Testosterone Replacement Therapy In India
Testosterone Deficiency is a global men’s health problem. Testosterone Replacement is supplementing basal T Levels with exogenous androgen hormones.
New Delhi Andrology Clinic is India’s number one Men’s Health Clinic. We offer comprehensive TRT in New Delhi from oral to injectables. Dr. Vijayant Govinda Gupta is an expert in Testosterone Replacent Therapy in India.
Low Testosterone can cause depression, mood swings and even heart problems. We link T levels to only Sexual weakness. But T is a much more potent hormone. #Testosterone has direct links to Heart, metabolism and Cognitive function.
- Benefits of Testosterone
- How to measure T Levels
- How to do Testosterone Replacement
- Types of available testosterone
- How to monitor patient
- Caution and side effects of TRT
Testosterone Replacement Therapy In India
Content is based on AUA Guidelines
What is Testosterone?
Steroid hormone from the androgen group
Stimulates development of male secondary sexual characteristics, produced mainly in the testes
Health Effects
Anabolic effects:
Muscle mass and strength
Increased bone density and strength
Stimulation of linear growth
Bone maturation. etc.
Androgenic effects:
Maturation of the sex organs
Deepening of the voice
Benefits of Testosterone
Currently available literature has consistently shown that low testosterone levels are associated with an increased incidence of major adverse cardiac events (MACE), such as myocardial infarction, stroke, and possible cardiovascular-related mortality.
Thirty-three studies that compared men with low testosterone to those with normal testosterone showed that testosterone deficient men were at significantly greater risk of having hypertension
A meta-analysis of 7 observational studies indicated that men with low testosterone, as compared to men with normal testosterone, have an increased risk of myocardial infarction
Less Fat, More Muscle
Leaner body mass helps control weight and increases energy.
Lean Body Mass.
In men w ith testosterone deficiency, testosterone therapy results in increased lean muscle mass and reduced fat mass, but no overall changes in BMI. Based on analyses of 12 studies, lean body mass increased by a mean 1.9 kg
Stronger Bones
Strong bones help support your muscles and internal organs, which can boost athletic performance.
At 24 months, men on testosterone therapy demonstrated an approximate 3-4% increase in BMD in the lumbar spine and femoral neck over those on placebo
Better Libido
Testosterone levels naturally rise in response to sexual arousal and activity.
Erectile Dysfunction
Testosterone levels naturally rise in response to sexual arousal and activity.
Diabetes Control
Depression
Cognition Memory
Anemia
Energy and Fatigue
Lipid Profile
Symptoms And Signs of Low Testosterone
Reduced energy
Reduced endurance
Diminished work performance
Diminished physical performance
Loss of body hair
Reduced beard growth
Fatigue
Reduced lean muscle mass
Obesity
Cognitive Symptoms and Signs
Depressive symptoms
Cognitive dysfunction
Reduced motivation
Poor concentration
Poor memory
Irritability
Reduced sex drive
Reduced erectile function
Testing For Low T
- Clinicians should use a total testosterone level below 300 ng/dL as a reasonable cut-off in support of the diagnosis of low testosterone. (Moderate Recommendation; Evidence Level: Grade B)
- The diagnosis of low testosterone should be made only after two total testosterone measurements are taken on separate occasions with both conducted in an early morning fashion. (Strong Recommendation; Evidence Level: Grade A)
- The clinical diagnosis of testosterone deficiency is only made when patients have low total testosterone levels combined with symptoms and/or signs.(Moderate Recommendation; Evidence Level: Grade B)
- Clinicians should consider measuring total testosterone in patients with a history of unexplained anemia, bone density loss, diabetes, exposure to chemotherapy, exposure to testicular radiation, HIV/AIDS, chronic narcotic use, male infertility, pituitary dysfunction, and chronic corticosteroid use even in the absence of symptoms or signs associated with testosterone deficiency. (Moderate Recommendation; Evidence Level: Grade B)
Adjunctive Testing For Low T
- In patients with low testosterone, clinicians should measure serum luteinizing hormone levels. (Strong Recommendation; Evidence Level: Grade A)
- Serum prolactin levels should be measured in patients with low testosterone levels combined with low or low/ normal luteinizing hormone levels. (Strong Recommendation; Evidence Level: Grade A)
- Patients with persistently high prolactin levels of unknown etiology should undergo evaluation for endocrine disorders. (Strong Recommendation; Evidence Level: Grade A)
- Serum estradiol should be measured in testosterone deficient patients who present with breast symptoms or gynecomastia prior to the commencement of testosterone therapy. (Expert Opinion)
- Men with testosterone deficiency who are interested in fertility should have a reproductive health evaluation performed prior to treatment. (Moderate Recommendation; Evidence Level: Grade B)
- Prior to offering testosterone therapy, clinicians should measure hemoglobin and hematocrit and inform patients regarding the increased risk of polycythemia. (Strong Recommendation; Evidence Level: Grade A)
- PSA should be measured in men over 40 years of age prior to commencement of testosterone therapy to exclude a prostate cancer diagnosis.
