Management of Adverse Effects in Testosterone Replacement Therapy.

IF 4.5 3区 医学 Q1 UROLOGY & NEPHROLOGY
Basheer Basheer, Vishal Ila, Rodrigo Barros, Francesco Mesquita, Leonardo Seligra Lopes, Victor Fernandes Negris Lima, Luciano A Favorito, Ranjith Ramasamy
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Abstract

Purpose: This narrative review aims to provide the most updated knowledge regarding the treatment of adverse effects secondary to testosterone replacement therapy (TRT), such as gynecomastia, cardiovascular and hematologic risks, prostate health risk, and liver dysfunction risks.

Materials and methods: An extensive literature review was conducted, incorporating guidelines from the American Urological Association and the Endocrine Society. The studies determined common adverse effects and their most common methods of management.

Results: TRT improves the quality of life, sexual function, and mood in hypogonadal men. Possible adverse effects associated with TRT include increased estrogen levels and gynecomastia, which are usually managed with aromatase inhibitors and tamoxifen. Cardiovascular risks from TRT include hypertension and erythrocytosis, which mandate periodic hematocrit and blood pressure monitoring; therapeutic phlebotomy is indicated if the hematocrit exceeds 52%. No significant concern regarding prostate cancer has been observed in the closely monitored patient. However, TRT should not be administered to individuals with active evidence of untreated prostate cancer, except under rare circumstances such as active surveillance for very low-risk disease. Older oral forms of TRT can affect liver function; therefore, transdermal, newer oral forms and injectables are generally favored in men with a history of liver disease.

Conclusions: Monitoring and management of adverse effects are critical to maximize benefit and minimize the risks of TRT. Ongoing research will further elucidate the safety of TRT while advancing evidence-based practices in managing its associated adverse effects. Effective patient education and counseling are also essential to improve compliance and treatment outcomes.

Abstract Image

睾酮替代疗法不良反应的处理。
目的:本综述旨在提供有关睾酮替代疗法(TRT)继发不良反应治疗的最新知识,如男性乳房发育症、心血管和血液风险、前列腺健康风险和肝功能障碍风险。材料和方法:我们进行了广泛的文献回顾,并纳入了美国泌尿学会和内分泌学会的指南。这些研究确定了常见的不良反应及其最常见的管理方法。结果:TRT可改善性腺功能低下男性的生活质量、性功能和情绪。与TRT相关的可能的不良反应包括雌激素水平升高和男性乳房发育症,通常用芳香化酶抑制剂和他莫昔芬来治疗。TRT的心血管风险包括高血压和红细胞增多,这需要定期监测红细胞压积和血压;如果血细胞比容超过52%,则需要进行治疗性静脉切开术。在密切监测的患者中未观察到与前列腺癌有关的显著问题。然而,除非在非常低风险疾病的主动监测等罕见情况下,TRT不应用于有明显证据表明前列腺癌未得到治疗的个体。老年口服TRT可影响肝功能;因此,对于有肝脏病史的男性,透皮、新型口服和注射剂通常更受青睐。结论:监测和管理不良反应是TRT获益最大化和风险最小化的关键。正在进行的研究将进一步阐明TRT的安全性,同时推进管理其相关不良反应的循证实践。有效的患者教育和咨询对于提高依从性和治疗效果也是必不可少的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
International Braz J Urol
International Braz J Urol UROLOGY & NEPHROLOGY-
CiteScore
4.60
自引率
21.60%
发文量
246
审稿时长
6-12 weeks
期刊介绍: Information not localized
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