was based on the panels judgment. Our goal was to present the strategy regarding the utilization of these tools and not to perform a comparative, qualitative, or quantitative analysis. Moreover, it must be noted that our research was focused on the clinical concept of LOH and the treatment with testosterone supplementation in the aging male. Our results may, or may not, have reproducibility in infertile men with secondary hypogonadism treated with HCG.15

Monitoring the QoL in men on TRT warrants a deep insight of the clinical spectrum of HG and thus, a cautious selection of surveillance tools. Questionnaires are the cornerstone, but the optimal tool is unknown. A tool assessing several domains of QoL should be selected. However, in order that all aspects of well-being are monitored, a clinician may need to combine the tools and target the chief complaint. Finally, as the clinical spectrum of HG is not specific, questionnaires can be used to unmask coexistent mental illness. In cases of high suspicion, a specialist referral must be considered.

The authors report no conflicts of interest in this work.

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60. Moncada I. Testosterone and mens quality of life. Aging Male Off J Int Soc Study Aging Male. 2006;9:189193. doi:10.1080/13685530601003180

61. Morley JE. Testosterone replacement in older men and women. J Gender. 2001;4:4953.

62. Dunlop E, Ferguson A, Mueller T, et al. What matters to patients and clinicians when discussing the impact of cancer medicines on health related quality of life? Consensus based mixed methods approach in prostate cancer. Support Care Cancer. 2021;30:31413150. doi:10.1007/s00520-021-06724-6

63. Coward RM, Simhan J, Carson CC. Prostate-specific antigen changes and prostate cancer in hypogonadal men treated with testosterone replacement therapy. BJU Int. 2009;103:11791183. doi:10.1111/j.1464-410X.2008.08240.x

64. Miah S, Tharakan T, Gallagher KA, et al. The effects of testosterone replacement therapy on the prostate: a clinical perspective [version 1; referees: 2 approved]. F1000Research. 2019;8:217. doi:10.12688/f1000research.16497.1

65. Kim JW. Questioning the evidence behind the saturation model for testosterone replacement therapy in prostate cancer. Investig Clin Urol. 2020;61:242249. doi:10.4111/icu.2020.61.3.242

66. Bell MA, Campbell JD, Joice G, Sopko NA, Burnett AL. Shifting the paradigm of testosterone replacement therapy in prostate cancer. World J Mens Health. 2018;36:103109. doi:10.5534/wjmh.170007

67. Kovac JR, Rajanahally S, Smith RP, et al. Patient satisfaction with testosterone replacement therapies: the reasons behind the choices. J Sex Med. 2014;11:553562. doi:10.1111/jsm.12369

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Testosterone Replacement Therapy in the Aged Male: Monitoring Patients | IJGM - Dove Medical Press

FROM NORTH AMERICA SYNDICATE, 300 W 57th STREET, 15th FLOOR, NEW YORK, NY 10019

CUSTOMER SERVICE: (800) 708-7311 EXT. 236

TO YOUR GOOD HEALTH #12345_20220929

FOR RELEASE WEEK OF SEPT. 26, 2022 (COL. 4)

BYLINE: By Keith Roach, M.D.

TITLE: Testosterone injections most likely led to a very severe stroke

---

DEAR DR. ROACH: My 75-year-old husband was frustrated with not being able to retain an erection. He talked to his doctor about it, and she prescribed 200 mg of testosterone cypionate, which he would inject into his bottom once a week. He did this for four months, and then had a severe bilateral stroke (as in, he does not know where he is, what happened to him, cannot read or write, cannot walk, etc.).

After spending two weeks in the ICU, he went to a rehabilitation hospital for three weeks. The hematologist there told me his hemoglobin level was up to 20, and there was no reason a 75-year-old should have been prescribed testosterone when it can elevate his hemoglobin so much. I looked at my husband's labs over the last three years, and his hemoglobin was never above 15. Of course, I had no idea testosterone would elevate hemoglobin, or that it should not be prescribed to a 75-year-old.

What are the normal protocols for testosterone with older men? Could his testosterone injections have led to his stroke? -- D.H.

ANSWER: I am very sorry to hear about your husband.

