Article by Abraham Morgentaler, William P Conners III
INTRODUCTION
Over the last several years, there has been a dramatic global surge in testosterone (T) prescriptions.1 This rise in treatment has been spurred by greater awareness of the positive impact of T deficiency on health and well‑being, coupled with a reduced concern regarding T therapy
and prostate cancer (PCa) risk.2.3 For several decades, it was assumed that higher serum levels of T would increase the risk of developing de novo PCa or cause rapid growth of an occult PCa.4 Indeed, the fear of PCa has been the greatest international concern regarding T therapy.5
Major changes in our understanding of the relationship of PCa to androgens as well as new, reassuring evidence has brought the traditional view of the relationship of T and PCa into question.2,6 This new understanding has lowered the threshold for clinicians to consider T therapy in symptomatic men, including those with a prior history of PCa, a practice that has been contraindicated for decades. Testosterone Therapy is now being used.
T deficiency is common and underdiagnosed. It has been estimated to affect 2.1%–12.8% of middle‑aged to older men in the US and Europe.7 The numbers of affected men is likely to grow as the population ages in many countries. For example, in the US, the fraction of the population over 65 is growing at a rate 2–3 times of that compared to younger men.8 T therapy has been shown to offer a number of important benefits for sexual and nonsexual symptoms, as well as improvement in metabolic parameters such as increased lean mass, decreased fat mass, reduced insulin sensitivity, and improved bone mineral density.
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