Hormone Replacement Therapy Antiaging Atlanta

Bioidentical hormones used in hormone replacement therapy are simply hormones that are identical to those naturally occurring in our bodies as opposed to those found in drugs such as Premarin.

Hormones are substances produced by specialized cells in our bodies. They affect the metabolism of other cells that have receptors for the particular hormone.

Bioidentical hormones used in hormone replacement therapy include estradiol, progesterone, human growth hormone, testosterone, DHEA, melatonin and others.

It is now understood that many of our hormone levels decline with age and that our hormone levels have broad reaching consequences for our metabolism and the state of our health which makes he case for hormone replacement therapy - returning hormone levels to more youthful ranges.

There is a fundamental question being debated in medicine today, and that is:

Do our hormone levels decline because we age or do we age because our hormone levels decline?

Many antiaging physicians believe that we develop many of the degenerative diseases of aging at least in part due to declining hormone levels.

One component of your personalized antiaging program will be hormone replacement therapy, to restore your hormone levels to those normally found in the 20 - 30 year age range. This approach avoids the complications that may be seen when unmonitored hormone doses are used.

Hormone replacement therapy is not to be confused with using anabolic steroids used by certain athletes or non-bioidentical hormones such as Premarin. We are simply replacing hormones that are normally produced in your body to youthful levels.

Complete bioidentical hormone replacement therapy is much more effective than replacing single hormones in achieving optimal health since hormones act synergistically. We therefore replace when appropriate human growth hormone, testosterone, DHEA and melatonin in men and human growth hormone, testosterone, estradiol, progesterone, DHEA and melatonin in women.

Most individuals realize health benefits associated with a more youthful metabolism including increased energy and vitality, improved mood and outlook on life, improved body composition, and a stronger immune system among others.

Dr. Smith is committed to help you achieve a state of optimal health and vitality.

Long term 10 year study of beneficial effects of continuous testosterone hormone replacement therapy in elderly men and no major adverse cardiovascular events.
Andrologia. 2016 Sep;48(7):793-9. doi: 10.1111/and.12514. Epub 2016 Jan 14.
Effects of continuous long-term testosterone therapy (TTh) on anthropometric, endocrine and metabolic parameters for up to 10 years in 115 hypogonadal elderly men: real-life experience from an observational registry study.
Yassin AA1,2,3, Nettleship J4, Almehmadi Y1, Salman M1, Saad F3,5.
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Abstract
Subnormal levels of testosterone are associated with significant negative health consequences, with higher risks of all-cause and cardiovascular mortality. The numbers of studies reporting on the benefits of normalisation of testosterone is increasing but longer-term data on (elderly) men receiving testosterone treatment are almost nonexistent. In this single-centre, cumulative, prospective, registry study, 115 hypogonadal men (mean age 59.05 years) received injections with testosterone undecanoate in 12-week intervals for up to 10 years. Waist circumference, body weight and mean BMI dropped progressively with statistical significance versus previous year for 7 years and, respectively, 8 years for weight and body mass index. Similarly, fasting glucose displayed a significant decrease after the first year continuing to decrease thereafter. A decline in HbA1c , from 6.4% to 5.6% (mean <6%), was observed from year 2 on, together with a decrease in the ratio of triglycerides:high-density lipoprotein (HDL), a surrogate marker of insulin resistance, with an increase in HDL levels. The total cholesterol:HDL ratio and non-HDL cholesterol declined significantly. A decrease was also observed in systolic and diastolic blood pressure, with a decrease in levels of the inflammation marker C-reactive protein. No major adverse cardiovascular events were observed throughout the study.

Men with testosterone deficiency and CVD benefit from long term testosterone hormone replacement therapy.
Vasc Health Risk Manag. 2016 Jun 14;12:251-61. doi: 10.2147/VHRM.S108947. eCollection 2016.
Men with testosterone deficiency and a history of cardiovascular diseases benefit from long-term testosterone therapy: observational, real-life data from a registry study.
Haider A1, Yassin A2, Haider KS1, Doros G3, Saad F4, Rosano GM5.
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Abstract
BACKGROUND/OBJECTIVES:
Long-term testosterone therapy (TTh) in men with hypogonadism has been shown to improve all components of the metabolic syndrome. In this study, we investigated the effects of long-term TTh up to 8 years in hypogonadal men with a history of cardiovascular disease (CVD).
PATIENTS AND METHODS:
In two urological clinics observational registries, we identified 77 hypogonadal men receiving TTh who also had a history of CVD. The effects of TTh on anthropometric and metabolic parameters were investigated for a maximum duration of 8 years. Any occurrence of major adverse cardiovascular events was reported. All men received long-acting injections of testosteroneundecanoate at 3-monthly intervals.
RESULTS:
In 77 hypogonadal men with a history of CVD who received TTh, we observed a significant weight loss and a decrease in waist circumference and body mass index. Mean weight decreased from 114±13 kg to 91±9 kg, change from baseline: -24±1 kg and -20.2%±0.5%. Waist circumference decreased from 112±8 cm to 99±6 cm, change from baseline: -13±0.3 cm. Body mass index decreased from 37±4 to 29±3, change from baseline: -8±0.2 kg/m(2). Cardio-metabolic parameters such as lipid pattern, glycemic control, blood pressure, heart rate, and pulse pressure all improved significantly and sustainably. No patient suffered a major adverse cardiovascular event during the full observation time.
CONCLUSION:
In men with hypogonadism, TTh appears to be effective in achieving sustained improvements in all cardiometabolic risk factors and may be effective as an add-on measure in the secondary prevention of cardiovascular events in hypogonadal men with a history of CVD.

