Injection of testosterone may be safer and more effective than transdermal administration for combating loss of muscle and bone in older men - Abstract

The value of testosterone replacement therapy (TRT) for older men is currently a topic of intense debate.

While US testosterone prescriptions have tripled in the last decade (7), debate continues over the risks and benefits of TRT. TRT is currently prescribed for older men with either low serum testosterone (T) or low T plus accompanying symptoms of hypogonadism. Serum T ≤ 300 ng/dL is considered to be low and T ≤ 250 is frank hypogonadism. Treatment for men who have low T without accompanying symptoms remains somewhat controversial. TRT produces benefits including increased muscle mass and strength, decreased fat mass, increased and bone mineral density. TRT also produces known risks including development of polycythemia, decrease in HDL, breast tenderness and enlargement, prostate enlargement, and increases in serum PSA and prostate-related events. Importantly, TRT does not increase the risk of prostate cancer. Several recent reports have also indicated that TRT may produce cardiovascular (CV) risks, while others report no risk or even benefit. To address the potential CV risks of TRT, we have recently reported via meta-analysis that oral TRT increases CV risk and suggested that the CV risk profile for i.m. TRT may be better than that for oral or transdermal TRT. Herein, we review the literature which indicates that i.m. TRT produces greater musculoskeletal and may be safer that either oral or transdermal preparations. We also review the literature discussing the use of 5α-reductase inhibitors as a promising means of improving the safety profile of TRT.

Written by:
Borst SE, Yarrow JF.   Are you the author?
VA Medical Center Gainesville FL; Malcolm Randall VA Medical Center.  

Reference: Am J Physiol Endocrinol Metab. 2015 Apr 21:ajpendo.00111.2015.
doi: 10.1152/ajpendo.00111.2015

PubMed Abstract
PMID: 25898953

Beyond the Abstract Androgen Deficiency Section

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