Testosterone; What s all the hype? KRISTEN WYRICK, LTCOL,USAFR, MC USUHS, FAMILY MEDICINE JOINT BASE LANGLEY-EUSTIS

Size: px
Start display at page:

Download "Testosterone; What s all the hype? KRISTEN WYRICK, LTCOL,USAFR, MC USUHS, FAMILY MEDICINE JOINT BASE LANGLEY-EUSTIS"

Transcription

1 Testosterone; What s all the hype? KRISTEN WYRICK, LTCOL,USAFR, MC USUHS, FAMILY MEDICINE JOINT BASE LANGLEY-EUSTIS

2 The faces of Low Testosterone

3 What your patients are seeing

4

5 Pharmacy Industry Testosterone sales in $300 million to $2.3 billion Estimated to hit $5 billion by 2018 Advertising budget $100 million annually Direct to consumer advertising Research that is pharma funded shows significantly lower risk from testosterone than those studies which are independently funded Some leading speakers/authors on this topic have relationships with makers of testosterone products or with the legal community

6 The Legal side

7

8 Preview Late onset Androgen Deficiency Clinical Practice Guideline Testosterone therapy Cardiovascular controversy Prostate Cancer Review recommendations Questions

9 Low T Syndrome Syndrome associated w/ serum testosterone <317ng/dL Normal decline in free testosterone w/ age- 1.3% a year age Approx 40% of men in their 60 s have testosterone levels in this range Studies show that 5% of all men years have symptomatic androgen deficiency Studies have not shown any significant patient oriented outcomes in treating the general population Side Note- If an obese male loses 17 lbs -testosterone will go up by 15% (no drugs)

10 Signs and Symptoms Low muscle mass Low energy Decreased libido Erectile Dysfunction Metabolic syndrome Gynecomastia Loss of Body Hair Dysthymia Poor concentration Sleep disturbances Anemia Increased BMI Diminished work performance Low bone mineral density

11 Endocrine Society CPG 2010 Reasonable to screen men with classic signs and symptoms of androgen deficiency Measure morning total Testosterone level with reliable assay If low, then confirm by repeating measurement with free and total Do not screen general population Evaluate and monitor patients on treatment at 3 mos and annually Goal for treatment is to restore their testosterone to mid-normal range ng/dl

12 Who Not to Treat Prostate Cancer/ Breast Cancer PSA > 3ng/ml Undiagnosed prostate nodule/ induration or symptomatic BPH HCT >50% Untreated obstructive sleep apnea Uncontrolled severe heart failure

13 Testosterone Therapy Recommended regimens for initiating therapy 100mg weekly or 200mg bi-weekly t. cypionate IM $30.00/mo 1-2 4mg patches applied to skin nightly $400.00/mo 5-10g of t. gel applied daily $500.00/mo 30mg of bioadhesive, buccal t. tablet q12h $400.00/mo ***Adjust dose and regimen based on serum testosterone level***

14 Risks of Testosterone Therapy Adverse events w/ evidence Erythrocytosis Acne and Oily skin Detection of subclinical prostate CA Growth of prostate cancer Reduced sperm production and fertility Uncommon adverse events w/ weak evidence Gynecomastia Male pattern balding Growth of Breast Cancer Induction or worsening of OSA

15 Cardiovascular Debate Vigen et al. JAMA 2013 Article- Increased risk of adverse CV Outcomes Complex retrospective study with a messy data set Omitted 1,132 men from the statistical analysis Raw event rate 10% testosterone grp vs 21% non-testosterone grp Basaria et al. N Engl J Med Adverse events w/ testosterone admin 209 patients enrolled, mean age in the treatment group vs 5 in the placebo group had adverse CV events Study was shut down early due to higher incidence of CV events Xu et al. BMC Med 2013 Meta-Analysis, poor inclusion criteria Finkle et al. Plos One 2014 Compared testosterone tx to PDE-5 inhibitors

16 Cardiovascular Debate (continued) Link between normalizing testosterone and improvement in metabolic syndrome 20 years of research that has shown improved mortality for those with hypogonadism when treated with testosterone therapy Shores et al. J Clin Endo Metab overall mortality is lower in treated patients with hypogonadism (<300ng/dL) Mortality was reduced by one half in men who received testosterone therapy Muraleedharan et al. Eur J Endocrin testosterone deficiency associated with increased mortality, improved survival in men with type 2 DM.

17 FDA Warning FDA Drug Safety Communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke with use March 2015

18 Testosterone and Prostate Cancer Average increase in PSA after starting testosterone ng/ml per year 1.4ng/mL increase or greater is considered abnormal Refer to urology Recommend checking PSA prior to starting testosterone Urology referral recommended if PSA >4.0 ng/ml or >3.0 ng/ml in high risk individuals If PSA >0.6 ng/ml at baseline then DRE and repeat PSA at 6 mos and annually If any nodules on DRE, then urology eval prior to starting testosterone

19 How do well do we do this therapy? Retrospective study looked at 10 years worth of patients who had received testosterone therapy, approx. 61, 000 males >40 years old 20% of patients treated did not meet criteria for low testosterone 50% received a follow-up testosterone level after starting therapy 40% received a follow-up PSA Patients followed by an endocrinologist or urologist were more likely to have received follow-up lab tests. Primary Care providers need to do better with follow up testing

20 Bottom Line Need additional investigation to sort out relationship between testosterone and CVD Use caution in individuals at high risk for CVD/ recent events Consider treating those with low T and metabolic syndrome/ diabetes Goal of treatment in older men should be low normal range ( ng/dl) Injectable testosterone has a peak immediately after dosing which may pose an increased risk compared to other forms- not well studied Not recommended to screen and/or treat asymptomatic men

