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Testosterone Therapy: Proper Monitoring is Essential

As men age, testosterone levels gradually decline. Commonly known as andropause, low testosterone levels (scientifically termed hypogonadism) lead to decreased well-being, increased risk of cardiovascular disease and loss of muscle, increased risk of Type 2 diabetes and other metabolic syndrome diseases, reduced sexual function, and bone loss.

Benefits of testosterone replacement therapy (TRT) are clearly established: improved sexual function, increase in lean muscle mass and strength, mood and cognitive function, with possible reduction in frailty and osteoporosis. Therefore, it comes as no surprise that an increasing number of men worldwide have begun requesting testosterone replacement therapy from their physicians.

There is no evidence that TRT is associated with increased risk of prostate cancer or symptomatic benign prostatic hyperplasia. The cardiovascular issues associated with TRT have been clarified by recent studies showing clearly that increased testosterone levels are associated with reduced mortality. Studies reporting to show increased risk have been subject to flawed designs with inadequate baseline diagnosis and follow-up testing.
 
An extensive review of the testosterone replacement therapy literature reveals that the majority of clinical studies show that properly administered testosterone replacement therapy, in which estradiol and dihydrotestosterone levels are also controlled, does not increase the risk of cardiovascular events. Testosterone replacement therapy should be monitored, and when needed, an aromatase inhibitor such as anastrazole should be added to control estradiol levels that tend to increase with testosterone therapy; as well as an a 5α-reductase inhibitor, such as dutasteride or finasteride to control dihydrotestosterone (DHT) levels. Dutasteride controls both Type I and Type II 5α-reductase while the older drug finasteride controls only Type II. If a patient receiving testosterone has high DHT levels while taking finasteride, it may be helpful to switch to dutasteride.

At the recommendation of the National Association of Boards of Pharmacy, we suggest that patients should always seek medical attention immediately if symptoms of a heart attack or stroke are present, such as:

  • Chest pain
  • Shortness of breath or trouble breathing
  • Weakness in one part or one side of the body
  • Slurred speech

Testosterone therapy is available in many forms, and transdermal preparations that are applied to the skin are quite popular. Creams are easy for the patient to use and many health care professionals and patients prefer daily administration of testosterone to long-lasting pellets and injections.

Another option is compounded troches, which offer these benefits:

  • Decreased risk of cross contamination, i.e., men need not be concerned about others contacting the site of application, such as the arm or leg when a child or pet is held.
  • Rapid buccal or sublingual absorption means the dose can reduced compared to that required for transdermal forms of testosterone.
  • Patients can quickly achieve peak levels when desired.

We welcome your questions. Our compounding pharmacists work together with physicians and their patients to customize medications by prescription based on each patient’s unique needs.
 

References

Ther Adv Urol. 2016 Apr;8(2):147-60.
Aging Male. 2015;18(4):205-6. 
Int J Pharm Compd. 2015 May-Jun;19(3):195-203.


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