testosterone Archives

The Association Between Testosterone Treatment and Incident of Cardiovascular Events among Testosterone Deficient U.S. Veterans

by Thomas J. Walsh, MD, MBA, MS | Mar 2024

In this 19-minute presentation, Thomas J. Walsh, MD, MBA, MS, University of Washington, Seattle, Washington, highlights the need for further research to clarify the long-term effects of testosterone therapy on cardiovascular health, advocating for a balanced approach that weighs the potential benefits against the risks. Dr. Walsh’s presentation underscores the importance of personalized medicine in managing testosterone deficiency.

Update on Testosterone and Treatment for Diabetes Mellitus: T2DM Australian Study

by T. Mike Hsiech, MD, MBA | Aug 2023

T. Mike Hsieh, MD, MBA, provides an update on a study examining the use of testosterone therapy (TT) to treat type 2 diabetes mellitus (T2DM) in men. He describes the Testosterone Trials and summarizes findings in men treated with TT, including a significant increase in testosterone (T) levels and subsequent improvement of symptoms.

Dr. Hsieh discusses T and diabetes, and explains that obesity with or without diabetes is associated with lower T and an increased risk of T2DM. He explains that lifestyle intervention and metformin were shown to prevent progression of prediabetes to T2DM without TT. He discusses TT and cardiovascular disease (CVD), explaining T deficiency is associated with CVD. Though there is conflicting data on the benefit of TT on CVD, the 2018 American Urological Association (AUA) Testosterone Deficiency guideline cites no definitive evidence linking TT to a higher incidence of venous thromboembolism (VTE).

Dr. Hsieh discusses an Australian double-blind, randomized, controlled trial that aimed to determine whether TT combined with lifestyle intervention vs. lifestyle intervention alone reduced T2DM incidence and improved glucose tolerance at two years, while closely monitoring for signs of CVD. The study supported that, while TT plus lifestyle modification can prevent or revert T2DM in men without hypogonadism, hematocrit (HCT) levels must be closely monitored in men undergoing TT, and long-term safety and cardiovascular outcomes of TT remains to be determined. Finally, Dr. Hsieh cites the ongoing TRAVERSE study, examining the complications of TT in older men.

Male Mortality and Men’s Health Issues: Barriers, Testosterone, PDE5 Therapy and GLP1 Agonist Therapy

by Martin M. Miner, MD | Apr 2023

Martin M. Miner, MD, discusses the role of testosterone therapy in improving men’s health outcomes, including in prostate cancer.

Should “Age-Related” Testosterone Deficiency (TD) Be Treated?

by Abdulmaged M. Traish, PhD, MBA | Nov 2022

Abdulmaged M. Traish, MBA, PhD, Research Director at The Institute for Sexual Medicine and Emeritus Professor of Urology, both at Boston University School of Medicine in Boston, MA, discusses what he calls a fundamental question—whether age-related testosterone deficiency (TD) should be treated. He cites data demonstrating that T therapy in older men with TD produces significant health benefits. Dr. Traish questions why the U.S. Food and Drug Administration (FDA) opposes testosterone (T) therapy in older men but not in men with classical hypogonadism, concluding his talk by asserting that age-related TD does, indeed, merit treatment and by respectfully disagreeing with the FDA stance.