21 In Summary Screen symptomatic men at risk for androgen deficiency Morning testosterone, reliable assay (talk to your friendly endocrinologist) Repeat if abnormal and include free and total LH/FSH, CBC and PSA at this time Monitor testosterone level at 3-6 mos and annually Shoot for ng/dl range on treatment Monitor symptom improvement More evidence needed to determine the link between CVD and testosterone therapy

22 References Bhasin S. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab Jun;95(6): Vigen R, et al. Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA 2013; 310: Basaria S, et al. Adverse Events Associated with Testosterone Administration. The New England journal of medicine. 2010;363(2): Finkle WD, et al. Increased risk of non-fatal myocardial infarction following testosterone therapy prescription in men. PLoS One. 2014;9 Shores M, et al. Testosterone treatment and mortality in men with low testosterone levels. J Clin Enocrin Metab Jun;97(6): Xu L, et al. Testosterone therapy and cardiovascular events among men: a systematic review and meta-analysis of placebo-controlled randomized trials. BMC Medicine. 2013;11:108. Traish, A. M. et al. (2014), Long-term testosterone therapy in hypogonadal men ameliorates elements of the metabolic syndrome: an observational, long-term registry study. International Journal of Clinical Practice, 68: Baillargeon, et al. Screening and monitoring in men prescribed testosterone therapy in the US, Public Health Rep Mar-Apr;130(2):

A list of FDA-approved testosterone products can be found by searching for testosterone at http://www.accessdata.fda.gov/scripts/cder/drugsatfda/.

A list of FDA-approved testosterone products can be found by searching for testosterone at http://www.accessdata.fda.gov/scripts/cder/drugsatfda/. FDA Drug Safety Communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke

More information

Testosterone Treatment in Older Men

Testosterone Treatment in Older Men Testosterone Treatment in Older Men J. Bruce Redmon, M.D. Professor Division of Endocrinology Departments of Medicine and Urologic Surgery Disclosure Information I have no financial relationships to disclose.

More information

TESTOSTERONE The Future?

TESTOSTERONE The Future? TESTOSTERONE The Future? Martin M. Miner MD Co-Director Men s Health Center The Miriam Hospital Clinical Professor of Family Medicine and Urology Warren Alpert School of Medicine of Brown University Providence,

More information

testosterone_pellet_implantation_for_androgen_deficiency_in_men 10/2015 N/A 11/2016 10/2015 This policy is not effective until December 30, 2015

testosterone_pellet_implantation_for_androgen_deficiency_in_men 10/2015 N/A 11/2016 10/2015 This policy is not effective until December 30, 2015 Corporate Medical Policy Testosterone Pellet Implantation for Androgen Deficiency in File Name: Origination: Last CAP Review: Next CAP Review: Last Review: testosterone_pellet_implantation_for_androgen_deficiency_in_men

More information

February 25, 2014. Dear Dr. Hamburg:

February 25, 2014. Dear Dr. Hamburg: February 25, 2014 Margaret A. Hamburg, M.D. Commissioner Food and Drug Administration Department of Health and Human Services WO 2200 10903 New Hampshire Avenue Silver Spring, MD 20993-0002 Division of

More information

Hypogonadism and Testosterone Replacement in Men with HIV

Hypogonadism and Testosterone Replacement in Men with HIV NORTHWEST AIDS EDUCATION AND TRAINING CENTER Hypogonadism and Testosterone Replacement in Men with HIV Stephanie T. Page, MD, PhD Robert B. McMillen Professor in Lipid Research, Associate Professor of

More information

t!k EUROPEAN MEDICINES AGENCY TESTOSTERONE UPDATE

t!k EUROPEAN MEDICINES AGENCY TESTOSTERONE UPDATE ACRUX (ACR) - ASX ANNOUNCEMENT 24 NOVEMBER 2014 EUROPEAN MEDICINES AGENCY TESTOSTERONE UPDATE The European Medicines Agency (EMA) released a statement regarding the use of Testosterone Replacement Therapy

More information

Committee Approval Date: October 14, 2014 Next Review Date: March 2015

Committee Approval Date: October 14, 2014 Next Review Date: March 2015 Medication Policy Manual Topic: Testosterone replacement therapy products: - Androderm, - Axiron, - Fortesta, - Striant, - Testim Gel, - Natesto, - Vogelxo Policy No: dru297 Date of Origin: March 15, 2013

More information

Medication Policy Manual

Medication Policy Manual Medication Policy Manual Topic: Non-preferred testosterone replacement therapy products (Androderm, Androgel, Aveed, Axiron, Fortesta, Natesto, Striant, Testim Gel, Testopel, Vogelxo, compounded testosterone

More information

Medication Policy Manual. Date of Origin: April 13, 2015. Topic: Testosterone cypionate, testosterone enanthate

Medication Policy Manual. Date of Origin: April 13, 2015. Topic: Testosterone cypionate, testosterone enanthate Medication Policy Manual Topic: Testosterone cypionate, testosterone enanthate Policy No: dru395 Date of Origin: April 13, 2015 Committee Approval Date: December 11, 2015 Next Review Date: April 2016 Effective

More information

Prevalence Diagnosis and Treatment of Hypogonadism in Primary Care Practice by Culley C. Carson III, MD, Boston University Medical Campus

Prevalence Diagnosis and Treatment of Hypogonadism in Primary Care Practice by Culley C. Carson III, MD, Boston University Medical Campus Prevalence Diagnosis and Treatment of Hypogonadism in Primary Care Practice by Culley C. Carson III, MD, Boston University Medical Campus Hypogonadism is defined as deficient or absent male gonadal function

More information

Androgens and CVD. Brandon Orr- Walker April 2014

Androgens and CVD. Brandon Orr- Walker April 2014 Androgens and CVD Brandon Orr- Walker April 2014 Agenda What is normal physiology of Aging? Hypogonadism and disease If some is good is more becer? CVD safety Clinical features of Androgen Deficiency