Story continues below video

Testosterone replacement therapy is commonly prescribed to men in their 70s and 80s. Elevations of the hemoglobin levels are certainly well-described, but levels above normal only happen about 1% of the time. Experts recommend checking a blood count to look for these elevations three to six months after starting treatment. Testosterone should be stopped if the hemoglobin level is above normal.

Sometimes, there are other causes for the hemoglobin to go up, but a rise that high, when he had never had it before, makes it seem very likely to me that the testosterone was the cause. A hemoglobin level that high, from any cause, is a risk for stroke and heart attack. It is very possible the testosterone prescription led directly to the stroke.

I am publishing this in the column so that men who are taking testosterone know they should be periodically tested for this unusual complication.

DEAR DR. ROACH: I had carpal tunnel surgery two years ago. I now have trigger fingers in my index and ring fingers. I had cortisone injections but that didn't cure it. I, at one point, was not able to open my fingers. Now, my fingers are really stiff, and I can't bend them. When they get down too far, they lock, but usually, they're so stiff I can't bend them. Surgery was suggested. I'm hesitant, because I'm wondering if this will get better on its own with exercises. -- J.T.

ANSWER: Trigger finger is caused by the tendon getting stuck inside one of the pulleys of the hand. To the best of my knowledge, carpal tunnel surgery doesn't predispose to trigger finger, but there are some conditions that put people at risk for both conditions. Initial treatment of trigger finger is conservative, with splinting and anti-inflammatory drugs. If that doesn't work, injection of cortisone by a hand surgeon is usually successful.

Most of the hand surgeons I know will try injection three times before recommending surgery. People who have not gotten better with conservative treatment and injection generally do not get better on their own; though, a few people will. Unfortunately, postponing surgery too long can lead to the finger getting a contracture, where it will not straighten at all. It's best to have surgery before this complication occurs.

* * *

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

(c) 2022 North America Syndicate Inc.

All Rights Reserved

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ROACH: Testosterone injections most likely led to a very severe stroke - New Castle News

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In 2018, I decided to stop using testosterone replacement therapy due to the side effects I was experiencing, most notably, increasingly aggressive behavior.

One concern I had at the time, though, was that ending the treatment would cause an increase in Cushings-related symptoms, because other hormones might be affected. This treatment had addressed my low testosterone levels caused by a pituitary tumor.

I do not recommend abruptly stopping treatment like I did without consulting a professional first. Although I am now seeing the benefits of my decision, it was not an easy road, and at one point, I began to question if my choice was the right one.

The first thing I noticed when I stopped taking my injections was that my mood deteriorated. Feelings of sadness led to an occasional lack of motivation. This sadness was partly due to my reluctance to stop the treatment. While I believed the medication was working, I became aware of how the side effects were affecting both me and those around me. Also, my body had grown accustomed to it over the past year, which led to more emotional imbalance.

The lows in my mood started to improve with effort, such as doing more research on ways to naturally balance testosterone levels, tinkering with areas of my life that were affected by testosterone, and being more active. Eventually, these strategies led to drastic change.

The second effect of stopping treatment was fatigue. The best way to describe it is like working outside all day in the heat. To combat it, what worked well for me was a combination of a plant-based caffeinated green drink, vitamin C, and vitamin B12. This drink has been part of my morning routine for the past four years, since ending testosterone replacement therapy.

I dont like coffee, so it was a good alternative. I also wanted to stay away from most store-bought caffeinated drinks due to their high sugar content.

Other issues I had to deal with again were pain and stiffness, mainly in my feet and lower back. If I was sitting or lying down, my feet would ache when I got up or tried to move. When standing, my lower back would get stiff. It didnt matter how long I was standing, it just appeared to happen randomly.Of the various side effects, the pain and stiffness took the longest to overcome.

To relieve the pain, my wife bought me some braces. I used them for a while but didnt experience much of a change. Then, one day, I started noticing that there was no more pain. This continued to improve each day. I suspect that the amount of weight I had been carrying due to Cushings disease was creating stress on the lower parts of my body, such as my knees. That might have compressed my spine, ankles, and feet. Once I began stretching and being more active including walking 2 miles a day these areas of my body grew stronger, which helped to alleviate the pain.

