Serum estradiol levels decrease after oophorectomy in transmasculine individuals on testosterone therapy / 亚洲男科学杂志(英文版)

Transmasculine individuals, considering whether to undergo total hysterectomy with bilateral salpingectomy, have the option to have a concomitant oophorectomy. While studies have evaluated hormone changes following testosterone therapy initiation, most of those patients have not undergone oophorectomy. Data are currently limited to support health outcomes regarding the decision to retain or remove the ovaries. We performed a retrospective chart review of transmasculine patients maintained on high-dose testosterone therapy at a single endocrine clinic in Vancouver, British Columbia, Canada. Twelve transmasculine individuals who underwent bilateral oophorectomy and had presurgical and postsurgical serum data were included. We identified 12 transmasculine subjects as controls, who were on testosterone therapy and did not undergo oophorectomy, but additionally matched to the first group by age, testosterone dosing regimen, and body mass index. There was a statistically significant decrease in the estradiol levels of case subjects postoophorectomy, when compared to presurgical estradiol levels (P = 0.02). There was no significant difference between baseline estradiol levels between control and case subjects; however, the difference in estradiol levels at follow-up measurements was significant (P = 0.03). Total testosterone levels did not differ between control and case subjects at baseline and follow-up (both P > 0.05). Our results demonstrate that oophorectomy further attenuates estradiol levels below what is achieved by high-dose exogenous testosterone alone. Correlated clinical outcomes, such as impacts on bone health, were not available. The clinical implications of oophorectomy versus ovarian retention on endocrinological and overall health outcomes are currently limited.

Testosterone therapy for women with low sexual desire: a position statement from the Brazilian Society of Endocrinology and Metabolism

ABSTRACT Objective To summarize current evidence regarding testosterone treatment for women with low sexual desire. Materials and methods The Female Endocrinology and Andrology Department of the Brazilian Society of Endocrinology and Metabolism invited nine experts to review the physiology of testosterone secretion and the use, misuse, and side effects of exogenous testosterone therapy in women, based on the available literature and guidelines and statements from international societies. Results Low sexual desire is a common complaint in clinical practice, especially in postmenopausal women, and may negatively interfere with quality of life. Testosterone seems to exert a positive effect on sexual desire in women with sexual dysfunction, despite a small magnitude of effect, a lack of long-term safety data, and insufficient evidence to make a broad recommendation for testosterone therapy. Furthermore, there are currently no testosterone formulations approved for women by the relevant regulatory agencies in the United States, Brazil, and most other countries, and testosterone formulations approved for men are not recommended for use by women. Conclusion Therefore, testosterone therapy might be considered if other strategies fail, but the risks and benefits must be discussed with the patient before prescription. Arch Endocrinol Metab. 2019;63(3):190-8

Does Testosterone Therapy Increase Risk of Cardiovascular Events among Men? A Meta-analysis