More information

Testosterone in Old(er) Men

Testosterone in Old(er) Men Testosterone in Old(er) Men Disclosure Information J. Bruce Redmon, M.D. Associate Professor Division of Endocrinology I have no financial relationships to disclose. I will not discuss off label use and/or

More information

Shalender Bhasin, MD. Glenn R Cunningham, MD. Mohit Khera, MD, MBA, MPH

Shalender Bhasin, MD. Glenn R Cunningham, MD. Mohit Khera, MD, MBA, MPH Shalender Bhasin, MD Program Chair Professor of Medicine Boston University School of Medicine Section Chief Division of Endocrinology, Diabetes & Nutrition Boston, MA Glenn R Cunningham, MD Professor of

More information

Use Of Testosterone In Men With Prostate Cancer. Traditional view: T is dangerous for PCa

Use Of Testosterone In Men With Prostate Cancer. Traditional view: T is dangerous for PCa Use Of Testosterone In Men With Prostate Cancer Abraham Morgentaler, MD, FACS Director, Men s s Health Boston Associate Clinical Professor of Urology Harvard Medical School Boston, USA Traditional view:

More information

CONCORD INTERNAL MEDICINE TESTOSTERONE DEFICIENCY PROTOCOL

CONCORD INTERNAL MEDICINE TESTOSTERONE DEFICIENCY PROTOCOL CONCORD INTERNAL MEDICINE TESTOSTERONE DEFICIENCY PROTOCOL Douglas G. Kelling, Jr., MD Carmella Gismondi-Eagan, MD, FACP George C. Monroe, III, MD Revised April 29, 2012 The information contained in this

More information

Testosterone Treatment: Myths Vs Reality. Fadi Al-Khayer, M.D, F.A.C.E

Testosterone Treatment: Myths Vs Reality. Fadi Al-Khayer, M.D, F.A.C.E Testosterone Treatment: Myths Vs Reality Fadi Al-Khayer, M.D, F.A.C.E The Biological Functions of Testosterone in Men Testosterone is essential to the musculoskeletal and metabolic systems throughout a

More information

Historical Basis for Concern

Historical Basis for Concern Androgens After : Are We Ready? Mohit Khera, MD, MBA Assistant Professor of Urology Division of Male Reproductive Medicine and Surgery Scott Department of Urology Baylor College of Medicine Historical

More information

Current Data and Considerations Novel Testosterone Formulations

Current Data and Considerations Novel Testosterone Formulations Current Data and Considerations Novel Testosterone Formulations 1 Diagnosis and Assessment Module 2 2 Objectives Identify clinical manifestations and symptoms of hypogonadism Describe components of comprehensive

More information

Scientific conclusions and detailed explanation of the scientific grounds for the differences from the PRAC recommendation

Scientific conclusions and detailed explanation of the scientific grounds for the differences from the PRAC recommendation Annex II Scientific conclusions and grounds for variation to the terms of the marketing authorisations subject to conditions and detailed explanation of the scientific grounds for the differences from

More information

Testosterone Replacement Therapy. Craig Ensign, MPAS, PA-C University of Utah School of Medicine Urology Division

Testosterone Replacement Therapy. Craig Ensign, MPAS, PA-C University of Utah School of Medicine Urology Division Testosterone Replacement Therapy Craig Ensign, MPAS, PA-C University of Utah School of Medicine Urology Division Lecture Outline 1. Anatomy and physiology 2. Definition and etiology 3. Signs and symptoms

More information

Treatment of Low T: Tips for Testosterone Supplementation and Impact on Erectile Dysfunction

Treatment of Low T: Tips for Testosterone Supplementation and Impact on Erectile Dysfunction Treatment of Low T: Tips for Testosterone Supplementation and Impact on Erectile Dysfunction Dr. Joshua A Broghammer, MD, FACS Assistant Professor, Dept of Urology Kansas University Medical Center Disclosures

More information

Testosterone, Growth Hormone and Bioidentical Hormones Prescription Issues

Testosterone, Growth Hormone and Bioidentical Hormones Prescription Issues Testosterone, Growth Hormone and Bioidentical Hormones Prescription Issues T. Brooks Vaughan III, MD Department of Endocrinology UAB July 11, 2015 Brooks Vaughan, MD Associate Professor, Medicine, Pediatrics

More information

COULD IT BE LOW TESTOSTERONE?

COULD IT BE LOW TESTOSTERONE? COULD IT BE LOW TESTOSTERONE? By Dr. Lauren M. Bramley For thousands of years women have been recognized for their sensitivity to hormones. PMS, post partum depression, menopause have long been plights

More information

GUIDELINES ON MALE HYPOGONADISM

GUIDELINES ON MALE HYPOGONADISM GUIDELINES ON MALE HYPOGONADISM G.R. Dohle (chair), S. Arver,. Bettocchi, S. Kliesch, M. Punab, W. de Ronde Introduction Male hypogonadism is a clinical syndrome caused by androgen deficiency. It may adversely

More information

PDL Class: Topical Androgens

PDL Class: Topical Androgens Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35, Salem, Oregon 97301-1079 Phone 503-945-5220 Fax 503-947-1119 Class Update: Topical Androgens Month/Year of Review:

More information

Journal of Men s Health Editorial. Death by Testosterone?

