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|Title:||Testosterone treatment in older men: clinical implications and unresolved questions from the Testosterone Trials.|
|Authors:||Yeap, Bu B;Page, Stephanie T;Grossmann, Mathis|
|Affiliation:||School of Medicine, University of Western Australia, Perth, WA, Australia; Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA, Australia|
Division of Metabolism and Endocrinology, University of Washington, Seattle, WA, USA
Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
|Citation:||The lancet. Diabetes & endocrinology 2018; 6(8): 659-672|
|Abstract:||A decrease in the concentration of circulating testosterone in many older men is a biomarker and possibly a rectifiable contributing factor to ill health. Low circulating testosterone concentration has been associated with cardiovascular disease, reduced cognition, fracture risk, and anaemia. However, randomised placebo-controlled trials are essential to clarify the benefits and possible risks of testosterone treatment in men without hypothalamic, pituitary, or testicular disease. The Testosterone Trials (T-Trials) were a coordinated set of trials that, following a screening-to-enrolment ratio of 65:1, randomly assigned 790 men aged 65 years or older who had a baseline testosterone concentration of less than 9·54 nmol/L and symptoms consistent with hypogonadism, but no recognisable hypothalamic-pituitary-testicular axis pathology, to daily transdermal testosterone or placebo for 12 months. In the main trial, testosterone treatment resulted in a modest benefit for sexual function, whereas the other primary outcomes of vitality and physical function were not met. Data from concomitant substudies raised a possible concern over changes in coronary plaque volume, showed a neutral effect on memory and other cognitive functions, and revealed improvements in volumetric bone mineral density and anaemia. Although insufficient to alter the existing clinical equipoise, the T-Trials provided substantial new data on organ-specific outcomes for testosterone treatment in older men. Further clinical trials are necessary to determine whether testosterone treatment will translate into patient-valued health outcomes and to clarify effects on the cardiovascular system.|
|Appears in Collections:||Journal articles|
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