The combination of testosterone and HGH hormone replacement therapy produced significant improvement in aerobic and anaerobic fitness, body composition, and lipoprotein profile in middle-aged men.
Ann Agric Environ Med. 2014;21(1):156-60.
Effects of growth hormone and testosterone therapy on aerobic and anaerobic fitness, body composition and lipoprotein profile in middle-aged men.
Zając A1, Wilk M2, Socha T3, Maszczyk A4, Chycki J2.
Author information
Abstract
INTRODUCTION:
Andropause and aging are associated with neuroendocrine dysfunctions. Growth hormone and testosterone play a significant role in several processes affecting adaptation and thereby also everyday functioning. The aim of this research project was to evaluate the effects of recombinant human growth hormone and testosterone enanthate injections on body mass and body composition, aerobic and anaerobic fitness and lipid profile in middle-aged men.
MATERIALS AND METHOD:
The research group was comprised of 14 men aged 45 - 60 years. Two series of laboratory analyses were performed. Independent tests were carried out at baseline and after 12 weeks of the experiment. The data were analyzed using Statistica 9.1 software.
RESULTS:
A two-way repeated measures ANOVA revealed a statistically significant effect of the intervention programme on fat-free mass (η(2)=0.34), total body fat (η(2)=0.79), total cholesterol (η(2)=0.30), high-density lipoprotein cholesterol (η(2)=0.31), low-density lipoprotein cholesterol (η(2)=0.42), triglyceride (η(2)=0.28), testosterone (η(2)=0.52), insulin-like growth factor 1 (η(2)=0.47) and growth hormone (η(2)=0.63). Furthermore, ANOVA revealed a statistically significant effect of the rhGH and T treatment on maximal oxygen uptake (η(2)=0.63), anaerobic threshold (η(2)=0.61) and maximal work rate (η(2)=0.53).
CONCLUSION:
It should be emphasized that the lipid profile was affected not only by rhGH+T replacement therapy, but also by the prescribed physical activity programme. The strength and endurance fitness programme alone did not cause significant changes in body mass and composition, nor the anaerobic and aerobic capacity. On the other hand, the rhGH=T treatment stimulated these changes significantly.

Erythrocytosis and Polycythemia Secondary to Testosterone Replacement Therapy in the Aging Male.
Jones SD Jr1, Dukovac T1, Sangkum P1, Yafi FA1, Hellstrom WJ2.
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Abstract
INTRODUCTION:
Testosterone replacement therapy (TRT) is a common treatment for hypogonadism in aging males. Men with low to low-normal levels of testosterone have documented benefit from hormone replacement. Recent meta-analyses have revealed that increases in hemoglobin (Hb) and hematocrit (Hct) are the variants most commonly encountered. Clinically, this response is described as erythrocytosis or polycythemia secondary to TRT. However, the recent Food and Drug Administration warning regarding the risk for venothromboembolism (VTE) has made the increases in Hb and Hct of more pertinent concern. The risks associated with androgen replacement need further examination.
AIM:
To review the available literature on erythrocytosis and polycythemia secondary to TRT. To discuss potential etiologies for this response, the role it plays in risk for VTE, and recommendations for considering treatment in at-risk populations.
METHODS:
A literature review was performed through PubMed regarding TRT and erythrocytosis and polycythemia.
MAIN OUTCOME MEASURES:
To assess the mechanisms of TRT-induced erythrocytosis and polycythemia with regard to basic science, pharmacologic preparation, and route of delivery. To review Hct and risk for thrombotic events. To offer clinical suggestions for therapy in patients at risk for veno-thrombotic events.
RESULTS:
Men undergoing TRT have a 315% greater risk for developing erythrocytosis (defined as Hct > 0.52) when compared with control. Mechanisms involving iron bioavailability, erythropoietin production, and bone marrow stimulation have been postulated to explain the erythrogenic effect of TRT. The association between TRT-induced erythrocytosis and subsequent risk for VTE remains inconclusive.
CONCLUSIONS:
All TRT formulations cause increases in Hb and Hct, but injectables tend to produce the greatest effect. The evidence regarding the risk for VTE with increased Hct is inconclusive. For patients with risk factors for veno-thrombotic events, formulations that provide the smallest effect on blood parameters hypothetically provide the safest option. Further trials are needed to fully evaluate the hematological side effects associated with TRT. Jones SD Jr, Dukovac T, Sangkum P, Yafi FA, and Hellstrom WJG. Erythrocytosis and polycythemia secondary to testosterone replacement therapy in the aging male. Sex Med Rev 2015;3:101-112.