Journal of Men s Health Editorial. Death by Testosterone? Journal of Men s Health Editorial 2/20/14 Death by Testosterone? Martin Miner MD Co- Director Men s Health Center The Miriam Hospital Clinical Associate Professor of Family Medicine and Urology The Warren

More information

MMM. Topic Diagnosis and Testosterone Replacement Therapy for Androgen Deficiency in the Aging Male (ADAM)

MMM. Topic Diagnosis and Testosterone Replacement Therapy for Androgen Deficiency in the Aging Male (ADAM) Dr Tan & Partners MMM Vol. 1 No. 3 Morbidity & Mortality Meeting 12 th December 2014 Topic Diagnosis and Testosterone Replacement Therapy for Androgen Deficiency in the Aging Male (ADAM) Introduction Androgen

More information

NDA 021015 LABELING SUPPLEMENT AND PMR REQUIRED REMS MODIFICATION NOTIFICATION

NDA 021015 LABELING SUPPLEMENT AND PMR REQUIRED REMS MODIFICATION NOTIFICATION DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration Silver Spring MD 20993 NDA 021015 LABELING SUPPLEMENT AND PMR REQUIRED REMS MODIFICATION NOTIFICATION AbbVie, Inc. Attention: Gennadiy

More information

Testosterone Replacement Therapies

Testosterone Replacement Therapies Testosterone Replacement Therapies Policy Number: 5.01.23 Last Review: 7/2015 Origination: 7/2015 Next Review: 7/2016 Policy BCBSKC will provide coverage for testosterone replacement therapies when it

More information

Risks of Testosterone?? Symptoms and Signs Suggestive of Hypogonadism

Risks of Testosterone?? Symptoms and Signs Suggestive of Hypogonadism Low T and The Heart: Testosterone Therapy & CVD Risk Kevin L. Billups, MD Director, Men s Health & Vitality Program The James Buchanan Brady Urological Institute Associate Professor of Urology & Medicine

More information

SEXUAL HEALTH & TESTOSTERONE -- DC ACP CHAPTER --

SEXUAL HEALTH & TESTOSTERONE -- DC ACP CHAPTER -- SEXUAL HEALTH & TESTOSTERONE -- DC ACP CHAPTER -- Michael S. Irwig, M.D. Associate Professor of Medicine, Director, Center for Andrology Division of Endocrinology & Metabolism Disclosures Pharma-Free Presentation

More information

Data Trends Report. Encuity. Testosterone Replacement Therapy

Data Trends Report. Encuity. Testosterone Replacement Therapy Encuity Data Trends Report Encuity has cost-effective solutions to suit your business needs through our various syndicated services. Encuity Data Trends Report provides insight on how our collective services

More information

Definitions. Androgen deficiency. Clinical Hypogonadism* Low serum testosterone level Also called biochemical hypogonadism

Definitions. Androgen deficiency. Clinical Hypogonadism* Low serum testosterone level Also called biochemical hypogonadism MALE HYPOGONADISM Mark Sigman Krishnamurthi Family Professor and Chief of Urology Warren Alpert Medical School of Brown University Chief of Urology Rhode Island and the Miriam Hospitals 1 Topics What is

More information

Lou Haenel, IV, DO Endocrinology October 3, 2015 TESTOSTERONE AND MALE HYPOGONADISM : DECIDING WHEN TO TREAT

Lou Haenel, IV, DO Endocrinology October 3, 2015 TESTOSTERONE AND MALE HYPOGONADISM : DECIDING WHEN TO TREAT Lou Haenel, IV, DO Endocrinology October 3, 2015 TESTOSTERONE AND MALE HYPOGONADISM : DECIDING WHEN TO TREAT Figure 1 The hypothalamic pituitary gonadal axis in men and the impact of testosterone therapy

More information

X-Plain Low Testosterone Reference Summary

X-Plain Low Testosterone Reference Summary X-Plain Low Testosterone Reference Summary Introduction Testosterone is the most important male sex hormone. It helps the body produce and maintain adult male features. Low levels of testosterone affect

More information

Testosterone and Heart Disease

Testosterone and Heart Disease Testosterone and Heart Disease By Pamela W. Smith, M.D., MPH, MS Introduction Two recent trials suggest that testosterone replacement therapy may increase the risk of heart disease and/or stroke. 1, 2

More information

Prevalence and Characteristics of Low Serum Testosterone Levels in Men with Type 2 Diabetes Mellitus Naïve to Injectable Therapy

Prevalence and Characteristics of Low Serum Testosterone Levels in Men with Type 2 Diabetes Mellitus Naïve to Injectable Therapy Prevalence and Characteristics of Low Serum Testosterone Levels in Men with Type 2 Diabetes Mellitus Naïve to Injectable Therapy International Society for Sexual Medicine 2014 Presenter: Felipe Borges

More information

Focus. Andropause: fact or fiction? Introduction. Johan Wilson is an Auckland GP KEY POINTS

Focus. Andropause: fact or fiction? Introduction. Johan Wilson is an Auckland GP KEY POINTS 1 of 5 Focus Andropause: fact or fiction? Johan Wilson is an Auckland GP Introduction Androgen deficiency in the ageing male, or andropause, is being diagnosed with increased frequency. A growing body

More information

Testosterone: Is Just for the GOP?

Testosterone: Is Just for the GOP? Testosterone: Is Just for the GOP? Brad Anawalt, MD Vice Chair and Professor of Medicine University of Washington May 1, 2015 banawalt@medicine.washington.edu Testosterone continuum Severe hypogonadism

More information

Testosterone safety and the prostate

Testosterone safety and the prostate Testosterone safety and the prostate Professor Dr. Ridwan Shabsigh Director, Division of Urology, Maimonides Medical Center, Brooklyn, NY, Professor of Clinical Urology, College of Physicians and Surgeons,

More information

The Truth about Testosterone Therapy

The Truth about Testosterone Therapy Mid-South Men s Health September 2014 The Truth about Testosterone Therapy In this Issue, we will cover All Aspects of Testosterone Replacement Therapy, including the published studies and links. U.S.

