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treatment, along with hemoglobin, hematocrit, PSA and
liver function.
- Testosterone has beneficial effects on sexual function;
TTH may increase the effect of PDE5 inhibitor mono-
therapy in men with LOH.
- TTH can be given to patients with mild to moderate LUTS.
Further research in men with severe LUTS is needed.
Caution should be exercised for men with significant
prostatic enlargement and significant residual urine in the
bladder.
- Men wishing to preserve their fertility should be informed
that TTH may cause impairment of fertility, ranging from
oligozoospermia to even azoospermia. Therefore, TTH
should not be used by hypogonadal (infertile) men who
have an active wish to conceive children or undergo
infertility treatment.
- Current evidence does not support an association between
TTH and higher risk of developing PCa. However,
sufficiently powered trials with long-term follow-up are
needed to reach definite conclusions. PSA testing and
digital rectal examination should be offered to men older
than 45 yr before commencing TTH, along with a
discussion of the potential benefits and harms according
to the EAU guidelines on PCa. TTH can be given to
hypogonadal patients after curative treatment for low-risk
PCa under close observation and after a prudent interval.
Active PCa is still considered a contraindication to TTH.
- Mammary carcinoma is an absolute contraindication to
TTH.
- Careful monitoring with clinical assessment is warranted
during TTH in men with pre-existing CVD. TTH is
contraindicated in men with severe chronic cardiac
failure (New York Heart Association grade IV).
- In men with elevated hematocrit (
>
0.54%) TTH is
contraindicated; whenever possible the underlying con-
dition should be corrected before TTH.
These contraindications are described further in the EAU
2016 guidelines on male hypogonadism
[1] .Conflicts of interest:
The authors have nothing to disclose.
Appendix A. URO-TRAM working group
The other members of the URO-TRAMworking group are
as follows:
- Maarten Albersen, Urology Department, University Hos-
pitals Leuven, Leuven, Belgium
- Richard Berges, PAN Klinik Ko¨ ln, Ko¨ ln, Germany
- Sabine Kliesch, Center of Andrology and Reproductive
Medicine, University of Mu¨ nster, Mu¨ nster, Germany
- Ignacio Moncada, Urology Department, Hospital Sanitas
La Zarzuela, Madrid, Spain
- Herman Leliefeld, Urology Department, Andros Clinic,
Baarn, The Netherlands
- Yacov Reisman, Sexuality Clinics, Amstelland Hospital,
Amstelveen, The Netherlands
- Jens Sønksen, Urology Department, Herlev Hospital,
Herlev, Denmark
- Aksam Yassin, Institute of Urology and Andrology,
Norderstedt-Hamburg, Germany
- Wolfgang Weidner, Urology Department, Pediatric Urol-
ogy and Andrology, University Clinic of Giessen, Giessen,
Germany
References
[1] Dohle G, Arver S, Bettocchi C, Jones T, Kliesch S, Punab M. EAU
guidelines on male hypogonadism. Arnhem, The Netherlands:
European Association of Urology; 2016
https://uroweb.org/ wp-content/uploads/EAU-Guidelines-Male-Hypogonadism-2016. pdf[2]
Khera M, Adaikan G, Buvat J, et al. Diagnosis and treatment of testosterone deficiency: recommendations from the Fourth Inter- national Consultation for Sexual Medicine (ICSM 2015). J Sex Med 2016;13:1787–804.[3]
Onasanya O, Iyer G, Lucas E, Lin D, Singh S, Alexander GC. Associa- tion between exogenous testosterone and cardiovascular events: an overview of systematic reviews. Lancet Diabetes Endocrinol 2016;4:943–56.[4]
Kloner RA, C arson 3rd C, Dobs A, Kopecky S, Mohler 3rd ER. Testosterone and cardiovascular disease. J Am Coll Cardiol 2016; 67:545–57.[5]
Corona G, Giagulli VA, Maseroli E, et al. Therapy of endocrine disease: testosterone supplementation and body composition: results from a meta-analysis study. Eur J Endocrinol 2016;174: R99–116.[6]
Gaffney CD, Pagano MJ, Kuker AP, Stember DS, Stahl PJ. Osteoporo- sis and low bone mineral density in men with testosterone defi- ciency syndrome. Sex Med Rev 2015;3:298–315.[7]
Kohn TP, Mata DA, Ramasamy R, Lipshultz LI. Effects of testosterone replacement therapy on lower urinary tract symptoms: a system- atic review and meta-analysis. Eur Urol 2016;69:1083–90.[8]
Kathrins M, Doersch K, Nimeh T, Canto A, Niederberger C, Seftel A. The relationship between testosterone-replacement therapy and lower urinary tract symptoms: a systematic review. Urology 2016; 88:22–32.[9]
Boyle P, Koechlin A, Bota M, et al. Endogenous and exogenous testosterone and the risk of prostate cancer and increased prostate-specific antigen (PSA) level: a meta-analysis. BJU Int 2016;118:731–41.[10]
Kaplan AL, Hu JC, Morgentaler A, Mulhall JP, Schulman CC, Montorsi F. Testosterone therapy in men with prostate cancer. Eur Urol 2016;69:894–903.[11]
Isidori AM, Buvat J, Corona G, et al. A critical analysis of the role of testosterone in erectile function: from pathophysiology to treat- ment—a systematic review. Eur Urol 2014;65:99–112.
[12]
Corona G, Isidori AM, Aversa A, Burnett AL, Maggi M. Endocrinologic control of men’s sexual desire and arousal/erection. J Sex Med 2016;13:317–37.
[13]
Podlasek CA, Mulhall J, Davies K, et al. Translational perspective on the role of testosterone in sexual function and dysfunction. J Sex Med 2016;13:1183–98.
[14]
Kelly DM, Jones TH. Testosterone: a vascular hormone in health and disease. J Endocrinol 2013;217:R47–71.[15]
Aversa A, Francomano D, Lenzi A. Does testosterone supplementa- tion increase PDE5-inhibitor responses in difficult-to-treat erectile dysfunction patients? Expert Opin Pharmacother 2015;16:625–8.
[16]
Corona G, Isidori AM, Buvat J, et al. Testosterone supplementation and sexual function: a meta-analysis study. J Sex Med 2014;11: 1577–92.E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 1 6 4 – 1 6 7
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