Semaglutide as a Game Changer for Weight Loss

by Mark A. Moyad, MD, MPH | Feb 2022

Mark A. Moyad, MD, MPH, the Jenkins/Pokempner Director of Preventive/Complementary and Alternative Medicine (CAM) at the University of Michigan Medical Center in the Department of Urology in Ann Arbor, Michigan, and Martin M. Miner, MD, Co-Director of the Men’s Health Center and Chief of Family and Community Medicine for Miriam Hospital, and Clinical Professor of Family Medicine and Urology at the Warren Alpert Medical School of Brown University in Providence, Rhode Island, discuss the potential benefits of semaglutide, a newly approved weight-loss drug. Dr. Moyad begins by summarizing the damage done by past weight-loss drugs, noting that they inevitably came with a huge catch and were never heart-healthy. He then introduces semaglutide, a recently-approved drug which has been shown to result in 15% weight loss over 2 years. Dr. Miner elaborates, explaining that there have been 4 studies of semaglutide featuring over 4500 individuals and that it is extremely safe. He highlights that the smaller dose in diabetics has also been shown to improve renal and cardiovascular outcomes, and that these outcomes are now being studied in non-diabetics. Dr. Miner argues that these results suggest semaglutide is a game changer. Dr. Moyad then discusses potential catches, noting that while the side effect profile seems good, the cost is very high at nearly $900 per month, and it is not covered by most insurance. Dr. Miner suggests that the price will go down once some time has passed from the initial approval. He does highlight as a negative the fact that semaglutide is given once per week as a subcutaneous injection, and suggests that it will be beneficial if the oral version currently under investigation is found to be effective. Drs. Miner and Moyad also ponder the long term impacts of semaglutide and sustained weight loss on testosterone levels, blood pressure, and depression. Dr. Moyad concludes by discussing his curiosity about the potential impact of semaglutide in a urologic setting.

Testosterone, Weight Loss / Weight Gain, and Testosterone Replacement Therapy (TRT)

by Mark A. Moyad, MD, MPH | Feb 2022

Mark A. Moyad, MD, MPH, the Jenkins/Pokempner Director of Preventive/Complementary and Alternative Medicine (CAM) at the University of Michigan Medical Center in the Department of Urology in Ann Arbor, Michigan, and Martin M. Miner, MD, Co-Director of the Men’s Health Center and Chief of Family and Community Medicine for Miriam Hospital, and Clinical Professor of Family Medicine and Urology at the Warren Alpert Medical School of Brown University in Providence, Rhode Island, investigate the ways in which body mass index (BMI) correlates with testosterone levels and how this knowledge can be used in a medical setting. Dr. Moyad begins the discussion with Dr. Miner’s presentation on the possibility of testosterone needs increasing as BMI increases, wherein Dr. Miner found that obese men required higher doses of testosterone to reach eugonadal levels than men who were not obese. Dr. Miner states that he expects the results of a long-term safety study of testosterone will soon show that testosterone therapy is safe over the long term, allowing physicians and researchers to focus on the symptomatic benefit of testosterone in areas such as mood and cardiovascular risk. Dr. Moyad asks if weight loss and increased fitness could possibly reduce the need for testosterone therapy, to which Dr. Miner responds that it may be possible if both weight loss and a reduction in comorbidities occur but it is unlikely in patients over 60. They conclude that weight loss can help make testosterone therapy more effective but it is unclear if it would be enough to reduce testosterone therapy altogether because of a multitude of genetic variables.

Semaglutide as a Game Changer for Weight Loss

by Martin M. Miner, MD | Jan 2022

Mark A. Moyad, MD, MPH, the Jenkins/Pokempner Director of Preventive/Complementary and Alternative Medicine (CAM) at the University of Michigan Medical Center in the Department of Urology in Ann Arbor, Michigan, and Martin M. Miner, MD, Co-Director of the Men’s Health Center and Chief of Family and Community Medicine for Miriam Hospital, and Clinical Professor of Family Medicine and Urology at the Warren Alpert Medical School of Brown University in Providence, Rhode Island, discuss the potential benefits of semaglutide, a newly approved weight-loss drug. Dr. Moyad begins by summarizing the damage done by past weight-loss drugs, noting that they inevitably came with a huge catch and were never heart-healthy. He then introduces semaglutide, a recently-approved drug which has been shown to result in 15% weight loss over 2 years. Dr. Miner elaborates, explaining that there have been 4 studies of semaglutide featuring over 4500 individuals and that it is extremely safe. He highlights that the smaller dose in diabetics has also been shown to improve renal and cardiovascular outcomes, and that these outcomes are now being studied in non-diabetics. Dr. Miner argues that these results suggest semaglutide is a game changer. Dr. Moyad then discusses potential catches, noting that while the side effect profile seems good, the cost is very high at nearly $900 per month, and it is not covered by most insurance. Dr. Miner suggests that the price will go down once some time has passed from the initial approval. He does highlight as a negative the fact that semaglutide is given once per week as a subcutaneous injection, and suggests that it will be beneficial if the oral version currently under investigation is found to be effective. Drs. Miner and Moyad also ponder the long term impacts of semaglutide and sustained weight loss on testosterone levels, blood pressure, and depression. Dr. Moyad concludes by discussing his curiosity about the potential impact of semaglutide in a urologic setting.