Given all of these experiences, I eventually learned that I had to give myself time. Quitting testosterone therapy wasnt a process with quick results. It helps to stay positive and motivated, and to take things one day at a time. The peaks and valleys of our journeys shouldnt discourage us from the goal of getting back to optimum health.

The decision to stop any treatment is not one to take lightly. Its always important to talk to your healthcare team before making any changes to a treatment regimen. Doctors can also help you develop a plan of action to replace a particular treatment, if needed.

Today, my energy levels are up again, Ive seen no signs of aggression in my behavior, and my overall sense of well-being has improved. For me, stopping testosterone replacement therapy was worth the trouble because it forced me to look at my mind and body as a whole. The trade-off has been beneficial, and it allowed me to live a healthier lifestyle.

Note:Cushings Disease Newsis strictly a news and information website about the disease. It does not provide medical advice,diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice,diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those ofCushings Disease Newsor its parent company, BioNews, and are intended to spark discussion about issues pertaining to Cushings.

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What I Learned When I Stopped Testosterone Replacement Therapy |... - Cushing's Disease News

Low testosterone levels known in some corners as man-o-pause are one of the byproducts of aging; according to the American College of Physicians (ACP), an age-associated decline in total testosterone levels begins in men in their mid-30s and gradually increases by an annual average rate of 1.6%. The ACP reports that the incidence of low testosterone in the U.S. stands at about 20% in men older than 60, 30% in those older than 70, and 50% in those older than 80.

I see a fair amount of patients in their mid-50s and older who tell me about how they feel more tired, that their erections arent what they used to be, and how they have less interest in having sex with their partner. With some of those patients, tests show that their testosterone levels are totally normal, so I find myself telling them, Welcome to middle age.

But that is not always the case. On average, a testosterone level of 3001,000 nanograms per deciliter (ng/dL) of blood is normal. Reduced testicular function is typically diagnosed when the total testosterone is less than 300 ng/dL.

Effects of declining testosterone levels can include a lower sex drive, erectile dysfunction, lack of energy, loss of muscle strength, moodiness and even depression. In some cases, the decline can be attributed to such factors as an injury to the testes, a pituitary gland issue, a history of cancer/radiation therapy, and/or a family history of stroke or heart attack. However, in many instances, the cause for this decline can be simply attributed to age. However, in most instances, the cause for this decline is idiopathic that is, we simply dont know.

Fortunately there are ways of addressing low testosterone for most men: testosterone replacement therapy (TRT). Offered by urologists and endocrinologists, TRT can take many forms: injections of testosterone cypionate (Depo-Testosterone) and testosterone enanthate can be done at home, usually bi-weekly, while those involving deep intramuscular injections of testosterone undecanoate (Aveed) are given at your providers office, usually every 10 weeks.

Note that Aveed is only available through your doctors office, clinic, or hospital, and therefore is not a medicine you can give yourself at home. You must also remain at the providers site for 30 minutes after injection so that the provider can watch for symptoms of POME or a serious allergic reaction. Symptoms of POME, or Pulmonary Oil Microembolism, include cough, difficult or labored breathing, chest pain, dizziness, and temporary loss of consciousness.

There are also a variety of topical creams, pills, nasal sprays application frequency varies widely and even implantable pellets, which involves your provider making a small incision, usually in the buttocks, every three to six weeks.

Quality of life usually improves within a few weeks, but the full effects of TRT can take three to six months. Patients tend to feel more energetic and can lose weight (with exercise and a proper diet), and see improvements in their sex drive. Pre-diabetic and diabetic patients can also benefit with improved insulin production.

However, there are side effects to consider. These can range from hair loss, acne and even breast enlargement to elevated red blood cell counts, changes in liver function, and in some cases cardiovascular issues, including heart attack and stroke. All of these will be discussed with your primary care physician and the TRT provider, and regular monitoring via blood and urine tests are necessary.

Interest in TRT continues to grow and, under the right circumstances, can make a very positive impact on ones quality of life physically, mentally and emotionally. Consult a provider to see if its right for you.