Testosterone injections safer and more effetive than transdermal route for preventing musle and bone loss in older men.
 Am J Physiol Endocrinol Metab. 2015 Jun 15;308(12):E1035-42. doi: 10.1152/ajpendo.00111.2015. Epub 2015 Apr 21.
Injection of testosterone may be safer and more effective than transdermal administration for combating loss of muscle and bone in older men.
Borst SE1, Yarrow JF2.
Author information
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 past decade (9), 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. The normal range for serum testosterone is 300 to 1,000 ng/dl. Serum T ≤ 300 ng/dl is considered to be low, and T ≤ 250 is considered to be frank hypogonadism. Most experts support TRT for older men with frank hypogonadism and symptoms. Treatment for men who simply have low T remains somewhat controversial. TRT is most frequently administered by intramuscular (im) injection of long-acting T esters or transdermally via patch or gel preparations and infrequently via oral administration. TRT produces a number of established benefits in hypogonadal men, including increased muscle mass and strength, decreased fat mass, increased bone mineral density, and improved sexual function, and in some cases those benefits are dose dependent. For example, doses of TRT administered by im injection are typically higher than those administered transdermally, which results in greater musculoskeletal benefits. TRT also produces known risks including development of polycythemia (Hct > 50) in 6% of those treated, decrease in HDL, breast tenderness and enlargement, prostate enlargement, increases in serum PSA, and prostate-related events and may cause suppression of the hypothalamic-pituitary-gonadal axis. Importantly, TRT does not increase the risk of prostate cancer. Putative risks include edema and worsening of sleep apnea. 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 im TRT may be better than that for oral or transdermal TRT.

Testosterone Hormone Replacement Therapy shown to benefit older patients with frailty.
 Asian J Androl. 2014 Mar-Apr;16(2):203-12. doi: 10.4103/1008-682X.122581.
Androgen effects on skeletal muscle: implications for the development and management of frailty.
O'Connell MD, Wu FC1.
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Abstract
Androgens have potent anabolic effects on skeletal muscle and decline with age in parallel to losses in muscle mass and strength. This loss of muscle mass and function, known as sarcopenia, is the central event in development of frailty, the vulnerable health status that presages adverse outcomes and rapid functional decline in older adults. The potential role of falling androgen levels in the development of frailty and their utility as function promoting therapies in older men has therefore attracted considerable attention. This review summarizes current concepts and definitions in muscle ageing, sarcopenia and frailty, and evaluates recent developments in the study of androgens and frailty. Current evidence from observational and interventional studies strongly supports an effect of androgens on muscle mass in ageing men, but effects on muscle strength and particularly physical function have been less clear. Androgen treatment has been generally well-tolerated in studies of older men, but concerns remain over higher dose treatments and use in populations with high cardiovascular risk. The first trials of selective androgen receptor modulators (SARMs) suggest similar effects on muscle mass and function to traditional androgen therapies in older adults. Important future directions include the use of these agents in combination with exercise training to promote functional ability across different populations of older adults, as well as more focus on the relationships between concurrent changes in hormone levels, body composition and physical function in observational studies.

Testosterone Hormone Replacement Therapy shown to benefit patients with Type 2 Diabetes nad Metabolic Syndrome.
Med Clin (Barc). 2016 Jan 15;146(2):69-73. doi: 10.1016/j.medcli.2015.06.020. Epub 2015 Oct 1.
[Testosterone deficiency, metabolic syndrome and diabetes mellitus].
[Article in Spanish]
Fernández-Miró M1, Chillarón JJ2, Pedro-Botet
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Abstract
Testosterone deficiency in adult age is associated with a decrease in libido, energy, hematocrit, muscle mass and bone mineral density, as well as with depression. More recently, testosterone deficiency has also been associated with various components of the metabolic syndrome, which in turn is associated with a five-fold increase in the risk of cardiovascular disease. Low testosterone levels are associated with increased insulin resistance, increase in fat mass, low HDL cholesterol, higher triglyceride levels and hypertension. Testosterone replacement therapy in patients with testosterone deficiency and type 2 diabetes mellitus and/or metabolic syndrome has shown reductions in insulin resistance, total cholesterol, LDL cholesterol and triglycerides and improvement in glycemic control and anthropometric parameters.
KEYWORDS:
Déficit de testosterona; Hipogonadismo; Hipogonadismo y diabetes; Hypogonadism; Hypogonadism and diabetes; Testosterone deficiency