Testosterone as a Fasting Blood Test?

by Mark A. Moyad, MD, MPH | Jan 2022

Mark A. Moyad, MD, MPH, the Jenkins/Pokempner Director of Preventive/Complementary and Alternative Medicine (CAM) at the University of Michigan Medical Center in the Department of Urology in Ann Arbor, Michigan, and Martin M. Miner, MD, Co-Director of the Men’s Health Center and Chief of Family and Community Medicine for Miriam Hospital, and Clinical Professor of Family Medicine and Urology at the Warren Alpert Medical School of Brown University in Providence, Rhode Island, discuss recent guidance suggesting that a fasting blood test is needed for testosterone. Dr. Moyad begins by explaining that in 2018, the Endocrine Society Clinical Practice Guidelines included a recommendation of measuring fasting morning testosterone. He suggests that this is a logical recommendation since, in a subset of men, testosterone levels may be temporarily lowered by food intake, but notes that this guidance does not appear to be widely known or followed. Dr. Miner says that he actually does usually include testosterone with other morning fasting tests to meet the demands of insurance, although he argues that this may also result in inaccurate levels since testosterone is supposedly at its peak in the afternoon. He also mentions that the American Urological Association does not recommend getting testosterone tested in a fasting specimen, although he is unsure why this is. Dr. Moyad concludes that this is a topic that is just beginning to be explored and should be watched.

Testosterone as a Fasting Blood Test?

by Martin M. Miner, MD | Jan 2022

Mark A. Moyad, MD, MPH, the Jenkins/Pokempner Director of Preventive/Complementary and Alternative Medicine (CAM) at the University of Michigan Medical Center in the Department of Urology in Ann Arbor, Michigan, and Martin M. Miner, MD, Co-Director of the Men’s Health Center and Chief of Family and Community Medicine for Miriam Hospital, and Clinical Professor of Family Medicine and Urology at the Warren Alpert Medical School of Brown University in Providence, Rhode Island, discuss recent guidance suggesting that a fasting blood test is needed for testosterone. Dr. Moyad begins by explaining that in 2018, the Endocrine Society Clinical Practice Guidelines included a recommendation of measuring fasting morning testosterone. He suggests that this is a logical recommendation since, in a subset of men, testosterone levels may be temporarily lowered by food intake, but notes that this guidance does not appear to be widely known or followed. Dr. Miner says that he actually does usually include testosterone with other morning fasting tests to meet the demands of insurance, although he argues that this may also result in inaccurate levels since testosterone is supposedly at its peak in the afternoon. He also mentions that the American Urological Association does not recommend getting testosterone tested in a fasting specimen, although he is unsure why this is. Dr. Moyad concludes that this is a topic that is just beginning to be explored and should be watched.

Testosterone, Weight Loss / Weight Gain, and Testosterone Replacement Therapy (TRT)

by Martin M. Miner, MD | Jan 2022

Mark A. Moyad, MD, MPH, the Jenkins/Pokempner Director of Preventive/Complementary and Alternative Medicine (CAM) at the University of Michigan Medical Center in the Department of Urology in Ann Arbor, Michigan, and Martin M. Miner, MD, Co-Director of the Men’s Health Center and Chief of Family and Community Medicine for Miriam Hospital, and Clinical Professor of Family Medicine and Urology at the Warren Alpert Medical School of Brown University in Providence, Rhode Island, investigate the ways in which body mass index (BMI) correlates with testosterone levels and how this knowledge can be used in a medical setting. Dr. Moyad begins the discussion with Dr. Miner’s presentation on the possibility of testosterone needs increasing as BMI increases, wherein Dr. Miner found that obese men required higher doses of testosterone to reach eugonadal levels than men who were not obese. Dr. Miner states that he expects the results of a long-term safety study of testosterone will soon show that testosterone therapy is safe over the long term, allowing physicians and researchers to focus on the symptomatic benefit of testosterone in areas such as mood and cardiovascular risk. Dr. Moyad asks if weight loss and increased fitness could possibly reduce the need for testosterone therapy, to which Dr. Miner responds that it may be possible if both weight loss and a reduction in comorbidities occur but it is unlikely in patients over 60. They conclude that weight loss can help make testosterone therapy more effective but it is unclear if it would be enough to reduce testosterone therapy altogether because of a multitude of genetic variables.