More information

Testosterone Therapy in Men with Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline

Testosterone Therapy in Men with Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline SPECIAL FEATURE Clinical Practice Guideline Testosterone Therapy in Men with Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline Shalender Bhasin, Glenn R. Cunningham, Frances

More information

NORTHWEST UROLOGICAL CLINIC, P.C. Physicians and Surgeons N W U C. Testosterone Replacement

NORTHWEST UROLOGICAL CLINIC, P.C. Physicians and Surgeons N W U C. Testosterone Replacement N W U C Testosterone Replacement Low testosterone (low T) is a very common problem in men over 40, and sometimes even in men younger than 40. Men s testosterone levels usually peak in the early 20 s, then

More information

PROSTATE CANCER. Normal-risk men: No family history of prostate cancer No history of prior screening Not African-American

PROSTATE CANCER. Normal-risk men: No family history of prostate cancer No history of prior screening Not African-American PROSTATE CANCER 1. Guidelines for Screening Risk Factors Normal-risk men: No family history of prostate cancer No history of prior screening Not African-American High-risk men: Family history of prostate

More information

Understanding the. Controversies of. testosterone replacement. therapy in hypogonadal men with prostate cancer. controversies surrounding

Understanding the. Controversies of. testosterone replacement. therapy in hypogonadal men with prostate cancer. controversies surrounding Controversies of testosterone replacement therapy in hypogonadal men with prostate cancer Samuel Deem, DO CULTURA CREATIVE (RF) / ALAMY Understanding the controversies surrounding testosterone replacement

More information

Men Sexual Dysfunction Associated with Obesity and Metabolic Syndrome

Men Sexual Dysfunction Associated with Obesity and Metabolic Syndrome Men Sexual Dysfunction Associated with Obesity and Metabolic Syndrome By Aly A. Abbassy, MD, FACE Professor of Medicine (Endocrinology) Alexandria University My Talk will include: 1-Types of Men sexual

More information

Talk to your doctor about low testosterone

Talk to your doctor about low testosterone Talk to your doctor about low testosterone Maybe he doesn t find me attractive any more? Maybe he needs to lose some weight? Maybe he s lost his spark? Bayer Pharma AG Müllerstraße 178 13353 Berlin Germany

More information

Management of Erectile Dysfunction and Cardiovascular Disease Princeton III Consensus Recommendations

Management of Erectile Dysfunction and Cardiovascular Disease Princeton III Consensus Recommendations Management of Erectile Dysfunction and Cardiovascular Disease Princeton III Consensus Recommendations Reptile Dysfunction This is a talk about sex, and contains potentially offensive images Men Avoid Doctors

More information

Hormone Restoration: Is It Right for You? Patricia A. Stafford, M.D. Founder, Wellness ReSolutions

Hormone Restoration: Is It Right for You? Patricia A. Stafford, M.D. Founder, Wellness ReSolutions Hormone Restoration: Is It Right for You? Patricia A. Stafford, M.D. Founder, Wellness ReSolutions IMPORTANCE OF HORMONE BALANCE Importance of Hormone Balance Help you live a long, healthy life Help you

More information

Varicocele: To Fix or Not to Fix? That is the Question. Edmund S. Sabanegh, MD

Varicocele: To Fix or Not to Fix? That is the Question. Edmund S. Sabanegh, MD Varicocele: To Fix or Not to Fix? That is the Question. Edmund S. Sabanegh, MD Professor and Chairman, Department of Urology, Cleveland Clinic Lerner College of Medicine; Cleveland, Ohio Objectives: Review

More information

CONSIDERATIONS BEFORE TESTOSTERONE THERAPY WHAT S UP WITH THE T?

CONSIDERATIONS BEFORE TESTOSTERONE THERAPY WHAT S UP WITH THE T? CONSIDERATIONS BEFORE TESTOSTERONE THERAPY WHAT S UP WITH THE T? Emily Wood Demetriou, MD MMP Endocrinology and Diabetes ACP Conference September 26, 2015 -29 yo man presents to your clinic for hypogonadism

More information

Continuity Clinic Educational Didactic. December 8 th December 12 th

Continuity Clinic Educational Didactic. December 8 th December 12 th Continuity Clinic Educational Didactic December 8 th December 12 th MKSAP Question 1 A 60-year-old man is evaluated for a 1-year history of generalized fatigue and lack of energy. He has had erectile dysfunction

More information

Protocol: Testosterone and cardiovasclar related events in men: a meta analysis of randomized controlled trials. Version: 1. Date: 5 th December 2011

Protocol: Testosterone and cardiovasclar related events in men: a meta analysis of randomized controlled trials. Version: 1. Date: 5 th December 2011 Protocol: Testosterone and cardiovasclar related events in men: a meta analysis of randomized controlled trials Version: 1 Date: 5 th December 2011 Study team: C Mary Schooling, CUNY School of Public Health

More information

Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes:

Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes: T h e E n d o c r i n e S o c i e t y s Clinical Guidelines Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline Authors: Shalender Bhasin,

More information

Male New Patient Package

Male New Patient Package Male New Patient Package The contents of this package are your first step to restore your vitality. Please take time to read this carefully and answer all the questions as completely as possible. Thank

More information

Testosterone & Testosterone Replacement Therapy

Testosterone & Testosterone Replacement Therapy your PR.i.VATES Testosterone & Testosterone Replacement Therapy www.yourprivates.org.uk CONTENTS TESTOSTERONE & TRT Contents Introduction 3 Purposes of testosterone 4 How will I be affected by an orchidectomy?

More information

Selling Low T Is Big Pharma Taking Big Risks with Patient Safety?

Selling Low T Is Big Pharma Taking Big Risks with Patient Safety? Selling Low T Is Big Pharma Taking Big Risks with Patient Safety? An Overview of the Testosterone Replacement Therapy Marketplace and Potential Risks to Consumers Prepared by the attorneys of the Charles

More information

Male Patient Questionnaire & History

Male Patient Questionnaire & History Male Patient Questionnaire & History Name: Today s Date: (Last) (First) (Middle) Date of Birth: Age: Occupation: Home Address: City: State: Zip: E- Mail Address: May we contact you via E- Mail? ( ) YES

More information

CARDIOMETABOLIC DISEASE AND TESTOSTERONE DEFICIENCY: IS THERE A LINK?