Advantages of treating LOH with HCG rather than Testosterone Hormone Replacement Therapy
Aging Male. 2016;19(1):34-9. doi: 10.3109/13685538.2015.1092021. Epub 2015 Oct 21.
Late-onset hypogonadism: the advantages of treatment with human chorionic gonadotropin rather than testosterone.
La Vignera S1, Condorelli RA1, Cimino L1, Russo GI2, Morgia G2, Calogero AE1.
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Abstract
The traditional pharmacological treatment of patients with late onset hypogonadism (LOH) is represented by different formulations of testosterone (T) or alternatively by the extractive human chorionic gonadotropin (HCG). The hormone replacement treatment (HRT) is associated with the potential increase of hematocrit, serum concentrations of prostate-specific antigen (PSA) and prostate volume. Moreover, the gynecomastia represent a condition frequently associated with HRT. Recent evidences showed the role of leydig cells in the 25-hydroxylation of vitamin D and the elevated frequency of hypovitaminosis D among LOH patients. Finally, another important aspect of LOH is represented by the frequency of secondary infertility due to age or to traditional HRT. This study evaluated 40 LOH patients treated for 6 months with extractive HCG (n = 10 patients) and three different formulations of T: transdermal (n = 10 patients), undecaonate (n = 10 patients) and enantate (n = 10 patients). Hormonal, anthropometric, metabolic and sperm parameters were evaluated and compared. Moreover, the main safety parameters and the results of the main questionnaires were evaluated. After treatment, HCG group showed serum concentrations of 25-OH-vitamin D significantly higher (p < 0.05) and serum concentrations of oestrogens significantly lower (p < 0.05) compared with other groups. Moreover, they showed a mean value of hematocrit, PSA and prostate volume significantly lower (p < 0.05) compared with other groups. Finally, all the groups treated with T showed a significant reduction (p < 0.05) of sperm density and of percentage of spermatozoa with progressive motility compared with HCG group.

Testosterone Hormone Replacement Therapy improves quality of life in older men with LOH.
Andrologia. 2017 May;49(4). doi: 10.1111/and.12630. Epub 2016 Jul 8.
Testosterone replacement therapy improves health-related quality of life for patients with late-onset hypogonadism: a meta-analysis of randomized controlled trials.
Nian Y1, Ding M1, Hu S1, He H2, Cheng S1, Yi L1, Li Y1, Wang Y1.
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Abstract
Although testosterone replacement therapy can restore serum testosterone concentrations to normal level in late-onset hypogonadism patients, whether it can improve patients' quality of life remains uncertain. Therefore, we perform a meta-analysis of randomized controlled trials on this issue. Five randomized controlled trials total 1,212 patients were included. Fixed-effect model was used to calculate the weighted mean difference of score of Aging Males' Symptom rating scale. Our result reveals that testosterone replacementtherapy improves patients' health-related quality of life in terms of the decrease in the AMS total score [WMD = -2.96 (-4.21, -1.71), p < .00001] and the psychological [WMD = -0.89 (-1.41, -0.37), p = .0008], somatic [WMD = -0.89 (-1.41, -0.37), p = .0008] and sexual [WMD = -1.29 (-1.75, -0.83), p < .00001] subscale score.

Low Testosterone Levels may predict high-grade prostate cancer - an argument for the use of Testosterone Hormone Replacment Therapy in aging men.
Turk J Urol. 2017 Sep;43(3):289-296. doi: 10.5152/tud.2017.35467. Epub 2017 Aug 1.
Low free and bioavailable testosterone levels may predict pathologically-proven high-risk prostate cancer: a prospective, clinical trial.
Bayar G1, Şirin H1, Aydın M2, Özağarı A3, Tanrıverdi O4, Kadıhasanoğlu M5, Kendirci M4.
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Abstract
OBJECTIVE:
To determine the predictive value of free and bioavailable testosterone levels on the detection of high-grade prostate cancer proven by histopathological examination of transrectal prostate biopsy specimens.
MATERIAL AND METHODS:
A total of 405 patients who underwent transrectal prostate biopsy due to high prostatic specific antigen (PSA) (>2.5 ng/mL) and/or abnormal findings at digital rectal examination were included in this study. Blood free and bioavailable testosterone levels were calculated by the formula recommended by International Society for the Study of the Aging Male (ISSAM). The patients were stratified according to the D'Amico classification based on PSA levels and histological outcomes of prostate biopsies as benign, low, intermediate and high-risk prostate cancer. Patients were also divided into five groups according to the percentage of cancerous cores.
RESULTS:
Prostate cancer was detected in 160 of 405 (39.5%) patients. Total, free and bioavailable testosterone levels did not differ significantly between the patients with benign or malign histology. However, mean free (6.2 vs. 5.2 ng/dL, p=0.02) and bioavailable (151 vs. 125 ng/dL, p=0.001) testosterone levels were found to be significantly different in men with low-intermediate and high-risk prostate cancer. Moreover, a significant correlation was found between free, and bioavailable testosterone levels and percentage of cores with cancer (p=0.002 for free and p=0.016 for bioavailable testosterone, respectively).
CONCLUSION:
This prospective clinical study demonstrates that reduced levels of calculated blood free and bioavailable testosterone levels are associated with an increased risk of high-grade prostate cancer. Based on these findings blood free and bioavailable testosterone levels may be be thought to be an adjunctive factor in the prediction of high-risk prostate cancer.

