© The Canadian Journal of Urology™; 21(Supplement 2); June 2014
primary care physician patient populations. Because
the constellation of signs and symptoms of TD include
a number of vague and/or non-specific factors (i.e.
lack of energy and low mood) a diagnosis of TD
must be made cautiously and only after ruling out
other potential physiological or psychological causes.
Prior to (or concurrent with) a trial of testosterone
therapy, clinicians should explore with their patients
therapeutic lifestyle changes, such as weight loss
and exercise, which are known to restore depressed
testosterone levels as well as improve a wide range of
other health parameters. Decisions about whether or
not to pursue TRT must rest firmly on a foundation of
good patient education about the potential risks and
benefits of hormonal therapy.
TRT can improve the health and quality-of-life in
testosterone-deficient men by stimulating libido and
sexual function, improving muscle mass and strength,
raising bone density, and raising mood levels.
Some emerging evidence suggests that TRT may
also improve glycemic control, insulin sensitivity,
and metabolic syndrome in men with diabetes or
metabolic syndrome. Many believe that TD itself is
related to a significant increase in CVD risk; others
support a notion that TRT may be associated with an
increased CVD risk. Only forthcoming randomized-
controlled trials will answer this question. Most
clinicians with experience in prescribing TRT will
continue to do so without any significant concern of
increased CVD risk.
Recent refinements of TRT formulations and
delivery systems, particularly the availability of higher-
potency, lower-volume transdermal formulations, may
allow greater individualization of dosing and may
reduce the risk of adverse events such as skin-to-skin
transfer of hormone. Although long term, high-quality
data documenting the benefits and risks of TRT are
missing, available knowledge and improved treatment
options can allow providers and their patients to
address TD with greater confidence that their efforts
will be safe and beneficial.
Disclosures
Dr. Martin Miner has been a consultant for Abbvie
and Endo. He has also done research for Forest.
Dr. Jack Barkin has been a clinical investigator, speaker
and medical advisory board member and consultant
forAbbott, Lilly, Bayer, Paladin, Actavis, AstraZeneca,
Astellas, Pfizer and Triton. Dr Matt T. Rosenberg has
been a speaker and consultant for Astellas, Easai,
Ferring, Forest, Horizon, Ortho-McNeil, Lilly, Pfizer
and Bayer.
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