Dr. Aaron Hagge-Greenberg is a urologist and urologic surgeon at White Plains Hospital Physician Associates. For an appointment, call 914-949-7556.

Related

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From White Plains Hospital: Feeling the Effects of Man-o-pause? - theLoop

Whether you search for SARMs results 1 month or results after using them for a few months, we assure you these are some miraculous compounds that are recently proven to be more effective than anabolic steroids. SARMs results popularity has outgrown many bodybuilding supplements and this is because they can help pack on mass, ripped physique, and exhilarating strength in a faster manner.

Checkout Best SARMs Alternatives online that works without any side effects!

In this article, we will talk about the worlds best and most renowned SARMs for Bulking and Cutting. We will also point out multiple SARMs there are for female bodybuilders and those who simply want to lose weight using bodybuilding exercises.

What are SARMs?Recently, many people with no background in scientific studies asking are SARM a drug? This is in fact a fair question because SARMs have infiltrated bodybuilding and somehow managed to replace anabolic steroids.SARMs are actually Selective Androgenic Receptor Modulators, they do resemble to anabolic steroids structure wise but their binding capacity is what makes them different from them. SARMs are unlike steroids in bodybuilding which means they only act on selective receptors without alerting other biological processes in the body.SARMs are less risky than steroids because they do not convert into DHT or Estrogen which is the reason why many male bodybuilders get the side effects. In terms of testosterone suppression, SARMs only cause this phase for a shorter time than steroids which results in prolonged testosterone suppression for bodybuilders.

SARMs Before and After ResultsSome obvious changes/results that you can experience after the intake of SARM are mentioned below. Highlighted Muscle GrowthMost athletes and bodybuilders do take SARMs because they work like a magic for outrageous muscle mass growth. Most of them expect to gain over 30 pounds of lean muscle which they achieved within 4 months time frame, but for this legit SARM supplement with proper prescribed dosage shall be taken into account. For example, regular use of 20mg Ostarine considerably helps with muscle growth which has been experienced by thousands of bodybuilders in the US alone. Weight/Fat lossBest SARMs for fat burning is amongst the top searches on Google and this is because SARMs are capable of incinerating the fat reservoir in the body. Not the healthy fat but the lipids that your body has been storing for years. In recent days, SARMs are more preferred than Clenbuterol a steroid which is used to get rid of extra fat in the body because of less risk associated with Andarine, one of the best SARM for fat loss. Escalated StaminaWhat is the use of SARMs if not for improved stamina and physical power? Nearly every SARM works on physical power and maximized strength which is the demand of every athlete and sportsman. Under the right dosage, SARMs not only amplify the stamina in men and women but also keeps them energetic, focused, and alert throughout the day. Stops Muscle Wasting SyndromeMany bodybuilders during working out with peak performance tend to lose healthy muscle tissues which arent supposed to be this way. This will also accumulate the water content in muscles which gives your arms and chest a flabby appearance. SARMs allocate the muscle and hydro content in a suitable way that will stop muscle wasting. Faster and Superior Recovery against Muscle FatigueStudies have shown that SARMs long-term use makes the body endure the pain and pressure efficiently. SARMs improve the energy production in muscles which also makes them resistant to sprains, injury, and fatigue during the workout or in the outside world.

Bulking SARMS Before and After ResultsHere are the most effective SARMs for bulking in 2022 which are currently being used by bodybuilders and athletes to compliment muscle mass growth.1. Testolone (RAD140)2. Ligandrol (LGD-4033)3. Ibutamoren (MK 677)

Testolone RAD 140 SARM Before and After ResultsTestolone is regarded as one of the latest and potentially active SARM for muscle growth and bulking cycle. RAD 140 is still under many clinical studies and is not been approved by the FDA yet. Bodybuilders like Testolone so much because of the rapid results and it resembles a testosterone steroid.The main use of Testolone RAD140 is in chemotherapy patients whove lost significant muscle mass, this SARM is given to them for rapid recovery by halting the muscle degenerative disorder. Many physicians around the world refer to RAD 140 as an alternative to Testosterone Replacement Therapy (TRT).Speaking of Testolone results, a vast majority of its user reported elevated energy levels and significant improvements in muscle growth. The mechanism hints at escalated protein synthesis which is very beneficial for bulking workouts. Although RAD 140 results take some time occasionally the gains are reportedly permanent and more solid. With the use of RAD140, users tend to feel nauseated and have other symptoms very little.