Research shows long term Testosterone Hormone Replacement Therapy not associated with risk of High Grade Prostate Cancer.J Urol. 2015 Dec;194(6):1612-6. doi: 10.1016/j.juro.2015.05.099. Epub 2015 Jun 9.
Long-term Exposure to Testosterone Therapy and the Risk of High Grade Prostate Cancer.
Baillargeon J1, Kuo YF2, Fang X3, Shahinian VB4.
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Abstract
PURPOSE:
To our knowledge no population based studies have been done to examine whether long-term exposure to testosterone therapy is associated with an increased risk of high grade prostate cancer. We examined whether exposure to testosterone during a 5-year period was associated with an increased risk of high grade prostate cancer and whether this risk increased in a dose-response fashion with the cumulative number of testosterone injections.
MATERIALS AND METHODS:
Using SEER (Surveillance, Epidemiology and End Results)-Medicare linked data we identified 52,579 mendiagnosed with incident prostate cancer between January 1, 2001 and December 31, 2006 who had a minimum of 5 years continuous enrollment in Medicare before the cancer diagnosis. We excluded patients diagnosed at death or after autopsy, those enrolled in a health maintenance organization in the 60 months before diagnosis and those with unknown tumor grade or tumor stage. In the 5 years before diagnosis 574 men had a history of testosterone use and 51,945 did not.
RESULTS:
On logistic regression adjusting for demographic and clinical characteristics exposure to testosterone therapy was not associated with an increased risk of high grade prostate cancer (OR 0.84, 95% CI 0.67-1.05) or receipt of primary androgen deprivation therapy following diagnosis (OR 0.97, 95% CI 0.74-1.30). In addition the risk of high grade disease did not increase according to the total number of testosterone injections (OR 1.00, 95% CI 0.98-1.01).
CONCLUSIONS:
Our finding that testosterone therapy was not associated with an increased risk of high grade prostate cancer may provide important information regarding the risk-benefit assessment for men with testosterone deficiency considering treatment.
Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

EMAS position statement supports use off Testosterone Hormone Replacement in aging men and reports multiple health benefits.
EMAS position statement: Testosterone replacement therapy in the aging male‏.
Dimopoulou C1, Ceausu I2, Depypere H3, Lambrinoudaki I4, Mueck A5, Pérez-López FR6, Rees M7, van der Schouw YT8, Senturk LM9, Simonsini T10, Stevenson JC11, Stute P12, Goulis DG13.
Author information
Abstract
INTRODUCTION:
Late-onset hypogonadism (LOH) represents a common clinical entity in aging males, characterized by the presence of symptoms (most usually of a sexual nature, such as decreased libido, decreased spontaneous erections and erectile dysfunction) and signs, in combination with low serum testosterone concentrations. Whether testosterone replacement therapy (TRT) should be offered to those individuals is still under extensive debate.
AIMS:
The aim of this position statement is to provide and critically appraise evidence on TRT in the aging male, focusing on pathophysiology and characteristics of LOH, indications for TRT, available therapeutic agents, monitoring and treatment-associated risks.
MATERIALS AND METHODS:
Literature review and consensus of expert opinion.
RESULTS AND CONCLUSIONS:
Diagnosis and treatment of LOH is justified, if a combination of symptoms of testosterone deficiency and low testosterone is present. Patients receiving TRT could profit with regard to obesity, metabolic syndrome, type 2 diabetes mellitus, sexual function and osteoporosis and should undergo scheduled testing for adverse events regularly. Potential adverse effects of TRT on cardiovascular disease, prostate cancer and sleep apnea are as yet unclear and remain to be investigated in large-scale prospective studies. Management of aging men with LOH should include individual evaluation of co-morbidities and careful risk versus benefit assessment.

Improved sexual functioning with testosterone hormone replacement therapy in older men.
J Clin Endocrinol Metab. 2016 Aug;101(8):3096-104. doi: 10.1210/jc.2016-1645. Epub 2016 Jun 29.
Testosterone Treatment and Sexual Function in Older Men With Low Testosterone Levels.
Cunningham GR1, Stephens-Shields AJ1, Rosen RC1, Wang C1, Bhasin S1, Matsumoto AM1, Parsons JK1, Gill TM1, Molitch ME1, Farrar JT1, Cella D1, Barrett-Connor E1, Cauley JA1, Cifelli D1, Crandall JP1, Ensrud KE1, Gallagher L1, Zeldow B1, Lewis CE1, Pahor M1, Swerdloff RS1, Hou X1, Anton S1, Basaria S1, Diem SJ1, Tabatabaie V1, Ellenberg SS1, Snyder PJ1.
Author information
Abstract
CONTEXT:
The Testosterone Trials are a coordinated set of seven trials to determine the efficacy of T in symptomatic men ≥65 years old with unequivocally low T levels. Initial results of the Sexual Function Trial showed that T improved sexual activity, sexual desire, and erectile function.
OBJECTIVE:
To assess the responsiveness of specific sexual activities to T treatment; to relate hormone changes to changes in sexual function; and to determine predictive baseline characteristics and T threshold for sexual outcomes.
DESIGN:
A placebo-controlled trial.
SETTING:
Twelve academic medical centers in the United States.
PARTICIPANTS:
A total of 470 men ≥65 years of age with low libido, average T <275 ng/dL, and a partner willing to have sexual intercourse at least twice a month.
METHODS:
Men were assigned to take T gel or placebo for 1 year. Sexual function was assessed by three questionnaires every 3 months: the Psychosexual Daily Questionnaire, the Derogatis Interview for Sexual Function, and the International Index of Erectile Function.
RESULTS:
Compared with placebo, T administration significantly improved 10 of 12 measures of sexual activity. Incremental increases in total and free T and estradiol levels were associated with improvements in sexual activity and desire, but not erectile function. No threshold T level was observed for any outcome, and none of the 27 baseline characteristics predicted responsiveness to T.
CONCLUSIONS:
In older men with low libido and low T levels, improvements in sexual desire and activity in response to T treatment were related to the magnitude of increases in T and estradiol levels, but there was no clear evidence of a threshold effect.