CARDIOMETABOLIC DISEASE AND TESTOSTERONE DEFICIENCY: IS THERE A LINK? CARDIOMETABOLIC DISEASE AND TESTOSTERONE DEFICIENCY: IS THERE A LINK? Abraham Morgentaler, MD Founder and Director, Men s Health Boston Associate Clinical Professor of Urology Beth Israel Deaconess Medical

More information

to the cases and then talk about management. But really who hasn t had a patient come into the

to the cases and then talk about management. But really who hasn t had a patient come into the JODIE REIDER, MD 1 So I m going to begin with just presenting a few cases and then at the end of the talk we ll go back to the cases and then talk about management. But really who hasn t had a patient

More information

Shira Miller, M.D. Los Angeles, CA 310-734-8864 www.shiramillermd.com. The Compounding Pharmacy of Beverly Hills Beverly Hills Public Library

Shira Miller, M.D. Los Angeles, CA 310-734-8864 www.shiramillermd.com. The Compounding Pharmacy of Beverly Hills Beverly Hills Public Library Shira Miller, M.D. Los Angeles, CA 310-734-8864 The Compounding Pharmacy of Beverly Hills Beverly Hills Public Library 2 Outline What is hormone therapy? Why would healthy men and women need to think about

More information

The ABC s and T s of Male Infertility

The ABC s and T s of Male Infertility The ABC s and T s of Male Infertility Men s Health Initiative of BC - Focus on Testosterone Ethan D. Grober, MD, MEd, FRCSC Assistant Professor University of Toronto Department of Surgery, Division of

More information

Treatment of Males with Low Testosterone

Treatment of Males with Low Testosterone Treatment of Males with Low Testosterone Noridian Healthcare Solutions, LLC Close Jump to Section... Please Note: This is a Proposed LCD. Proposed LCDs are works in progress and not necessarily a reflection

More information

ELEMENTS FOR A PUBLIC SUMMARY. Overview of disease epidemiology. Summary of treatment benefits

ELEMENTS FOR A PUBLIC SUMMARY. Overview of disease epidemiology. Summary of treatment benefits VI: 2 ELEMENTS FOR A PUBLIC SUMMARY Bicalutamide (CASODEX 1 ) is a hormonal therapy anticancer agent, used for the treatment of prostate cancer. Hormones are chemical messengers that help to control the

More information

Understanding the long-term risks and benefits of testosterone replacement

Understanding the long-term risks and benefits of testosterone replacement Understanding the long-term risks and benefits of testosterone replacement Nathan Hale, DO Samuel Deem, DO SHUTTERSTOCK.COM Male hypogonadism, also called andropause and androgen deficiency of the aging

More information

Research Skills for Non-Researchers: Using Electronic Health Data and Other Existing Data Resources

Research Skills for Non-Researchers: Using Electronic Health Data and Other Existing Data Resources Research Skills for Non-Researchers: Using Electronic Health Data and Other Existing Data Resources James Floyd, MD, MS Sep 17, 2015 UW Hospital Medicine Faculty Development Program Objectives Become more

More information

Issues Concerning Development of Products for Treatment of Non-Metastatic Castration- Resistant Prostate Cancer (NM-CRPC)

Issues Concerning Development of Products for Treatment of Non-Metastatic Castration- Resistant Prostate Cancer (NM-CRPC) Issues Concerning Development of Products for Treatment of Non-Metastatic Castration- Resistant Prostate Cancer (NM-CRPC) FDA Presentation ODAC Meeting September 14, 2011 1 Review Team Paul G. Kluetz,

More information

Neal Rouzier responds to the JAMA article on Men and Testosterone

Neal Rouzier responds to the JAMA article on Men and Testosterone Neal Rouzier responds to the JAMA article on Men and Testosterone On the first day the JAMA article was released I received 500 emails from physicians and patients requesting my opinion of the article

More information

February 1, 2014 RESTORING STRENGTH AND VITALITY THROUGH HORMONES FACTS, FANTASIES, POSSIBILITIES, AND PITFALLS

February 1, 2014 RESTORING STRENGTH AND VITALITY THROUGH HORMONES FACTS, FANTASIES, POSSIBILITIES, AND PITFALLS February 1, 2014 RESTORING STRENGTH AND VITALITY THROUGH HORMONES FACTS, FANTASIES, POSSIBILITIES, AND PITFALLS Calvin Hirsch, MD Professor of Clinical Internal Medicine (Geriatrics) UC Davis School of

More information

Testosterone Therapy for Women

Testosterone Therapy for Women Testosterone Therapy for Women The Facts You Need Contents 2 INTRODUCTION: The Facts You Need... 3-4 CHAPTER 1: Testosterone and Women... 5-9 CHAPTER 2: Testosterone Therapy for Women... 10-14 CONCLUSION:

More information

UPMC Rehab Grand Rounds

UPMC Rehab Grand Rounds W i n t e r 2 0 1 0 UPMC Rehab Grand Rounds University of Pittsburgh School of Medicine Department of Physical Medicine and Rehabilitation Pittsburgh, Pennsylvania Address correspondence to: Michael C.

