Pros And Cons Of New Testosterone Replacement Therapy

Pros

Restoring or near-normal serumtestosterone levels with new testosterone replacement therapy has significantefficacy in many patients with hypogonadism. These effects include improvedmood, energy levels, sexual function, muscle mass and strength, erythropoiesis,BMD, cognition, and cardiovascular risk factors.

BMD

Male patients with chronic diseasemay have significant androgen deficiency and symptoms such as decreased bonemass, bone loss, osteoporosis, and fractures. The incidence of osteoporosis intestosterone-deficient patients is twice as high as in men with normaltestosterone levels. Testosterone levels are closely related to BMD, and BMDcan be significantly improved in hypogonadal patients after administration ofsufficient testosterone, which increases osteoblast activity and reducesosteoclast activity by aromatizing into estrogen. Prostate cancer patients havea significantly increased risk of osteoporotic fractures after androgen deprivationtherapy, and new testosterone replacement therapy may improve spinal BMD inhypogonadal patients.

Body Composition, Muscle Mass andStrength

The aging process is characterizedby marked changes in body composition accompanied by increased and redistributedfat mass. These changes limit function and increase the incidence of disease.Testosterone can directly affect muscle cells or stimulate the expression ofinsulin-like growth factor 1, leading directly or indirectly to the synthesisand growth of muscle protein. New testosterone replacement therapy caneffectively reverse age-related changes in body composition and reduce theincidence of accompanying diseases, improve body composition, reduce fat mass,and increase lean body mass.

Mood, Energy and Quality of Life

FT levels begin to decline in menover age 50, with a concomitant decline in quality of life. Patients arehypogonadal and often complain of asexuality, restlessness, fatigue, andirritability. Depression scores in older men were inversely correlated withbioavailable testosterone levels, but not with age and weight. New testosteronereplacement therapy improves gonadal function, improves patients' depressivesymptoms, elevates mood and enhances well-being, and reduces fatigue andirritability. New testosterone replacement therapy has a significantantidepressant effect in hypogonadal patients with severe depression, and itsefficacy is better than that of selective serotonin reuptake inhibitors. Newtestosterone replacement therapy is effective and well tolerated in improvingsymptoms of hypogonadism in men infected with acquired immunodeficiencysyndrome virus.

Cognitive function

Subclinical androgen deficiency ispostulated to be associated with increased in vivo expression of Alzheimer's disease-relatedpolypeptides. The ratio of total testosterone to sex hormone-binding globulinin AD patients was significantly lower than that in male controls of the sameage. After adjustment for potential factors such as age, education level, andcardiovascular disease among men aged 35-90, it was found that high levels ofbioavailable testosterone and FT concentrations were associated with goodmemory, cognitive ability, optimal arithmetic ability, independent of totaltestosterone levels. A new testosterone replacement therapy improves spatialcognition and language skills in hypogonadal older men and reduces workingmemory errors in non-demented older men. Transdermal testosterone ordihydrotestosterone therapy improves verbal and spatial memory, respectively,in men aged 34-70. Intramuscular testosterone improves verbal and spatialmemory in male hypogonadal patients with mild cognitive impairment and AD. In astudy of healthy men aged 50-90 years, intramuscular testosterone alone or incombination with anastrozole improved spatial memory, while verbal memoryimprovement was only found with testosterone alone, presumably due to exogenousPartial aromatization of sexual testosterone to estradiol. Although resultshave been inconsistent across studies, low levels of FT appear to be associatedwith poorer cognitive function. It is speculated that testosterone therapy inmale hypogonadal patients may be beneficial for cognitive enhancement.

Anemia

It is known that endogenousandrogens stimulate erythropoiesis, increasing reticulocyte counts, hemoglobinlevels, and erythroid activity in mammalian bone marrow, with the oppositeeffect in castrated men. A lack of testosterone causes the concentration ofhemoglobin in the blood to drop by about 10% to 20%, which can lead to anemia.Young men with hypogonadism often have a reduced number of red blood cells anda drop in hemoglobin levels. The mechanism by which testosterone promotesnormal hematopoiesis is thought to be related to the direct stimulation of thekidney to produce erythropoietin, and may also act directly on erythroid stemcells.

Cons

The risks of new testosteronereplacement therapy depend on age, living environment, and other medicalconditions, and may increase the risk of certain diseases, such as prostatecancer, increased symptoms of benign prostatic hyperplasia, liver toxicity andtumors, and sleep apnea syndrome. Worsening symptoms, congestive heart failure,breast development, infertility and skin disease symptoms. High-dosetestosterone therapy is generally not suitable for male patients seekingfertility because exogenous testosterone suppresses thehypothalamic-pituitary-testis axis. Low-dose testosterone therapy can improvelibido and clinical pregnancy rates in infertile men with low testosteronelevels.