Position statement of AACE and ACE on Menopause and the use of Hormone Replacement Therapy
Endocr Pract. 2017 Jul;23(7):869-880. doi: 10.4158/EP171828.PS.
AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY POSITION STATEMENT ON MENOPAUSE-2017 UPDATE.
Cobin RH, Goodman NF; AACE Reproductive Endocrinology Scientific Committee.
Abstract
EXECUTIVE SUMMARY This American Association of Clinical Endocrinologists (AACE)/American College of Endocrinology (ACE) Position Statement is designed to update the previous menopause clinical practice guidelines published in 2011 but does not replace them. The current document reviews new clinical trials published since then as well as new information regarding possible risks and benefits of therapies available for the treatment of menopausal symptoms. AACE reinforces the recommendations made in its previous guidelines and provides additional recommendations on the basis of new data. A summary regarding this position statement is listed below: New information available from randomized clinical trials and epidemiologic studies reported after 2011 was critically reviewed. No previous recommendations from the 2011 menopause clinical practice guidelines have been reversed or changed. Newer information enhances AACE's guidance for the use of hormone therapy in different subsets of women. Newer information helps to support the use of various types of estrogens, selective estrogen-receptor modulators (SERMs), and progesterone, as well as the route of delivery. Newer information supports the previous recommendation against the use of bioidentical hormones. The use of nonhormonal therapies for the symptomatic relief of menopausal symptoms is supported. Newer information enhances AACE's guidance for the use of hormone therapyin different subsets of women. Newer information helps to support the use of various types of estrogens, SERMs, and progesterone, as well as the route of delivery. Newer information supports the previous recommendation against the use of bioidentical hormones. The use of nonhormonal therapies for the symptomatic relief of menopausal symptoms is supported. New recommendations in this position statement include: 1.
RECOMMENDATION:
the use of menopausal hormone therapy in symptomatic postmenopausal women should be based on consideration of all risk factors for cardiovascular disease, age, and time from menopause. 2.
RECOMMENDATION:
the use of transdermal as compared with oral estrogen preparations may be considered less likely to produce thrombotic risk and perhaps the risk of stroke and coronary artery disease. 3.
RECOMMENDATION:
when the use of progesterone is necessary, micronized progesterone is considered the safer alternative. 4.
RECOMMENDATION:
in symptomatic menopausal women who are at significant risk from the use of hormone replacement therapy, the use of selective serotonin re-uptake inhibitors and possibly other nonhormonal agents may offer significant symptom relief. 5.
RECOMMENDATION:
AACE does not recommend use of bioidentical hormone therapy. 6.
RECOMMENDATION:
AACE fully supports the recommendations of the Comité de l'Évolution des Pratiques en Oncologie regarding the management of menopause in women with breast cancer. 7.
RECOMMENDATION:
HRT is not recommended for the prevention of diabetes. 8.
RECOMMENDATION:
In women with previously diagnosed diabetes, the use of HRT should be individualized, taking in to account age, metabolic, and cardiovascular risk factors.
ABBREVIATIONS:
AACE = American Association of Clinical Endocrinologists; ACE = American College of Endocrinology; BMI = body mass index; CAC = coronary artery calcification; CEE = conjugated equine estrogen; CEPO = Comité de l'Évolution des Pratiques en Oncologie; CAD = coronary artery disease; CIMT = carotid intima media thickness; CVD = cardiovascular disease; FDA = Food and Drug Administration; HDL = high-density lipoprotein; HRT = hormone replacement therapy; HT = hypertension; KEEPS = Kronos Early Estrogen Prevention Study; LDL = low-density lipoprotein; MBS = metabolic syndrome; MPA = medroxyprogesterone acetate; RR = relative risk; SERM = selective estrogen-receptor modulator; SSRI = selective serotonin re-uptake inhibitor; VTE = venous thrombo-embolism; WHI = Women's Health Initiative.

