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A landmark study in the literature, which provides data supporting that endogenous testosterone levels correlate with longevity in a large population of patients from the VA system
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• Shores MM, Smith NL, Forsberg CW, Anawalt BD, Matsumoto AM. Testosterone treatment and mortality in men with low testosterone levels. J Clin Endocrinol Metab. 2012;97(6):2050-8. A landmark study in the literature, which provides data supporting that endogenous testosterone levels correlate with longevity in a large population of patients from the VA system.
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(2012)
J Clin Endocrinol Metab
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DOI 10.1161/CIRCULATIONAHA.107.719005
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Khaw KT, Dowsett M, Folkerd E, Bingham S,Wareham N, Luben R, et al. Endogenous testosterone and mortality due to all causes, cardiovascular disease, and cancer in men: European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) Prospective Population Study. Circulation. 2007;116:2694-701. (Pubitemid 350291241)
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Khaw, K.-T.1
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Day, N.8
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40
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Cortisol, testosterone, and coronary heart disease: Prospective evidence from the caerphilly study
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DOI 10.1161/CIRCULATIONAHA.104.489088
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Smith GD, Ben-Shlomo Y, Beswick A, Yarnell J, Lightman S, Elwood P. Cortisol, testosterone, and coronary heart disease: prospective evidence from the Caerphilly study. Circulation. 2005;112(3):332-40. (Pubitemid 41022073)
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Smith, G.D.1
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Yarnell, J.4
Lightman, S.5
Elwood, P.6
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41
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77954421915
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Adverse events associated with testosterone administration
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This is a must-read for physicians administering testosterone therapy. The study was performed on extremely debilitated individuals who were started on TRT to determine whether it impacted mobility. The study was prematurely terminated due to a disproportionate number of cardiovascular events within the testosterone treatment arm. It is important to note that testosterone levels were not reported in patients, and a large percentage of patients received very high doses of testosterone, which are not usually administered to average patients with LOH
-
•• Basaria S, Coviello AD, Travison TG, Storer TW, Farwell WR, Jette AM, et al. Adverse events associated with testosterone administration. N Engl J Med. 2010;363(2):109-21. This is a must-read for physicians administering testosterone therapy. The study was performed on extremely debilitated individuals who were started on TRT to determine whether it impacted mobility. The study was prematurely terminated due to a disproportionate number of cardiovascular events within the testosterone treatment arm. It is important to note that testosterone levels were not reported in patients, and a large percentage of patients received very high doses of testosterone, which are not usually administered to average patients with LOH.
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(2010)
N Engl J Med
, vol.363
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, pp. 109-121
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Basaria, S.1
Coviello, A.D.2
Travison, T.G.3
Storer, T.W.4
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Jette, A.M.6
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42
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84887056433
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Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels
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This is another "must-read" for practitioners who prescribe testosterone. This retrospective cohort study evaluated men with low testosterone levels who underwent coronary artery angiography in the VA system between 2005 and 2011 were. The study found that the risk of myocardial infarction, stroke, and death was higher in hypogonadal men who were started on TRT than in those who were not treated. There are many controversies and questions regarding the statistical models employed in this study. The raw numbers seem to indicate that there were more adverse events in the untreated group of hypogonadal veterans, but with very complicated statistical weighting, the results are reversed. Because this article was just published,many letters to the editor are expected, so stay tuned...
-
•• Vigen R, O'Donnell CI, Baron AE, Grunwald GK, Maddox TM, Bradley SM, et al. Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA. 2013;310(17):1829-36. This is another "must-read" for practitioners who prescribe testosterone. This retrospective cohort study evaluated men with low testosterone levels who underwent coronary artery angiography in the VA system between 2005 and 2011 were. The study found that the risk of myocardial infarction, stroke, and death was higher in hypogonadal men who were started on TRT than in those who were not treated. There are many controversies and questions regarding the statistical models employed in this study. The raw numbers seem to indicate that there were more adverse events in the untreated group of hypogonadal veterans, but with very complicated statistical weighting, the results are reversed. Because this article was just published,many letters to the editor are expected, so stay tuned....
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(2013)
JAMA
, vol.310
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Vigen, R.1
O'Donnell, C.I.2
Baron, A.E.3
Grunwald, G.K.4
Maddox, T.M.5
Bradley, S.M.6
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43
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Calof OM, Singh AB, Lee ML, Kenny AM, Urban RJ, Tenover JL, et al. Adverse events associated with testosterone replacement in middle-aged and older men: a meta-analysis of randomized, placebo-controlled trials. J Gerontol A Biol Sci Med Sci. 2005;60(11):1451-7. (Pubitemid 41798454)
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(2005)
Journals of Gerontology - Series A Biological Sciences and Medical Sciences
, vol.60
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Calof, O.M.1
Singh, A.B.2
Lee, M.L.3
Kenny, A.M.4
Urban, R.J.5
Tenover, J.L.6
Bhasin, S.7
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44
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Haddad RM, Kennedy CC, Caples SM, et al. Testosterone and cardiovascular risk in men a systematic review and meta-analysis of randomized, placebo-controlled trials.Mayo Clin Proc. 2007;82:29-39. (Pubitemid 46036319)
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(2007)
Mayo Clinic Proceedings
, vol.82
, Issue.1
, pp. 29-39
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Haddad, R.M.1
Kennedy, C.C.2
Caples, S.M.3
Tracz, M.J.4
Bolona, E.R.5
Sideras, K.6
Uraga, M.V.7
Erwin, P.J.8
Montori, V.M.9
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45
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77954394453
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Adverse effects of testosterone therapy in adult men: A systematic review and meta-analysis
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An important level 1 analysis of the current literature that comprehensively evaluates the risks and benefits of TRT. While prior meta-analyses were equally important at the time (references 45, 46), this represents the most current meta-analysis, and therefore it is highlighted
-
• Fernandez-Balsells MM, Murad MH, Lane M, Lampropulos JF, Albuquerque F, Mullan RJ, et al. Adverse effects of testosterone therapy in adult men: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2010;95:2560-75. An important level 1 analysis of the current literature that comprehensively evaluates the risks and benefits of TRT. While prior meta-analyses were equally important at the time (references 45, 46), this represents the most current meta-analysis, and therefore it is highlighted.