The best way to take Testolone is by taking it for 60 days straight (if you are looking for 10-20 lbs muscle gain), but it also depends on the dosage of the compounds. For more remarkable results, Testolone is often combined with other SARM for bulking named Ligandrol.

Ligandrol LGD 4033 SARM Before and After ResultsIn 2022, a vast group of bodybuilders prefers Ligandrol for the best-looking body. The SARM is typically run for 12 weeks straight in a 10-20mg per day dosage after which you can expect to achieve 20 pounds of lean mass.First-time Ligandrol LGD 4033 SARM users take it in little dosage i.e. 6-10 mg for 6 weeks which is to experience a very little amount of side effects. As a suitable SARM for bulking cycle, Ligandrol is also being used for improved fat loss, the SARM binds to the androgen receptors located in the adipose tissues which tend to fasten the metabolism and this will lead rapid weight loss.Ligandrol is sometimes compared to Trenbolone because both compounds stimulate the production of trep muscles. Following a calorie-restricted diet and another regular workout, there are many results you can expect while using Ligandrol. Increased energy, sharpened focus, and lean abs are some of them.

Ibutamoren MK 677 SARM Before and After ResultsNot always a SARM but MK 677 sometimes referred to as Growth Hormone Secretagogue which produces growth hormone and protein in the body. In dire need of supplements, bodybuilders occasionally take Somatropin steroids for HGH stimulation but Ibutamoren is replacing the steroids as we know. Thats because very few side effects are associated with Ligandrol than Somatropin.Ibutamoren MK 677 SARM is the ideal compound for power-lifters who dont take no for an answer when it comes to showing their full body potential. You can also observe increased fertility while consuming Ibutamoren.In the latest reviews about Ibutamoren SARM, it was concluded that it may not be too much helpful to prevent muscle soreness and injury. It can shorten the muscle healing time but thats nothing compared to what Testolone RAD 140 does.In addition, the growth hormone stimulator like MK 677 aids peaceful and sound sleep which is another useful gimmick for muscle recovery. Ibutamoren users reportedly take a brief amount of sleep but they wake up feeling energetic and fresh like they have been sleeping for a day. You can experience the same Ibutamoren result but the condition is to take it in the evening. Stacking Ibutamoren is easy with other SARMs and the surprising part about the compound is there are no need for Post Cycle Therapy. In fact, some users take MK 677 SARM as a part of their PCT which is to replenish the dropped testosterone and HGH levels.Cutting SARM Before and After ResultsBest SARMs for Cutting in 2022 are reviewed by the experts on the reddit forum and other notable platforms online. Some of these SARMs are perplexedly made but the science justifies the results.

Cardarine Before and After ResultsMany reviews about Cardarine GW-501516 SARM say its not a proper SARM but rather a PPAR receptor agonist. The function of such molecules is to provide the fat-burning effects to the body by burning fats and not glucose entirely. The fat cells fulfill the energy demands more efficiently than glucose does and by this, we mean better muscle definition and improved stamina ahead.Cardarine is used by exceptional types of bodybuilders who want to build an ethos out of themselves. GW 501516 tells us about the eradication of stubborn fat from the belly, only 15mg daily dosage for 8 weeks is sufficient for the desired results. You can see at the end of the first month that your body begins to react to strenuous workouts and that it also loses around 5% of body fats.Most people in 2022 are looking for a supplement that can help them shrink their love handles, after spending a sedentary lifestyle most of us get determined to the workout that only stays for a few days. SARMs like Cardarine is the name of the game when you keep wanting to be dedicated and punctual to the workout without any compunction for laters.

