Human chorionic gonadotropin monotherapy for the treatment of hypogonadal symptoms in men with total testosterone > 300 ng/dL

ABSTRACT Purpose The 2018 American Urological Association guidelines on the Evaluation and Management of Testosterone Deficiency recommended that 300 ng/dL be used as the threshold for prescribing testosterone replacement therapy (TRT). However, it is not uncommon for men to present with signs and symptoms of testosterone deficiency, despite having testosterone levels greater than 300 ng/dL. There exists scant literature regarding the use of hCG monotherapy for the treatment of hypogonadism in men not interested in fertility. We sought to evaluate serum testosterone response and duration of therapy of hCG monotherapy for men with symptoms of hypogonadism, but total testosterone levels > 300 ng/dL. Materials and Methods We performed a multi-institutional retrospective case series of men receiving hCG monotherapy for symptomatic hypogonadism. We evaluated patient age, treatment indication, hCG dosage, past medical history, physical exam findings and serum testosterone and gonadotropins before and after therapy. Descriptive analysis was performed and Mann Whitney U Test was utilized for statistical analysis. Results Of the 20 men included in the study, treatment indications included low libido (45%), lack of energy (50%), and erectile dysfunction (45%). Mean testosterone improved by 49.9% from a baseline of 362 ng/dL (SD 158) to 519.8 ng/dL (SD 265.6), (p=0.006). Median duration of therapy was 8 months (SD 5 months). Fifty percent of patients reported symptom improvement. Conclusions Treatment of hypogonadal symptoms with hCG for men who have a baseline testosterone level > 300 ng/dL appears to be safe and efficacious with no adverse events.

La terapia hormonal de la menopausia ¿disminuye el riesgo de enfermedades crónicas? / Does menopause hormone therapy reduce the risk of chronic diseases?

The hormonal deficit of post menopause is not only linked to the classic hot flashes, but also to a higher risk of chronic diseases. Menopausal hormone therapy (MHT) adequately treats climacteric symptoms and can prevent some chronic diseases such as osteoporosis. The Women's Health Initiative (WHI) study, which indicated risks of MHT in elderly postmenopausal women, caused a massive withdrawal of this therapy. But, in recent years the results of the WHI have been challenged by methodological problems and by several studies indicating that, if MHT is initiated early and the non-oral route is preferred, the risks could be minimized and it could improve not only the quality of life but also reduce the risk of chronic diseases. However, the US Preventive Services Task Force (USPSTF) recommends against the use of MHT for the prevention of chronic diseases, a position that has been challenged by publications of the North American Menopause Society and the International Menopause Society. This controversy persists so far. We report data that suggest a preventive role of MHT in perimenopausal women.

Outcomes of Prostate Biopsy in Men with Hypogonadism Prior or During Testosterone Replacement Therapy

Introduction: The relationship between Testosterone Replacement Therapy (TRT) and prostate cancer remains controversial. Most TRT studies show no change in prostate specific antigen (PSA) but some men do have PSA rise or develop an abnormal digital rectal exam (aDRE). Our objective was to examine the biopsy results of men with symptomatic hypogonadism before or during therapy. Materials and Methods: Data was extracted from our medical record on men with hypogonadism who had a prostate biopsy within the past 4 years done by 3 Urologists with guideline driven practice patterns. Results: 96 men were identified. Mean age at biopsy was 63 (range 40–85) and median PSA was 3.78ng/dL (0.5–662). Of the 61 men not on TRT, median PSA was 4.34 (0.5 to 662) and mean total testosterone 254 (191–341). There were 29 (47.5%) prostate cancers found (6 Gleason score 6, 13 Gleason score 7, 10 Gleason score 8 or 9). Of the 35 men on TRT, median PSA was 3.27 (0.5 to 13.7). The %PSA increase ranged from 2 to 251% (mean 93.5%). Mean total testosterone was 383 (146–792). Of the 14 men treated < 2 years, none had cancer. Of the 21 men treated 2 or more years 5 had cancer (2 Gleason score 6, 3 Gleason score 7). Conclusions: Men with hypogonadism and a clinical indication for biopsy often have prostate cancer, many high grade. No men with an initial PSA rise on TRT had cancer. Men on long term TRT should be monitored with PSA and DRE per guidelines.