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(2010)
J Clin Endocrinol Metab
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Fernandez-Balsells, M.M.1
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Lampropulos, J.F.4
Albuquerque, F.5
Mullan, R.J.6
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46
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Provides an excellent overview of the current state of TRT
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• Corona G, Rastrelli G, Forti G, Maggi M. Update in testosterone therapy for men. J Sex Med. 2011;8:639-54. Provides an excellent overview of the current state of TRT.
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J Sex Med
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Corona, G.1
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48
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Iehlé C, Radvanyi F, Gil Diez de Medina S, et al. Differences in steroid 5 alpha-reductase iso-enzymes expression between normal and pathological human prostate tissue. J Steroid Biochem Mol Biol. 1999;68(5-6):189-95. (Pubitemid 29290654)
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49
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McConnell JD, Brukewitz R,Walsh P, et al. The effect of finasteride on the risk for acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Finasteride long-term efficacy and safety study group. N Engl J Med. 1998;338(9):557-63. (Pubitemid 28114643)
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more..
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52
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Roehrborn CG, Siami P, Barkin J, et al. The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study. Eur Urol. 2010;57(1):123-31.
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53
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This is an important contribution to a field that has too many short term outcomes reported with TRT. IN this article, the authors provide follow up of 1365 men who were placed on TRT, with some men monitored for up to 20 years. Long term safety of TRT is reported. Additionally, the risks of malignancy in these patients is no more than would be expected for the general population of eugonadal men not treated with TRT
-
•• Feneley MR, Carruthers M. Is testosterone treatment good for the prostate: study of the safety during long-term treatment. J Sex Med. 2012;9:2138-49. This is an important contribution to a field that has too many short term outcomes reported with TRT. IN this article, the authors provide follow up of 1365 men who were placed on TRT, with some men monitored for up to 20 years. Long term safety of TRT is reported. Additionally, the risks of malignancy in these patients is no more than would be expected for the general population of eugonadal men not treated with TRT.
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J Sex Med
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54
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Another important study in the field, which provides prospective follow up of hypogonadal men on TRT. Serum PSA levels increased more profoundly in those men with T levels of 250 ng/dl at baseline than in those with levels above this at baseline. Overall, the latter group did not demonstrate a statistically significant increase in the serum PSA following TRT, an important fact to understand when treating men with TRT
-
•• Khera M, Bhattacharya RK, Blick G, Kushner H, Nguyen D, Miner M. Changes in prostate specific antigen in hypogonadal men after 12 months of testosterone replacement therapy: support for the prostate saturation theory. J Urol. 2011;186:1005-11. Another important study in the field, which provides prospective follow up of hypogonadal men on TRT. Serum PSA levels increased more profoundly in those men with T levels of 250 ng/dl at baseline than in those with levels above this at baseline. Overall, the latter group did not demonstrate a statistically significant increase in the serum PSA following TRT, an important fact to understand when treating men with TRT.
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(2011)
J Urol
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Khera, M.1
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55
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The authors outline one of the most important concepts that underlie how we currently approach TRT. The saturation model is discussed above, and is a very important contribution to andrology and oncology
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•• Morgentaler A, Traish AM. Shifting the paradigm of testosterone and prostate cancer: the saturation model and the limits of androgen-dependent growth. Eur Urol. 2009;55:310-21. The authors outline one of the most important concepts that underlie how we currently approach TRT. The saturation model is discussed above, and is a very important contribution to andrology and oncology.
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(2009)
Eur Urol
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Morgentaler, A.1
Traish, A.M.2
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56
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IPASS: A study on the tolerability and effectiveness of injectable testosterone undecanoate for the treatment of male hypogonadism in a worldwide sample of 1,438 men
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Zitzmann M, Mattern A, Hanisch J, Gooren L, Jones H, Maggi M. IPASS: a study on the tolerability and effectiveness of injectable testosterone undecanoate for the treatment of male hypogonadism in a worldwide sample of 1,438 men. J Sex Med. 2013;10:579-88.
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59
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Endogenous Hormones and Prostate Cancer Collaborative Group. This article is an extremely important contribution to the field. The authors provide an excellent meta-analysis that confirms that there is little association between serum testosterone levels and prostate cancer risk
-
• Endogenous Hormones and Prostate Cancer Collaborative Group. Endogenous sex hormones and prostate cancer: a collaborative analysis of 18 prospective studies. J Natl Cancer Inst. 2008;100:170-83. This article is an extremely important contribution to the field. The authors provide an excellent meta-analysis that confirms that there is little association between serum testosterone levels and prostate cancer risk.
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Marks LS, Mazer NA, Mostaghel E, et al. Effects of testosterone replacement therapy on prostate tissue in men with late-onset hypogonadism: a randomized controlled trial. JAMA. 2006;296(19):2351-61. A very interesting study that evaluates serum and intracellular prostate changes in men placed on TRT. The study provides excellent evidence that TRT does not increase intraprostatic T or DHT levels, and does not appear to incite benign or malignant growth within the short term. (Pubitemid 44749363)
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