Ostarine Before and After ResultsAn athletic physique means you will develop cuts as well as muscle mass which is a pleasant sight for the viewers. With the help of the Ostarine cycle, many users reportedly gained over 8 pounds of lean muscle mass but they also get immense energy levels that help them with fat eradication.Ostarine cycle results in improved bone density, and insulin resistance and it does not interfere with the hormonal system. Many steroids and SARMs end up disturbing the levels of Testosterone, Progesterone, Growth Hormones, and Estrogen but Ostarine is exempted from all those nasty side effects.Ostarine is considered the mildest SARM which means its also safer than most bodybuilding SARMs available in 2022. So many clinical trials are already done on Ostarine and its awaiting FDA approval, there are fewer side effects than any other SARMs. You can take Ostarine in conjunction with RAD 140 Testolone or Ligandrol but you have to be punctual during the workout sessions.

Stenabolic SR9009 SARM Before and After ResultsStenabolic SARM is an ideal SARM for every type of body whether endomorphs or ectomorphs, the SARM is greatest in fat eradiation while replacing them with healthy muscle mass. Recently, the SR9009 Stenabolic cycle has taken a new turn in which bodybuilders are taking it as a weight loss supplement.Stenabolic is indeed a REV-ERB agonist which means it manages and regulates a special type of protein called REV-ERB. This protein is located throughout the body, especially in the muscle tissue, upon activation the regulation of fat metabolism and energy generation takes place and this turns the user into a more energetic, result-oriented, and literally a beast in the gym.Stenabolic is the best SARM for females in order to accomplish their weight loss goals. Different men and women athletes are getting fond of gene expression effects of Stenabolic which seems to increase the mitochondrial energy in each muscle cell. Mitochondria are frequently referred to as the "powerhouses" of cells because they produce most of the cell's energy. Therefore, by increasing the number of mitochondria in muscle cells, Stenabolic SR9009 may help a woman's muscles to produce more energy and become stronger.

Conclusion - Are SARMs Before and After Results Real?You have the liberty to not believe what they say about mere bodybuilding supplements, but SARMs or steroids are not just any other bodybuilding supplements. It took years of research and critical studies to define them and make them available in the consumer market. Just like the SARMs results, SARM side effects are also real which takes a heavy toll on the body at times.To avoid such outcomes, you may start with the minimum dosage of any SARM that you have chosen, also make sure to stick with a healthy diet plan and workout session which gets the most out of the SARMs before and after results.(Disclaimer : The above is a sponsored post, the views expressed are those of the sponsor/author and do not represent the stand and views of Outlook editorial.)

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SARMs Before And After Results Real SARM Results And Users Review In 2022 - Outlook India

Larry Wheels is known as one of the strongest men in the world because of the breath-taking feats of strength he performs. However, he has never attempted to deceive anyone into believing that he performed these accomplishments as a natural athlete. Despite Wheels openness when it came to his use of steroids and PEDs (Performance Enhancing Drugs), it became evident recently that he was pushing the limits, putting himself at risk for further injury and lasting damage.

Most recently, Larry Wheels injured his back because of rushing a process, which he hoped would help him deadlift 1,000 pounds (453.6 kilograms). The injury also forced him to withdraw from the 2022 Middle Easts Strongest Man contest. However, despite this deadlift being his greatest goal in life, the injury helped Larry realize how important his health is. So, he decided to stop using Steroids and will now try to maximize his off-cycle potential. The news was revealed in a new YouTube video that Larry posted on August 20th.

Related: Powerlifter Larry Wheels Describes Experience with Trenbolone as Living Hell

Having used steroids and PEDs for a decade, Larry Wheels describes his experience with them. Larrys use of these substances for such a long time has left some consequences, which affected his natural testosterone production.

Much like you dont know, I dont know what I am capable of off-cycle. Now, going completely off isnt an option for me. I cannot produce testosterone naturally. So, I am going to be on testosterone replacement therapy (TRT). I tried pull cycle therapy several times when I began cycling and I was unable to recover.

So Larry Wheels will no longer use steroids or performance-enhancing drugs, but since his body cannot produce testosterone on its own, he will have to undergo testosterone replacement therapy to reach a normal testosterone level. Having taken inspiration from a fellow YouTuber and fitness enthusiast, Derek from More Plates More Dates, he already has an idea of what he wants to do.

