Bom... vamos por evidencias(JCEM, MAYO, AHA, ICUROLOGY...):
Testosterone therapy in men with testosterone deficiency: Are we beyond the point of no return?(https://www.icurology.org/DOIx.php?id=10.4111/icu.2016.57.6.384)
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Testosterone and weight loss: the evidence(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4154787/)
"Lifestyle modifications are considered a cornerstone in combating obesity. However, this is difficult to maintain over the long term, and the ability to achieve modest weight loss with lifestyle modification is limited, at best. Pharmacotherapy coupled with lifestyle modification provides an alternative to combating obesity with lifestyle changes alone. We propose that testosterone therapy in obese men with testosterone deficiency offers a well tolerated and effective therapy and produces sustained and significant weight loss. Testosterone therapy increases LBM, reduces fat mass and produces sustained and significant weight loss, reduction in waist circumference and BMI. We believe that testosterone therapy in obese men with testosterone deficiency is a unique and effective therapeutic approach to management of obesity. The fact that this therapy has been used over the past 7 decades to treat hypogonadism (testosterone deficiency) and is proven to be well tolerated and effective should be an added tool to the armament for the war on obesity."
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The safety of available treatments of male hypogonadism in organic and functional hypogonadism(https://www.tandfonline.com/doi/abs/10.1080/14740338.2018.1424831?journalCode=ieds20)
Introduction: In the case of primary male hypogonadism (HG), only testosterone (T) replacement therapy (TRT) is possible whereas when the problem is secondary to a pituitary or hypothalamus alteration both T production and fertility can be, theoretically, restored. We here systematically reviewed and discussed the advantages and limits of medications formally approved for the treatment of HG.
Areas covered: Data derived from available meta-analyses of placebo controlled randomized trials (RCTs) were considered and analyzed. Gonadotropins are well-toleratedand their use is mainly limited by higher costs and a more cumbersome treatment schedule than TRT. Available RCTs on TRT suggest that cardiovascular (CV) and venous thromboembolism risk is not a major issue and that prostate safety is guaranteed. The risk of increased hematocrit is mainly limited to the use of short terminjectable preparations.
Expert opinion: In the last few years the concept of ‘organic’ irreversible HG and ‘functional’ or age- and comorbidity-related HG has been introduced. This definition is not evidence-based. The majority of RCTs enrolled patients with ‘functional’ HG. Considering the significant improvement in body composition, glucose metabolism and sexual activity, TRT should not be limited to ‘organic’ HG, but also offered for ‘functional’.
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Fundamental Concepts Regarding Testosterone Deficiency and Treatment: International Expert Consensus Resolutions.(https://www.ncbi.nlm.nih.gov/pubmed/27313122)
To address widespread concerns regarding the medical condition of testosterone (T) deficiency (TD) (male hypogonadism) and its treatment with T therapy, an international expert consensus conference was convened in Prague, Czech Republic, on October 1, 2015.
Experts included a broad range of medical specialties including urology, endocrinology, diabetology, internal medicine, and basic science research. A representative from the European Medicines Agency participated in a nonvoting capacity.
Nine resolutions were debated, with unanimous approval:
(1) TD is a well-established, clinically significant medical condition that negatively affects male sexuality, reproduction, general health, and quality of life;
(2) symptoms and signs of TD occur as a result of low levels of T and may benefit from treatment regardless of whether there is an identified underlying etiology;
(3) TD is a global public health concern;
(4) T therapy for men with TD is effective, rational, and evidence based;
(5) THERE IS NO T CONCENTRATION THRESHOLD THAT RELIABLY DISTINGUISHES THOSE WHO WILL RESPOND TO TREATMENT FROM THOSE WHO WILL NOT;
(6) THERE IS NO SCIENTIFIC BASIS FOR ANY AGE-SPECIFIC RECOMMENDATIONS AGAINST THE USE OF T THERAPY IN MEN;
(7) THE EVIDENCE DOES NOT SUPPORT INCREASED RISKS OF CARDIOVASCULAR EVENTS WITH T THERAPY;
(8) THE EVIDENCE DOES NOT SUPPORT INCREASED RISK OF PROSTATE CANCER WITH T THERAPY; AND
(9) the evidence supports a major research initiative to explore possible benefits of T therapy for cardiometabolic disease, including diabetes.
These resolutions may be considered points of agreement by a broad range of experts based on the best available scientific evidence.
Morgentaler A, Zitzmann M, Traish AM, et al. Fundamental Concepts Regarding Testosterone Deficiency and Treatment: International Expert Consensus Resolutions. Mayo Clin Proc.
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