Testosterone kinetics on hypogonadal men under clomiphene.

OBJECTIVE: To evaluate total testosterone (TT) kinetics and its predictors 6 months after the discontinuation of clomiphene citrate (CC) in patients with hypogonadism. MATERIALS AND METHODS: Consecutive patients with normal testicles and male hypogonadism defined by TT < 300 ng/dl in the presence of signs or symptoms according to the previous consensus were prospectively evaluated in a urologic outpatient clinic by TT levels at baseline (T0), after a daily dose of 50 mg CC for 40 days (T1), and after the washout period of 6 months of CC discontinuation (T2). RESULTS: Among 75 patients, mean age 56.8 years, testosterone at T1 > 300 ng/dl was achieved by 69 (92%), 450-600 ng/dl by 32 (42.6%), and > 600 ng/dl by 27 (36.0%). 18 subjects (24%) maintained asymptomatic and TT levels over 300 ng/dl at T2. Age negatively related to testosterone response and T1 response > 810 ng/dl predicts a median gain of 166.5 ng/dl at 6 months of CC discontinuation. CONCLUSIONS: CC is a compelling option to treat male hypogonadism, although a chronic treatment is needed in most patients. About one in every four patients respond to a CC short trial to "reboot" the physiology. Further understanding of TT kinetics in these patients in the long term is warranted.

[Prostate cancer: evidence based clinical practice]. / Cáncer de próstata: práctica clínica basada en la evidencia.

OBJECTIVES: Evidence-based medicine allows the best available external clinical evidence from systematic literature research to be graded in order to determine the strength of its recommendation. This guideline aims to assist physicians and health professionals in clinical decisions related to prostate cancer treatment, particularly in urology, clinical oncology and radiotherapy. METHODS: The publications used as information sources were obtained from structured data search in electronic databases, such as CENTRAL (Cochrane Central Register of Controlled Clinical Trials) and MEDLINE (online). Each item of this guideline derived from an original question which was distributed to the participants. Search strategies were prepared to select the studies presenting the best methodological quality, according to predefined levels of evidence. RESULTS: All the recommendations were followed by a level of evidence (LE) and a degree of recommendation (DR). We used a formal ranking system to help the reader to judge the strength of the evidence behind the results published in support of each recommendation. CONCLUSIONS: The existing parameters should be viewed as guidelines of conduct. The final trial on which the clinical procedure or treatment plan is most suitable for a particular patient should be done by a physician, who should discuss the available treatment options with the patient according to the diagnosis.