TRT for me would be anywhere from as low as 70 milligrams per week, as high as 175 I think 175 is a good place for me to start. If I speak with my doctor and we get my bloods done and we see that its more than whats necessary then I will decrease it, but I certainly wont increase it.

Wheels has been looking for a way to lift 1,000 pounds (453.6 kilograms) for some time now, and he does not appear to be giving up just yet. Currently, however, he will not be looking to do so since it is almost impossible to do so without the aid of performance-enhancing drugs. Larry has hinted that he may get back on PEDs in the future to deadlift 1,000 pounds, but it wont happen anytime soon.

I am not calling quits on it, but I am putting the brakes on attempting PRs like that at the moment Why do I have to do it right now? I am 27, I can take my time, it can be several years from now. Ill still be in my prime. Ill still be healthy.

It is likely that Larry Wheels greatest achievement in life will be deadlifting 1,000 pounds. This means that it cannot be easy and that it should not be rushed either. Its time for Larry to take care of his health and see what he can accomplish without the use of steroids in the future.

Seeing what Im capable of on TRT is more of a priority to me. Its more exciting. It makes me feel invigorated I dont know how I will perform without the assistance (steroids), because the fact of the matter is that PEDs make a tremendous difference in your physique, strength, psyche, recovery more than the general population understands.

Now that hes off PEDs, Larry Wheels will have to focus on his training, diet, recovery, and a whole lot more. He also does not plan to jump back on steroids and PEDs in the near future.

lbkg

Data Source: Open Powerlifting. Last Updated: August 3, 2022

Analyze Lifts

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He now wants to check out how different his deadlift program will be now that he is no longer on steroids. He will also regularly put out updates and training videos, so his transparency could help everyone understand the process he is going through. There is a lot to learn from Larrys experience, so it is exciting to envision what the future holds for him.

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Larry Wheels Stops Using Steroids: "I Am Going To Be On Testosterone Replacement Therapy" Fitness Volt - Fitness Volt

Overview

Hormone replacement therapy is a bit of a misnomer. Its natural for mens testosterone levels to decrease as they get older. So, hormone therapy doesnt replace anything that is naturally missing.

Testosterone is required for:

However, the natural decrease of this hormone in men typically doesnt affect overall health any more than the aging process does. Medical experts disagree about the significance of a testosterone level decrease. They also disagree about the health benefits of hormone therapy use to combat the natural aging process in men, especially given the risks.

Learn more: Is low testosterone dangerous to your health?

Some men with unnaturally low levels of testosterone can benefit from hormone therapy. For example, the condition hypogonadism can cause unnaturally low levels of testosterone. Its a dysfunction of the testicles that prevents the body from producing the right amount of testosterone.

Whats less certain is whether testosterone therapy can benefit healthy men whose testosterone decline is simply caused by aging. This has been a difficult question for researchers to answer. Not many studies have observed the effects of testosterone therapy in men with healthy levels of the hormone. The studies that have were smaller and had unclear results.

Read more: Testosterone levels by age

If your doctor suggests testosterone therapy, several options are available. These include:

Side effects are a primary drawback of hormone therapy with testosterone. While some of the side effects are relatively minor, others are more serious.

Minor potential side effects of hormone therapy with testosterone include:

More severe potential side effects include:

An increased number of red blood cells can cause:

Hormone therapy can be a helpful treatment for men with unnaturally low levels of testosterone. However, it doesnt come without risks. These risks may outweigh the benefits if youre considering hormone therapy to make up for a natural decrease in testosterone levels.

Talk with your doctor about safer alternatives. Resistance exercise can help you build muscle mass, and walking, running, and swimming can help keep your heart strong.

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Hormone Replacement Therapy for Men: What to Know - Healthline

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The post Testosterone Replacement Therapy Market Trends, Analysis, Demand and Global Industry Research Report, Region, and Segment Forecasts 2028 appeared first on Market O Graphics.

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Testosterone Replacement Therapy Market Trends, Analysis, Demand and Global Industry Research Report, Region, and Segment Forecasts 2028 - Digital...