The article abstract below suggests testosterone hormone replacement therapy in men improves strength, power, and stair climbing in older men.
J Clin Endocrinol Metab. 2017 Feb 1;102(2):583-593. doi: 10.1210/jc.2016-2771.
Effects of Testosterone Supplementation for 3 Years on Muscle Performance and Physical Function in Older Men.
Storer TW1, Basaria S1, Traustadottir T2,3, Harman SM2,4, Pencina K1, Li Z1, Travison TG1,5, Miciek R6,7, Tsitouras P2,8, Hally K1, Huang G1, Bhasin S1.
Author information
Abstract
CONTEXT:
Findings of studies of testosterone's effects on muscle strength and physical function in older men have been inconsistent; its effects on muscle power and fatigability have not been studied.
OBJECTIVE:
To determine the effects of testosterone administration for 3 years in older men on muscle strength, power, fatigability, and physical function.
DESIGN, SETTING, AND PARTICIPANTS:
This was a double-blind, placebo-controlled, randomized trial of healthy men ≥60 years old with total testosterone levels of 100 to 400 ng/dL or free testosterone levels <50 pg/mL.
INTERVENTIONS:
Random assignment to 7.5 g of 1% testosterone or placebo gel daily for 3 years.
OUTCOME MEASURES:
Loaded and unloaded stair-climbing power, muscle strength, power, and fatigability in leg press and chest press exercises, and lean mass at baseline, 6, 18, and 36 months.
RESULTS:
The groups were similar at baseline. Testosterone administration for 3 years was associated with significantly greater performance in unloaded and loaded stair-climbing power than placebo (mean estimated between-group difference, 10.7 W [95% confidence interval (CI), -4.0 to 25.5], P = 0.026; and 22.4 W [95% CI, 4.6 to 40.3], P = 0.027), respectively. Changes in chest-press strength (estimated mean difference, 16.3 N; 95% CI, 5.5 to 27.1; P < 0.001) and power (mean difference 22.5 W; 95% CI, 7.5 to 37.5; P < 0.001), and leg-press power were significantly greater in men randomized to testosterone than in those randomized to placebo. Lean body mass significantly increased more in the testosterone group.
CONCLUSION: Compared with placebo, testosterone replacement in older men for 3 years was associated with modest but significantly greater improvements in stair-climbing power, muscle mass, and power. Clinical

The article abstract below suggests clomiphene may be used effectively in some men to treat low testosterone levels instead of hormone replacement therapy.
Endocr Pract. 2017 Mar;23(3):279-287. doi: 10.4158/EP161543.OR. Epub 2016 Nov 16.
CLOMIPHENE CITRATE IN THE TREATMENT OF IDIOPATHIC OR FUNCTIONAL HYPOGONADOTROPIC HYPOGONADISM IN MEN: A CASE SERIES AND REVIEW OF THE LITERATURE.
Liel Y.
Abstract
OBJECTIVE:
Late-onset hypogonadotropic hypogonadism (LOH) is a complex, heterogeneous entity. Whenever treatment is indicated, the endocrine literature has recommend testosterone replacement. We present our experience with clomiphene citrate treatment in patients with LOH and a review of the literature.
METHODS:
This retrospective case series included 18 male patients with hypogonadotropic hypogonadism, roughly according to the European Male Aging Study criteria for LOH, attended at an academic hospital outpatient clinic. Data were retrieved from the patients' electronic medical records.
RESULTS:
The patients' mean age (±SD) was 44.3 ± 6.3 years (range 21-67 years) referred for evaluation of low testosterone together with decreased libido, erectile dysfunction, fatigue or tiredness, anxiety, and osteoporosis. Clomiphene was initially prescribed at doses between 25 mg 3 times a week and 50 mg/day. At 6 to 8 weeks following initiation of treatment, mean basal total-testosterone increased from 7.6 ± 2.6 to 19.3 ± 5.2 nmol/L (P<.0001). Mean basal luteinizing hormone (LH) increased from 2.7 ± 2.1 to 8.3 ± 3.5 nmol/L (P<.0001). Mean basal follicle-stimulating hormone (FSH) increased from 4.2 ± 3.6 to 8.6 ± 6.2 nmol/L (P = .007). Testosterone and LH responses were invariably observed, including 2 patients with history of nonpituitary cranial pathologies, 2 with somewhat elevated FSH, and 1 with an eating disorder. Twelve (67%) patients reported improvement in symptoms. Side effects included transient nipple tenderness in 1 patient.
CONCLUSION:
Available data suggest that clomiphene is an efficient and convenient alternative to testosterone replacement therapy in a substantial subset of patients with LOH. Additional long-term controlled studies should further establish the role of clomiphene in LOH.
ABBREVIATIONS:
FSH = follicle-stimulating hormone LH = luteinizing hormone LOH = late-onset hypogonadotropic hypogonadism.

