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12 Apr 2008, 12:38

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The new AACE guidelines include a detailed discussion of clinical and laboratory findings, plus a diagnosis and treatment algorithm based on testicular size, hormone levels, and semen analysis. The revision is the first since the guidelines were initially issued in 1996.

It's important to focus attention on the recognition and treatment of the disorder because many men are reluctant to discuss the symptoms of hypogonadism with their physicians. Symptoms usually include decreased libido, impotence, decreased muscle mass, fatigue, and decreased bone density.

“Many men don't seek out medical attention for health problems in the early stage,” Dr. Petak said. “And they don't feel comfortable talking about the major symptom, loss of libido.”

Even if patients do mention decreased sexual urge, physicians might be more likely to prescribe Viagra than to perform a full evaluation. “Lots of physicians don't delve into the matter too deeply, either for lack of time or because of the level of discomfort,” he said. A thorough evaluation is important because hypogonadism may arise from problems with the testes, pituitary, or hypothalamus, or by a genetic disorder.

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The treatment goal is the same in each target population—to restore sexual function (including fertility, if desired and possible), libido, behavior, and physical well-being. In addition to decreased sex drive and sexual activity, men with low testosterone levels may exhibit anger, depression, fatigue, and confusion, as well as physical effects such as decreased muscle mass and bone density and associated osteoporosis.

Based on the results of recent studies, the new guidelines state that testosterone replacement often alleviates associated psychological conditions, increases virilization, and optimizes bone density. Recent studies also indicate that the therapy may normalize growth hormone levels in elderly men. Therapy also may decrease cardiac mortality in this population, but the guidelines make no specific recommendations in this area because the link between cardiovascular disease and low testosterone is not fully understood.

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Testosterone May Boost Endurance In Heart Failure

Andropause - Male Menopause
Testosterone May Boost Endurance In Heart Failure
By eInternal Medicine News: by Timothy F. Kirn
Dec 22, 2002, 8:55pm

Testosterone therapy was associated with a 95-meter improvement on the shuttle walk test in a double-blind study of 20 heart failure patients, Dr. T. Hugh Jones said at the annual meeting of the Endocrinology Society.

The patients, men with ejection fractions of around 35%, increased their distance walked during the test from an average 280 m to an average 375 m—an increase of 34%—after 12 weeks of testosterone therapy. In contrast, patients who received placebo increased their distance by an average of 2%. Testosterone was given as 100-mg injections delivered once every 2 weeks in the trial.

A larger, confirmatory trial is underway, Dr. Jones of the academic unit of endocrinology at the University of Sheffield (England) said in a press conference.

Low testosterone levels may contribute to exercise intolerance and general fatigue in men with heart failure. Testosterone can promote vasodilatation and may have some beneficial anti-inflammatory properties.

There was no evidence that testosterone increased skeletal muscle strength or bulk, or that it changed plasma levels of proinflammatory cytokines, Dr. Jones said.

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United Medical Network - AndroGel

These ads were paid for by Unimed, a division of the Belgian conglomerate Solvay. Unimed makes AndroGel, a drug that was approved by the F.D.A. two years ago, and is the fastest-growing form of testosterone-replacement therapy for men. Pills, introduced in the sixties, often caused liver damage. Intramuscular injections, particularly favored by bodybuilders and competitive athletes, produce a sharp spike of the hormone, and then a fall, and these fluctuations are often accompanied by swings in mood, libido, and energy. In the late eighties, a transdermal patch was developed, and its use is still widespread. The patch provides safer and steadier dosing, but often causes skin irritation, and sometimes falls off during exercise. AndroGel, by contrast, delivers testosterone in a colorless, drying gel that is simply rubbed on an area of the body—usually the shoulders—once a day. It has thus made testosterone available in a form that almost any man can use conveniently.

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