Hormones are chemical messages sent around the body that stimulate physiological change, bringing improved states of function and balance. Insulin, for example, is released after a meal and tells receptor cells around the body to absorb glucose in readiness for future energy demands. Unfortunately, our hormonal efficacy tends to deteriorate as we age.

Insulin is just one of many hormones that comprise our endocrine system, which is responsible for the hormones that control metabolism, growth, organs, mood and reproduction but we also have dominant sex hormones that drive our development, function and daily lived experience.

Testosterone is a key sex steroid for males (although it also circulates in females at lower levels) used to calibrate functions including libido, muscle mass, bone density and fat storage.

As you may have guessed, testosterone declines slowly past the age of 30 such that a normal level for under-50 males is 8.7-29nmol/L (female 0.2-1.7nmol/L), while the over-50 male range drops to 6-26nmol/L.

This is a very gradual drop that can, to a point, be offset with strength training, nutrition, and lifestyle adaptations, says endocrinologist Dr Nicky Keay. The hormone drop in males is linear, while for many females, especially masters athletes, the opposite is true.

Photo: Thomas Barwick via Getty

The principal female hormones are oestrogen and progesterone. The former has positive ramifications for heart and bone health as well as brain function and general mood. The latters primary role is to balance oestrogen levels to ensure the ongoing health of the uterus.

The menopause is the point in time when female ovaries stop producing hormones and eggs. But this is not an on/off switch. Perimenopause is the transition to retirement of the ovaries, says Dr Keay. Sometimes you feel OK and sometimes you dont.

Symptoms of perimenopause include hot flushes, poor sleep, fatigue, feeling happy or sad for no reason, muscle and joint aches. For masters athletes the list of symptoms adds even more stress, precisely because female hormones are so critical for the maintenanceof consistent intense training and performance.

Until relatively recently, women had to accept it, but hormone replacement therapy, HRT, has changed that. As Dr Keay says, Why should females feel like this for the rest of their lives? We could potentially spend between one third to a half of our lives feeling like this.

Photo: Tom Roberton via Getty

HRT is a prescribed combination of progesterone and oestrogen. Dr Keay cites several key issues to consider for athletes contemplating HRT.

First off, its better to start HRT early to get the best long-term effects. The most effective HRT chemicals have the same molecular structure as your body produces and should be taken through the skin as a gel or patch, and thedose will require personalising.

So what will a female athlete feel when they start on HRT? Dr Keay predicts they should feel better recovery, focus and drive, but also cautions that female masters athletes, even on HRT, should plan to be kinder to themselves, as well as scheduling more time for recovery and strength training to offset both bone-minerality and muscle-bulk loss.

Jenny Copnall, five-time national mountain-bike champion turned cycling coach, says, As a coach Id approach menopause in much the same way as I do working with any rider, and that is through good communication, great attention to recovery and recovery indicators, and working with the individual to tailor a plan to suit their needs and lifestyle. Just like menstrual cycles, its a pretty individual thing.

Photo: Justin Paget via Getty

The controversy over HRT has now largely been dispelled by recent research, so what about testosterone replacement therapy (TRT) as males advance in age and lose hair, muscle mass and vitality? TRT and HRT are not actually compatible propositions, because testosterone and oestrogen decline at very different rates.

Females lose 90% of their hormones over a very short time-span. Post-30 males, on the other hand, have a constant and shallow decline in testosterone production, around 1-2% per year.

TRT carries health risks such as liver damage, cardiac problems and increased incidence of prostate cancer, while health and performance advantages are at best questionable.

Instead, male masters athletes can modify their lifestyle, training and diet. For many female masters athletes, however, HRT is potentially an incredibly effective tool to keep performing at a high level.

Photo: Danny Bird

Phil Cavell is co-founder and bikefitter atCyclefitin London. His bookThe Midlife Cyclistis available on Amazon (12.59)

This article is for informational purposes only and does not constitute medical advice. If you're interested in HRT or other therapies, consult your doctor.

Looking for more women's cycling? Head to our dedicated women's cycling hub.

Main image: SolStock via Getty

Read more:
Cycling and HRT: How will it affect me? - Cyclist