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Benefits of Testosterone Replacement Therapy
Many benefits of testosterone replacement therapy have been recorded, including better stability with moods, energy levels, and libido. Testosterone replacement has also been shown to enhance libido and the frequency of sexual acts and sleep-related erections. Transdermal testosterone replacement therapy, in particular, has been linked to positive effects on fatigue, mood, and sexual function, as well as significant increases in sexual activity. More specifically, testosterone replacement therapy has been shown to improve positive mood parameters, such as a feeling of friendliness, reducing negative mood parameters, such as anger and irritability.
Testosterone replacement therapy is also associated with potentially positive changes in body composition. In hypogonadal men, testosterone replacement therapy has demonstrated a number of effects, including an increase in lean body mass and a decrease in body fat, eight, and increases in muscle size.
Improvements in bone density have also been shown with testosterone replacement therapy. Increases in spinal bone density have been realized in hypogonadal men, with most treated men maintaining bone density above the fracture threshold.
Contraindications to Testosterone Replacement Therapy
Testosterone replacement is contraindicated in men with carcinoma of the breast or known or suspected carcinoma of the prostate, as it may cause rapid growth of these tumors. Hormone therapy is also inappropriate in men with severe benign prostatic hypertrophy (BPH)-related bladder outlet obstruction. The use of testosterone to improve athletic performance or correct short stature is potentially dangerous and inappropriate.
Lipid Abnormalities
Physiologic testosterone replacement is known to reduce total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) levels. Some authorities recommend that lipid values be followed closely in men receiving testosterone replacement therapy.
Prostate Changes
Although PSA is not specific for prostate cancer, it is a good surrogate for judging the effects of androgens on the prostate. In one study of testosterone-treated men, PSA rose to normal levels but no higher than in the controls, leading the authors to conclude that testosterone-induced prostate growth should not preclude hypogonadal men from testosterone replacement therapy. Indeed, another study indicates that even men who achieved supraphysiologic levels of serum testosterone had no significant changes in PSA levels.
The effects of transdermal testosterone replacement on prostate size and PSA levels in hypogonadal men have also been evaluated. Prostate size during therapy with transdermal testosterone was comparable to that reported in normal men, and PSA levels were within the normal range.
Prostate Cancer
There appears to be little association between testosterone replacement therapy and the development of prostate cancer. The etiology of prostate cancer is apparently multifactorial and dietary, geographic, genetic, and other influences are all thought to play a role in the development of the disease. Recent studies indicate that testosterone levels have no apparent systematic relationship to the incidence of prostate cancer.