The article abstract below suggests Testosterone Hormone Replacement Therapy improves body composition, bone metabolism, and lipid profile in middle aged men.
Clin Endocrinol (Oxf). 2005 Sep;63(3):280-93.
Effects of testosterone on body composition, bone metabolism and serum lipid profile in middle-aged men: a meta-analysis.
Isidori AM1, Giannetta E, Greco EA, Gianfrilli D, Bonifacio V, Isidori A, Lenzi A, Fabbri A.
Author information
Abstract
OBJECTIVES:
Ageing in men is associated with a gradual decline in serum testosterone levels and a concomitant loss of muscle mass, accumulation of central adiposity, impaired mobility and increased risk of bone fractures. Whether androgen treatment might be beneficial in these subjects is still under debate. We have carried out a systematic review of randomized controlled trials (RCTs) evaluating the effects of testosterone (T) administration to middle-aged and ageing men on body composition, muscle strength, bone density, markers of bone metabolism and serum lipid profile.
DATA SOURCE:
A comprehensive search of all published randomized clinical trials was performed using the MEDLINE, Cochrane Library, EMBASE and Current Contents databases.
REVIEW METHODS:
Guided by prespecified criteria, software-assisted data abstraction and quality assessed by two independent reviewers, 29 RCTs were found to be eligible. For each investigated variable, we reported the results of pooled estimates of testosterone treatment using the random effect model of meta-analysis. Heterogeneity, reproducibility and consistency of the findings across studies were explored using sensitivity and meta-regression analysis.
RESULTS:
Overall, 1,083 subjects were evaluated, 625 randomized to T, 427 to placebo and 31 to observation (control group). Weighted mean age was 64.5 years (range 49.9--77.6) and mean serum testosterone was 10.9 nmol/l (range 7.8--19). Testosterone treatment produced: (i) a reduction of 1.6 kg (CI: 2.5--0.6) of total body fat, corresponding to -6.2% (CI: 9.2--3.3) variation of initial body fat, (ii) an increase in fat free mass of 1.6 kg (CI: 0.6--2.6), corresponding to +2.7% (CI: 1.1--4.4) increase over baseline and (iii) no change in body weight. The effects of T on muscle strength were heterogeneous, showing a tendency towards improvement only at the leg/knee extension and handgrip of the dominant arm (pooled effect size=0.3 standard mean difference (SMD), CI: -0.0 to 0.6). Testosterone improved bone mineral density (BMD) at the lumbar spine by +3.7% (CI: 1.0--6.4%) compared to placebo, but not at the femoral neck, and produced a consistent reduction in bone resorption markers (pooled effect size = -0.6 SMD, CI: -1.0 to -0.2). Testosterone also reduced total cholesterol by 0.23 mmol/l (CI: -0.37 to -0.10), especially in men with lower baseline T concentrations, with no change in low density lipoprotein (LDL)-cholesterol. A significant reduction of high density lipoprotein (HDL)-cholesterol was found only in studies with higher mean T-values at baseline (-0.085 mmol/l, CI: -0.017 to -0.003). Sensitivity and meta-regression analysis revealed that the dose/type of T used, in particular the possibility of aromatization, explained the heterogeneity in findings observed on bone density and HDL-cholesterol among studies.
CONCLUSION:
The present analysis provides an estimate of the average treatment effects of testosterone therapy in middle-aged men. Our findings are sufficiently strong to justify further interventional studies focused on alternative targets of androgenic treatment carrying more stringent clinical implications, in particular the cardiovascular, metabolic and neurological systems.

The article abstract below suggests medical Hormone Replacement Therapy guidelines for testosterone replacement therapy for men utilizing hormone replacement therapy as a single agent rather than stimulating testosterone production. Causes and incidence of androgen deficiency are also reviewed.
Practitioner. 2017 Apr;261(1803):19-22.
Diagnosing and managing androgen deficiency in men.
Sandher RK, Aning J.
Abstract
Androgens play a crucial role in bone, muscle and fat metabolism, erythropoiesis and cognitive health. In men aged 40-79 years the incidence of biochemical deficiency and symptomatic hypogonadism is 2.1-5.7%. Decreased libido or reduced frequency and quality of erections, fatigue, irritability, infertility or a diminished feeling of wellbeing may be presenting complaints. However, a significant proportion of men with androgen deficiency will be identified when they present for unrelated concerns. Important factors to elicit from the history in addition to the presenting complaint include: a medical history of obesity, type 2 diabetes, systemic diseases or metabolic syndrome which all impact on testosterone physiology. A comprehensive medical review will identify agents which can cause low testosterone levels such as statins, steroids, opioids, dopamine antagonists and 5-alpha reductase inhibitors. Alcohol, anabolic steroids and illicit substance use such as marihuana can impact on testosterone levels and non-prescribed drug use should be routinely discussed. The mainstay of treatment in persisting androgen deficiency is to restore normal physiological levels of testosterone by using exogenous testosterone. It may take at least three to six weeks to notice any clinical improvement in symptoms. Men receiving testosterone supplementation should be followed closely and have their testosterone, haematocrit and PSA levels checked at three, six and twelve months after initiation of testosterone replacementtherapy. Men should then be reviewed at least annually thereafter.

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