Changing Paradigm in Testosterone Therapy Treatment Options

by Mohit Khera, MD, MBA, MPH | Jan 2022

Mohit Khera, MD, MBA, MPH, Professor of Urology and Director of the Laboratory for Andrology Research at the McNair Medical Institute at Baylor College of Medicine in Houston, Texas, discusses testosterone therapy, focusing on four key topics: oral testosterone, testosterone and COVID-19, testosterone and prostate cancer, and lifestyle modification. Dr. Khera provides a historical context for oral testosterone treatments, noting that the US has only recently seen expansion of this option. He describes the inTUne study which showed that 7% of patients may increase or start hypertension medication while on a testosterone oral therapy, but that overall patients experience a lower rate of erythrocytosis when compared with those receiving injectable and topical forms of testosterone. Dr. Khera then reviews several studies examining the relationship between COVID-19 and testosterone. Early studies showed men were more severely affected by COVID-19 than women. Paradoxically, low serum testosterone may be protective against acquiring COVID-19, but the same low serum testosterone can also result in a more severe outcome if that same patient acquires COVID-19. Additionally, COVID-19 also directly impacts the testicles in that serum testosterone levels significantly decrease from their pre-COVID-19 levels. Transitioning to prostate cancer, Dr. Khera describes the paradigm shift over the past 15 years, with physicians previously viewing testosterone as dangerous to now seeing it as protective. He illustrates the point with a prostate saturation model that shows the non-linear relationship between testosterone, PSA, and prostate size. Dr. Khera then considers treatment options with high levels of testosterone, such as bipolar androgen therapy, that have shown promising results. He concludes with a review of lifestyle modifications that can also improve testosterone levels, such as weight loss, sleep, and varicocele.

Testosterone Therapy in Men with Biochemical Recurrence and Metastatic Prostate Cancer

by Abraham Morgentaler, MD, FACS | Sep 2021

Abraham Morgentaler, MD, FACS, Associate Clinical Professor of Urologic Surgery at Harvard University, summarizes results from a recent study on testosterone (T) therapy for patients with biochemical recurrence and metastatic prostate cancer. He provides some background, explaining that physicians have been taught that raising testosterone in a man with prostate cancer is like “pouring gasoline on a fire,” even though approximately 20 years of evidence suggests that T therapy is safe after radical prostatectomy, after radiation therapy, in patients with prostatic intraepithelial neoplasia, and in patients on active surveillance. Dr. Morgentaler notes that his and his colleagues’ research indicates that T therapy is also safe for patients with advanced disease. He then goes over the makeup and design of the observational study, which featured 22 symptomatic men of a median age of 70.5. The median duration of T therapy was 12 months, and all patients reported symptomatic benefit from the treatment. The overall mortality was 13.6% with only one prostate cancer-specific death, and morbidity was fairly low, with no cases of pulmonary embolism, spinal cord compression or pathological fractures, and no observed rapid or precipitous progression of disease. Dr. Morgentaler highlights one 94-year-old patient’s experience, describing how this man wanted to be on testosterone because androgen deprivation made him too tired to do the things he enjoyed. After 6 weeks of T therapy, this patient’s brain was clearer, his appetite had improved, and he was exercising daily, and even though he died at age 95 after 11 months of therapy, Dr. Morgentaler emphasizes the importance of T therapy’s benefit to his quality of life in his final months. He concludes that there are men who prioritize quality of life over duration, that data contradict the idea that T therapy is dangerous for patients with prostate cancer, and that T therapy might in fact be a reasonable option for selected men with metastatic disease who refuse androgen deprivation.