Sex, Testosterone and Prostate Cancer:Androgen Replacement in the Aging Male

Israel Barken M.D.Prostate Cancer Research and Education Foundation

San Diego, CA

Testosterone replacement

• Morning and evening changes in Testosterone.

• Testosterone found in the following forms:

1. Testosterone bound to SHBG – 80%2. Testosterone weakly bound to

Albumin3. Free Testosterone.

Sex, Testosterone and Prostate Cancer:Androgen Replacement in the Aging Male

Sex and Testosterone:Contraindications to Testosterone Replacement

• Pre-existing prostate cancer

• Symptomatic BPH

• Pre existing breast cancer

• Sleep apnea

Sex and Testosterone

• Testosterone replacement in older men was not studied.

• One study showed elevation of PSA.

• Studies’ duration for only 3 years. Longer term effects are not known.

• High hemoglobin the only difference between groups of treated and non-treated.

Sex and Testosterone

• Testosterone replacement in older men is more likely to have positive effect on libido than ED.

• In younger men – effect on mood. The issue not studied in older men.

• Effect on cognition- conflicting results.

Testosterone Replacement

• Effect on bone density:

– Baseline testosterone 400ng/dl.

• 0.9% increase in bone density.

– Baseline testosterone 200mg/dl

• 6% increase in bone density.

Effects of Testosterone Therapy

• Effect on muscle mass:

– Increase 3%-5% in the older men.

– Increase 9%-19% in the younger men.

• Conflicting studies.

Effects of Testosterone Therapy

• Effect on serum lipoproteins:

– Beneficial effects on markers of cardiovascular risk.

• Reduced Cholesterol and LDL.

– Effects more pronounced in elderly men.

• Large scale studies are needed.

When to treat?

• Gray zone of Testosterone levels: 200-400

ng/dl

• Time of test, reliability of lab and symptoms.

• Contraindications

Sex and Testosterone

• Response to erotic stimuli may remain intact in the face of hypogonadism and the ability to maintain sexual function has occasionally been reported among castrates.

Sex and Testosterone

• Reflexogenic component– Genitalia stimulated

• Independent of Testosterone

• Psychogenic component– Central, psychological

• Dependent on Testosterone.

Sex and Testosterone

• Epidemiological studies suggests that hypogonadism contributes relatively little to the overall etiology of erectile dysfunction.

• Erectile dysfunction is primarily caused by:– Vascular– Neurogenic

Sex and Testosterone

• In a study of 1022 men presenting with ED, Hypogonadism was found only in 6.6%

• Only 36.4% of the 6.6% had improvement with the testosterone replacement.

• In a study of 2722 subjects a similar finding that 8.3% had hypogonadism.

Sex and Testosterone

• Healthy young men underwent suppression of testosterone.

• Replacement to high-normal did not improve their sexual abilities compared to low normal replacement.

Sex and TestosteroneScreening for Hypogonadism

• Men younger than 50 with complaints of ED accompanied by low libido and findings suggestive of hypogonadism as well as all men older than 50 years who have ED should be screened for hypogonadism.

• There is little evidence to support androgen therapy in men with complains of ED and low-normal serum testosterone levels.

Sex and Testosterone

Stay tuned.

More to come.