Nanostructured transdermal hormone replacement therapy for relieving menopausal symptoms: a confocal Raman spectroscopy study

OBJECTIVE: To determine the safety and efficacy of a transdermal nanostructured formulation of progesterone (10%) combined with estriol (0.1%) + estradiol (0.25%) for relieving postmenopausal symptoms. METHODS: A total of 66 postmenopausal Brazilian women with climacteric symptoms of natural menopause received transdermal nanostructured formulations of progesterone and estrogens in the forearm daily for 60 months to mimic the normal ovarian secretory pattern. Confocal Raman spectroscopy of hormones in skin layers was performed. Clinical parameters, serum concentrations of estradiol and follicle-stimulating hormone, blood pressure, BI-RADS classification from bilateral mammography, and symptomatic relief were compared between baseline and 60 months post-treatment. Clinicaltrials.gov: NCT02033512. RESULTS: An improvement in climacteric symptoms was reported in 92.5% of women evaluated before and after 60 months of treatment. The serum concentrations of estradiol and follicle-stimulating hormone changed significantly (p<0.05) after treatment; the values of serum follicle-stimulating hormone decreased after 60 months from 82.04±4.9 to 57.12±4.1 IU/mL. A bilateral mammography assessment of the breasts revealed normal results in all women. No adverse health-related events were attributed to this hormone replacement therapy protocol. CONCLUSION: The nanostructured formulation is safe and effective in re-establishing optimal serum levels of estradiol and follicle-stimulating hormone and relieving the symptoms of menopause. This transdermal hormone replacement therapy may alleviate climacteric symptoms in postmenopausal women. .

Reposição de GH na "somatopausa": solução ou problema ? / Growth hormone replacement for \"somatopause\": solution or problem?

O prolongamento da expectativa de vida tem levado a esforços para que a qualidade de vida e a produtividade dos idosos tornem-se cada vez melhores. Sabe-se que, após o pico puberal, ocorre um declínio progressivo na atividade do eixo GH/IGF-1 com o passar da idade, sendo que, acima dos 60 anos, muitos indivíduos normais apresentam secreçäo de GH nas 24 horas, indistingüível da dos pacientes adultos com deficiência de GH por lesöes hipotálamo-hipofisárias (DGHA). Este fenômeno fisiológico apresenta paralelo com vários aspectos clínicos encontrados na DGHA, tais como aumento da gordura visceral e subcutânea, reduçäo da massa magra, osteoporose, distúrbios neuropsicológicos e psiquiátricos. Como a reposiçäo de GH humano recombinante tem se mostrado útil na reversäo desta sintomatologia na DGHA, vários estudos direcionaram o uso de GH para o idoso "saudável", com o intuito de verificar se os mesmos benefícios poderiam ser alcançados. Nesta revisäo, procurei analisar os potenciais mecanismos relacionados com o hipo-somatotropismo do idoso, as manifestaçöes clínicas do mesmo, e o resultado dos estudos mais relevantes publicados sobre a reposiçäo de GH no envelhecimento, avaliando os benefícios e os efeitos colaterais

Andropausa: insuficiência androgênica parcial do homem idoso: uma revisäo / Andropause: partial androgenic failure of aged man: a review

Andropausa é uma designaçäo inapropriada para o quadro clínico resultante do declínio progressivo da produçäo androgênica encontrado em pelo menos 20 por cento dos homens com idad entre 60 e 70 anos, e que algumas vezes se inicia a partir dos 50 anos. Uma designaçäo mais adequada é insuficiência androgênica parcial do homem idoso. Como a produçäo de testosterona diminui regularmente, em homens de 75 anos os níveis médios de testosterona säo somente 65 por cento daqueles dos adultos jovens, sendo que pelo menos 25 por cento destes idosos apresentam níveis subnormais de testosterona biodisponível. A etiologia deste declínio da testosterona dependente da idade é multifatorial e envolve alteraçöes testiculares primárias, disfunçäo da regulaçäo neuroendócrina das gonadodropinas, elevaçäo das concentraçöes séricas de globulina ligadora de hormônios sexuais e reduçäo da sensibilidade dos receptores androgênicos. A senescência é acompanhada de uma série de sinais e sintomas, muitos deles baastante semelhantes aos observados em hipogonádicos jovens. Este quadro clínico complexo pode se dever aos efeitos conjuntos do próprio processo de senescência e de doeças intercorrentes. No entanto, existem evidências que o declínio dos níveis de testosterona próprio da idade é, pelo menos em parte, codeterminante deste quadro clínico, visto que a reposiçäo androgênica tem mostrado efeitos favoráveis em mais de 30 por cento destes idosos sintomáticos. No momento, esta reposiçäo hormonal deveria somente ser considerada em presença de níveis séricos de testosterona abaixo dos limites normais mínimos para adultos jovens, acompanhada de sinais inequívocos de insuficiência androgênica, na ausência de outras causas reversíveis de hipoandrogenismo e após a exclusäo de contra-indicaçöes.