More information

Testosterone deficiency: myth, facts, and controversy Martin Miner, MD, 1 Jack Barkin, MD, 2 Matt T. Rosenberg, MD 3 1

Testosterone deficiency: myth, facts, and controversy Martin Miner, MD, 1 Jack Barkin, MD, 2 Matt T. Rosenberg, MD 3 1 Testosterone deficiency: myth, facts, and controversy Martin Miner, MD, 1 Jack Barkin, MD, 2 Matt T. Rosenberg, MD 3 1 Departments of Family Medicine and Urology, Miriam Hospital, Brown University, Providence,

More information

Us TOO University Presents: Estrogen Deficiency Side Effects Due to Androgen Deprivation Therapy

Us TOO University Presents: Estrogen Deficiency Side Effects Due to Androgen Deprivation Therapy Us TOO University Presents: Estrogen Deficiency Side Effects Due to Androgen Deprivation Therapy Today s speaker is Samir Taneja, MD Program moderator is Pam Barrett, Us TOO International Made possible

More information

Testosterone. Testosterone For Women

Testosterone. Testosterone For Women Testosterone Testosterone is a steroid hormone. Popular use of the term steroid leads people to believe that it signifies a drug that s illegal and abused by some body builders and other athletes. While

More information

13165 (55%) Trials 1 intervention type = drug biological, genetic, device, OR radiation AND/OR IND or IDE protocol? = yes AND NOT Common Rule only

13165 (55%) Trials 1 intervention type = drug biological, genetic, device, OR radiation AND/OR IND or IDE protocol? = yes AND NOT Common Rule only Figure. Inclusion Criteria of Trials 123 098 Clinical trials posted in ClinicalTrials.gov as of September 13, 2013 Study type = interventional 59588 Trials with at least 1 site located in the United States

More information

BIOCHEMICAL TESTS FOR THE INVESTIGATION OF COMMON ENDOCRINE PROBLEMS IN THE MALE

BIOCHEMICAL TESTS FOR THE INVESTIGATION OF COMMON ENDOCRINE PROBLEMS IN THE MALE Authoriser: Moya O Doherty Page 1 of 7 BIOCHEMICAL TESTS FOR THE INVESTIGATION OF COMMON ENDOCRINE PROBLEMS IN THE MALE The purpose of this protocol is to describe common tests used for the investigation

More information

Statins and Risk for Diabetes Mellitus. Background

Statins and Risk for Diabetes Mellitus. Background Statins and Risk for Diabetes Mellitus Kevin C. Maki, PhD, FNLA Midwest Center for Metabolic & Cardiovascular Research and DePaul University, Chicago, IL 1 Background In 2012 the US Food and Drug Administration

More information

The role of TRT in the management of hypogonadism and TRT: Dispelling the myths. Dr Geoff Hackett

The role of TRT in the management of hypogonadism and TRT: Dispelling the myths. Dr Geoff Hackett The role of TRT in the management of hypogonadism and TRT: Dispelling the myths Dr Geoff Hackett Safety concerns over testosterone replacement therapy (TRT) Concerns over the safety of testosterone may

More information

Roux-en-Y Gastric Bypass

Roux-en-Y Gastric Bypass Roux-en-Y Gastric Bypass Restrictive and malabsorptive procedure Most frequently performed bariatric procedure in the US First done in 1967 Laparoscopic since 1993 75% EWL in 18-24 months 50% EWL is still

More information

Testosterone Therapy in the 21st Century Man.! Wayne Kuang MD MD for Men LLC 505 Urology LLC

Testosterone Therapy in the 21st Century Man.! Wayne Kuang MD MD for Men LLC 505 Urology LLC Testosterone Therapy in the 21st Century Man! Wayne Kuang MD MD for Men LLC 505 Urology LLC Disclosures Wayne Kuang MD MenMD Theralogix United Therapies No testosterone products MD for Men LLC Enlarged

More information

About Andropause (Testosterone Deficiency Syndrome)

About Andropause (Testosterone Deficiency Syndrome) About Andropause (Testosterone Deficiency Syndrome) There are many myths, misconceptions and a general lack of awareness about this easily treated hormonal imbalance that research shows affects 20% of

More information

Take a moment Confer with your neighbour And try to solve the following word picture puzzle slides.

Take a moment Confer with your neighbour And try to solve the following word picture puzzle slides. Take a moment Confer with your neighbour And try to solve the following word picture puzzle slides. Example: = Head Over Heels Take a moment Confer with your neighbour And try to solve the following word

More information

Testosterone propionate, phenylpropionate, isocaproate and decanoate. Please read this leaflet carefully before you start using SUSTANON 250.

Testosterone propionate, phenylpropionate, isocaproate and decanoate. Please read this leaflet carefully before you start using SUSTANON 250. SUSTANON 250 Testosterone propionate, phenylpropionate, isocaproate and decanoate What is in this leaflet Please read this leaflet carefully before you start using SUSTANON 250. This leaflet answers some

More information

Hormone Replacement Therapy For Men Consultation Information. Round Rock Jollyville Westlake 512-231-1444 www.urologyteam.com.

Hormone Replacement Therapy For Men Consultation Information. Round Rock Jollyville Westlake 512-231-1444 www.urologyteam.com. Hormone Replacement Therapy For Men Consultation Information Round Rock Jollyville Westlake 512-231-1444 www.urologyteam.com Rev 05/13 Table of Contents Biological Aging and Hormones 2 As we age.... 3

More information

Subcutaneous Testosterone-Anastrozole Therapy in Breast Cancer Survivors. 2010 ASCO Breast Cancer Symposium Abstract 221 Rebecca L. Glaser M.D.

