Underdiagnosis, hesitant physicians, client prejudgments: Treating low testosterone levels is a difficult company in France in spite of the tested advantages of replacement treatment. About 20% of clients with symptomatic low testosterone levels are dealt with for the shortage, stated Eric Huygue, MD, PhD, urologic cosmetic surgeon at Toulouse University Hospital in France, at the 117th yearly conference of the French Urology Association (AFU).
“Treatment for low testosterone works and safe. It enhances a client’s lifestyle and basic health,” especially impacting tiredness, state of mind, and sex drive, stated Huygue, who was associated with preparing the very first French suggestions on dealing with low testosterone in 2021.
“We should maintain interaction efforts to make clients and physicians conscious” of the advantages of supplements, he stated.
Testosterone Levels
Testosterone shortage mainly impacts guys older than 40 years. A drop in androgen levels, which differs by person, can cause sexual issues (such as impotence and low sex drive), physical signs (tiredness, hot flashes, loss of muscle mass, and osteoporosisand mental illness (stress and anxiety, irritation, and anxiety.
There are an approximated 340,000 guys with symptomatic testosterone shortage in France. Simply 70,000 of these are getting replacement treatment (see box), which represents just 20% of those impacted. For Huygue, this low treatment rate is because of underdiagnosis, in addition to unwillingness on the part of medical professionals and clients.
Regular screening of low testosterone in the basic population is not advised, some people are especially at threat, kept in mind the urologist.
This is particularly real for clients with metabolic conditions related to insulin resistance (such as weight problems and type 2 diabetesheart diseases (high blood pressure cardiac arrestand atrial fibrillationor other persistent conditions (persistent obstructive lung illnesscancer, and anxiety). Some medications (corticosteroids, antipsychotics, chemotherapy drugs, and antiretroviral treatments) can likewise cause low testosterone.
Per the French suggestions for handling low testosterone, medical diagnosis needs to be based upon complimentary or bioavailable testosterone and not overall testosterone levels, which can provide a manipulated outcome. Levels should be checked two times, 1 month apart, in the early morning and while fasting. The recommendation variety is identified by taking the lower limit level of boys as determined in the lab.
Limit Values
The existing practice of utilizing the recommendation variety related to the client’s age unquestionably adds to the underdiagnosis of low testosterone, stated Huygue. According to a study of AFU members in 2021, the year in which the suggestions were released, 77% of urologists spoke with reported describing reference varieties for clients of the very same age.
In their defense, “this approach has actually long remained in usage, however it has actually ultimately emerged that symptomatic clients with an undiagnosed shortage might be in the referral clients’ group,” Huygue discussed.
When a shortage has actually been identified, physicians might hesitate to recommend replacement treatment due to the viewed danger of establishing prostate cancerNumerous worldwide research studies have actually revealed that “the threat of prostate cancer is the single greatest factor for medical professionals declining to recommend testosterone,” stated Huygue.
In spite of this hesitation, many research studies have actually plainly revealed that there is no link in between a high testosterone level and the danger of establishing prostate cancer. It even appears that a low testosterone level may expose an individual to an increased threat for an aggressive kind of cancer.
“This is a time of lots of unexpected discoveries worrying the link in between the prostate and testosterone, which break what we have actually believed up to now. It has actually been observed that males with low testosterone establish more major kinds of cancer,” stated Huygue at a previous conference of the AFU, throughout which he revealed the publication of the French suggestions.
Prostate Cancer Recurrence
Urologists are likewise cautious of testosterone supplements in clients with a previous history of prostate cancer. According to the AFU’s study, 40% of urologists questioned believe that testosterone is contraindicated in this population. One in 2 urologists recommend testosterone after extreme prostatectomy for low or intermediate threat and most frequently after 3 years of undetected prostate-specific antigen (PSA) levels.
“a number of retrospective research studies reveal the security of testosterone replacement treatment in guys who have actually gone through extreme prostatectomy or radiotherapy or who are under active tracking,” stated Huygue. Testosterone “does not appear to increase the danger of regression” after treatment of prostate cancer.
Huygue welcomed recommending doctors to describe the French suggestions, which define that 1 year of undetected PSA after prostatectomy suffices before recommending replacement treatment. “This is plainly shown in the suggestions for clients with a previous history of prostate cancer.”
Neither prostate cancer nor benign prostatic hyperplasia is a contraindication. According to the suggestions, the only contraindications to testosterone prescription are the following:
- Hematocrit > > 54%
- Existing breast or prostate cancer
- Cardiovascular occasion less than 3-6 months prior
- Attempting to develop
Cardiovascular Benefits
Another more typically utilized argument by family doctors and endocrinologists to validate their hesitation to recommend testosterone is the danger to cardiovascular health. In early 2010, a series of American research studies informed clinicians to this threat when taking testosterone. Ever since, other research studies have actually had comforting findings.
In action to the alert released by the United States, the European Medicines Agency defined that “the information are not adequate for a caution,” before the American Heart Association associates concluded that testosterone ought to just be prevented in the very first 6 months following a serious cardiovascular occasion
Alternatively, in 2021, the European Society of Cardiology advanced the advantages of testosterone in a post in favor of replacement treatment to avoid cardiovascular threatIn specific, the hormonal agent is believed to have an advantageous result on arterial tightness, the look of calcified plaques, and coronary artery dilatation.
The last obstacle to conquer before a testosterone prescription is filled connects to clients themselves, who frequently concern such treatment unfavorably. Numerous incorrectly think that androgens are hormonal agents that “increase the threat of cancer, make you aggressive, trigger weight gain, result in loss of hair, and trigger body hair development,” stated Huygue.
Breaks in the supply chain for Androtardyl, the only injectable type readily available for repayment by French social security plans, were reported in the nation in 2023, stated Huygue. This scenario just makes complex even more the prescription and usage of testosterone replacement treatment.
Which Supplement?
Testosterone replacement treatments are offered on the marketplace in the following solutions:
- Via transcutaneous administration: Testosterone-based gels, not covered by the French social security system (Androgel and Fortigel), to be used daily. Users should beware to prevent any prospective transfer of the item to females or kids in case of contact with the website after application.
- Via an injection: Androtardyl (testosterone enanthate), covered by French social security, to be administered intramuscularly when a month. Nebido (testosterone undecanoate), not covered by French social security, with a more useful bioavailability profile, to be administered when every 3 months.
Pantestone (testosterone undecanoate), administered orally, is not marketed considering that 2021. It had the significant drawback of needing a high-fat diet plan to guarantee optimum absorption.
This post was equated from the Medscape French edition