Importance: There has been increasing interest in use of testosterone therapy (TT) beyond patients with hypogonadism to include younger men without documented hormone measurements for the purpose of improving libido, sexual function, bone density, and body mass. However, there is no conclusive data about safety of TT due to lack of adequately powered randomized clinical trials (RCTs) specifically designed for this purpose. Objective: To examine the overall risk of cardiovascular events associated with TT via meta-analysis of published randomized and observational studies. Data Sources: We searched MEDLINE, EMBASE, CINAHL, the Cochrane Controlled Trials Register and the National Institute of Health Clinical Trials.gov database from 1966 to 2014. Study Selection: Out of the initial 2,800 studies identified, we obtained a total of 34 studies for detailed analysis after applying our inclusion/exclusion criteria. Two reviewers used eligibility criteria to assess all titles, abstracts, and full texts and resolved disagreements by discussion. Data Extraction and Synthesis: One reviewer did data abstractions and quality assessments, which were confirmed by a second reviewer. Data were then collected and analyzed using random and fixed effect model, as appropriate. Risk estimates were extracted as adjusted hazard ratios (HRs) from included studies. Main Outcome and Measures: Association of TT with cardiovascular events as a primary endpoint and association of TT with ischemic heart disease, all-cause mortality and cerebrovascular events as secondary endpoints. Results: TT was associated with increased incidence of cardiovascular events (adjusted hazard ratio (HR) = 1.41, 95% CI = 1.19-1.67, p = 0.0004), all-cause mortality (adjusted HR = 1.29, 95% CI = 1.03-1.62, p = 0.02), and ischemic heart disease (adjusted HR=1.51, 95% CI = 1.05-2.18, p = 0.02) but there was no clear association with cerebrovascular events (adjusted HR=0.91, 95% CI = 0.66-1.25, p=0.54). Subgroup analyses of our primary endpoint by study type (randomized versus observational studies) did not change our results (adjusted HR=1.40, 95% CI = 1.05-1.87, p = 0.02 and adjusted HR=1.54, 95% CI = 1.09-2.17, p = 0.01 respectively). Additional analysis using meta-regression and sensitivity analyses to account for factors such as history of prior CV events, indication for TT and duration of follow up did not change our results. However, we did notice lack of association between CV events and Intramuscular testosterone. Conclusions and Relevance: TT may be associated with an increased risk of all-cause mortality, cardiovascular events, and ischemic heart disease. These findings support the need for an adequately powered randomized study.

Awareness of andropause in males: A North Indian study.

Background: According to the Indian census 2011, India has the largest population of the elderly. Very few studies have been carried out in North India to assess the awareness about andropause in men, which is why this study was conceived. Objectives: To assess the awareness about andropause and its treatment modalities among the men of Chandigarh. Materials and Methods: The present study was conducted at an Urban Health Training Center (UHTC-44 B) of Government Medical College and Hospital Sector 32, Chandigarh (GMCH) in male patients attending the outpatient department. This non-interventional individual cross-sectional study was carried out from August 2010 to August 2011 in men aged 40 years and above. Systematic, random sampling was carried out and the study sample comprised 757 men. The subjects were given pre-structured and pre-tested questionnaires that had questions pertaining to socio-demographic profile, ADAM scale, views about andropause, its treatment modalities, etc., Results: Out of the sample size of 757 men, subjects from the urban area (323; 43.1) were more in contrast to that of the peri-urban (41; 31.9) and slum areas (393; 259). Maximum number of patients belonged to the age group of 40-49 years (342; 26.3), followed by those in age group 60-69 years (141; 18.6). It was found that awareness about the term andropause was found only among 17 (2.2%) subjects, whereas the knowledge of a syndrome synonymous to that of menopause in females was even less 7 (0.9%) patients positive for andropause were found to increase with increase of age (40-49; 35.7, 50-59; 81.2, 60-69; 96.5). Only 123 (11.4%) had an idea about the treatment of andropause. The keenness to resort to treatment or seek medical advice was shown by 355 (47.3%). Subjects in the age group of less than 60 years resorted to injections (15; 4.7) and transdermal patches (6; 1.09) as testosterone-replacement therapy. Herbal medicines were especially taken by those subjects in the age group 60-70 years, (74.3%; 101). Conclusion: Awareness about andropause and its treatment modalities is less in men.

Androgen Deficiency in Postmenopausal Women / 대한폐경학회지

In contrast to previous dogma, the decline in testosterone levels in postmenopausal women is thought to be age-related and not a specific function of the menopause. In addition to normal aging, many conditions affecting ovarian and adrenal function, factors leading to increased SHBG levels can decrease androgen levels below the physiologic range in women. Clinical symptoms of female androgen deficiency include a loss of libido, lack of well-being, and persistent fatigue. However, the diagnosis of female androgen deficiency, as recently provided by the Princeton consensus statement, is under debate due to several limitations. Testosterone therapy in postmenopausal women with symptoms suggestive of androgen deficiency remains controversial. The adverse effects of testosterone therapy appear to be low in incidence, but more studies are necessary to assess long-term safety. Therefore, the decision to treat or not to treat androgen deficiency in postmenopausal women must be carefully considered on an individual basis by comprehensive evaluation of potential benefits and risks.