Subcutaneous Testosterone-Anastrozole Therapy in Breast Cancer Survivors. 2010 ASCO Breast Cancer Symposium Abstract 221 Rebecca L. Glaser M.D. Subcutaneous Testosterone-Anastrozole Therapy in Breast Cancer Survivors 2010 ASCO Breast Cancer Symposium Abstract 221 Rebecca L. Glaser M.D., FACS Learning Objectives After reading and reviewing this

More information

AUANEWS. Testosterone Replacement Therapy AUA 2014 ANNUAL MEETING HIGHLIGHTS. 2014 ANNUAL MEETING HIGHLIGHTS Testosterone Replacement Therapy

AUANEWS. Testosterone Replacement Therapy AUA 2014 ANNUAL MEETING HIGHLIGHTS. 2014 ANNUAL MEETING HIGHLIGHTS Testosterone Replacement Therapy American Urological Association AUANEWS THE OFFICIAL NEWSMAGAZINE OF THE AMERICAN UROLOGICAL ASSOCIATION 2014 ANNUAL MEETING HIGHLIGHTS Testosterone Replacement Therapy Course #017PG Male Health: Strategies

More information

Testosterone Testing

Testosterone Testing 20, 2012 Health Technology Assessment Testosterone Testing Final Evidence Report February 6, 2015 Health Technology Assessment Program (HTA) Washington State Health Care Authority PO Box 42712 Olympia,

More information

THE ROLE OF FREE TESTOSTERONE COMPARATIVE WITH TOTAL TESTOSTERONE IN MALE PATIENTS WITH ERECTILE DYSFUNCTION

THE ROLE OF FREE TESTOSTERONE COMPARATIVE WITH TOTAL TESTOSTERONE IN MALE PATIENTS WITH ERECTILE DYSFUNCTION THE ROLE OF FREE TESTOSTERONE COMPARATIVE WITH TOTAL TESTOSTERONE IN MALE PATIENTS WITH ERECTILE DYSFUNCTION Porav-Hodade Daniel 1, Coman Ioan 2, Boja Radu M 1, Todea Ciprian 1, Georgescu Carmen 2, Crisan

More information

A novel testosterone gel formulation normalizes androgen levels in hypogonadal men, with improvements in body composition and sexual function

A novel testosterone gel formulation normalizes androgen levels in hypogonadal men, with improvements in body composition and sexual function Original Article TESTOSTERONE GEL NORMALIZES ANDROGEN LEVELS T.A. McNICHOLAS et al. Men s health has become so important that it is now virtually a political issue. With advancing age, testosterone levels

More information

ABRAHAM MORGENTALER, MD, FACS TESTOSTERONE THERAPY FOR LIFE

ABRAHAM MORGENTALER, MD, FACS TESTOSTERONE THERAPY FOR LIFE Life Extension Magazine June 2010 By Julius Goepp, MD ABRAHAM MORGENTALER, MD, FACS TESTOSTERONE THERAPY FOR LIFE MAKING THE DIAGNOSIS With the growing number of scholarly articles on T replacement therapy

More information

TO SCREEN OR NOT TO SCREEN: THE PROSTATE CANCER

TO SCREEN OR NOT TO SCREEN: THE PROSTATE CANCER TO SCREEN OR NOT TO SCREEN: THE PROSTATE CANCER DILEMMA Thomas J Stormont MD January 2012 http://www.youtube.com/watch?v=8jd 7bAHVp0A&feature=related related INTRODUCTION A government health panel (the

More information

Adverse effects of testosterone replacement therapy: an update on the evidence and controversy

Adverse effects of testosterone replacement therapy: an update on the evidence and controversy 548680TAW0010.1177/2042098614548680Therapeutic Advances in Drug SafetyHeidelbaugh research-article2014 Therapeutic Advances in Drug Safety Review Adverse effects of testosterone replacement therapy: an

More information

Vitamin D and Cardiometabolic risk

Vitamin D and Cardiometabolic risk Vitamin D and Cardiometabolic risk 서울의대, 분당서울대병원 내과 최 성 희 2013년 대한당뇨병학회 춘계학술대회 Metabolism Of Vitamin D Risk factors for vitamin D deficiency - Aging decreased concentrations of 7-dehydro-cholesterol in

More information

Ask your healthcare provider about LONG-ACTING AVEED (testosterone undecanoate) AVEED TESTOSTERONE INJECTION 5 SHOTS A YEAR. Not an actual patient.

Ask your healthcare provider about LONG-ACTING AVEED (testosterone undecanoate) AVEED TESTOSTERONE INJECTION 5 SHOTS A YEAR. Not an actual patient. Ask your healthcare provider about LONG-ACTING AVEED (testosterone undecanoate) AVEED TESTOSTERONE INJECTION 5 SHOTS A YEAR AFTER THE FIRST MONTH OF THERAPY Not an actual patient. CONSUMERS What is the

More information

An Introduction to PROSTATE CANCER

An Introduction to PROSTATE CANCER An Introduction to PROSTATE CANCER Being diagnosed with prostate cancer can be a life-altering experience. It requires making some very difficult decisions about treatments that can affect not only the

More information

Acrux (ASX: ACR) 28 April 2014

Acrux (ASX: ACR) 28 April 2014 Acrux (ASX: ACR) 28 April 2014 FORWARD-LOOKING STATEMENTS 2 This presentation includes forward-looking statements that are subject to risks and uncertainties. Such statements involve known and unknown

More information

GARY S. DONOVITZ, M.D., F.A.C.O.G.

GARY S. DONOVITZ, M.D., F.A.C.O.G. Sub-Cutaneous Hormone Pellet Therapy- The Comprehensive Treatment to Optimize and Balance Hormones Using the BioTE Method GARY S. DONOVITZ, M.D., F.A.C.O.G. The BioTE method of hormone replacement is a

More information

MEDICATION GUIDE testosterone gel Testosterone (tes-tos-te-rone gel) CIII

MEDICATION GUIDE testosterone gel Testosterone (tes-tos-te-rone gel) CIII MEDICATION GUIDE testosterone gel Testosterone (tes-tos-te-rone gel) CIII Read this Medication Guide that comes with testosterone gel before you start using it and each time you get a refill. There may

More information

Hypogonadism affects ap -

Hypogonadism affects ap - Richard A. Bebb, MD, ABIM, FRCPC Testosterone deficiency: Practical guidelines for diagnosis and treatment Testosterone can be administered orally, transdermally, or by injection to improve a hypogonadal

More information