Treatment of Low Testosterone
Clinicians should adjust testosterone therapy dosing to achieve a total testosterone level in the middle tertile of the normal reference range. (Conditional Recommendation; Evidence Level: Grade C)
Exogenous testosterone therapy should not be prescribed to men who are currently trying to conceive. (Strong Recommendation; Evidence Level: Grade A)
Testosterone therapy should not be commenced for a period of three to six months in patients with a history of a cardiovascular events. (Expert Opinion)
Clinicians should not prescribe alkylated oral testosterone. (Moderate Recommendation; Evidence Level: Grade B)
Clinicians should discuss the risk of transference with patients using testosterone gels/creams. (Strong Recommendation; Evidence Level: Grade A)
Clinicians may use aromatase inhibitors, human chorionic gonadotropin, selective estrogen receptor modulators, or a combination thereof in men with testosterone deficiency desiring to maintain fertility. (Conditional Recommendation; Evidence Level: Grade C)
The goal of testosterone therapy is the normalization of total testosterone levels combined with improvement in symptoms or signs.
Clinicians use the minimal dosing necessary to drive testosterone levels to the normal physiologic range of 450-600 ng/dL, which is the middle tertile of the normal range for most laboratories.
The goal of testosterone therapy is the normalization of total testosterone levels combined with improvement in symptoms or signs.
Clinicians use the minimal dosing necessary to drive testosterone levels to the normal physiologic range of 450-600 ng/dL, which is the middle tertile of the normal range for most laboratories.
Follow Up On TRT
Symptom Assessment
T Levels every 3 months
Hb HCT
LFT
PSA every 6 month
Blood Pressure
Body Weight
Blood Sugar
Precaution on Testosterone Replacement
Cardiovascular
Hypertension
Venous Thrombosis
Prostate
Fertility
Major Adverse Cardiac Events (MACE) On TRT
There is maybe association between testosterone therapy and subsequent MACE events nor can it be stated definitely that testosterone therapy is associated with reduced incidence of MACE.
However, the FDA added a warning to testosterone product labeling after reviewing five observational studies and two meta-analyses of RCTs that examined the effects of testosterone therapy on MACE.
VTE (Venothrombolic Events) On TRT
The concern about the possible association between testosterone therapy and venothrombolic events (VTE) led the FDA to require pharmaceutical companies to add a warning to their product labeling regarding postmarketing reports of VTE;
Since the FDA warning in June 2014, four large observational studies198, 359-361 have been conducted, none of which showed an association between testosterone therapy and an increased risk of VTE.
Baillargeon J, Urban RJ, Morgentaler A et al: Risk of venous thromboembolism in men receiving testosterone therapy. Mayo Clin Proc 2015; 90: 1038.Sharma R, Oni OA, Chen G et al: Association between testosterone replacement therapy and the incidence of DVT and pulmonary embolism: a retrospective cohort study of the veterans administration database. Chest 2016; 150: 563.
References
Prostate Cancer And TRT
While the FDA retains a warning regarding the potential risk of prostate cancer in patients who are prescribed testosterone products (“patients treated with androgens may be at increased risk for prostate cancer”)
there is accumulating evidence against a link between testosterone therapy and prostate cancer development.
A meta-analysis of 7 RCTs showed that there was no significant increase in the rate of a prostate cancer diagnosis in older, testosterone deficient men who were treated with testosterone compared to placebo
Steidle C, Schwartz S, Jacoby K et al: AA2500 testosterone gel normalizes androgen levels in aging males with improvements in body composition and sexual function. J Clin Endocrinol Metab 2003; 88: 2673.Srinivas-Shankar U, Roberts SA, Connolly MJ et al: Effects of testosterone on muscle strength, physical function, body composition, and quality of life in intermediate-frail and frail elderly men: a randomized, double-blind, placebo controlled study. J Clin Endocrinol Metab 2010; 95: 639.
O’Connell MD, Roberts SA, Srinivas-Shankar U et al: Do the effects of testosterone on muscle strength, physical function, body composition, and quality of life persist six months after treatment in intermediate-frail and frail elderly men? J Clin Endocrinol Metab 2011; 96: 454.
References
