AACE MENA 2025-Testosterone Replacement - Indications and Challenges

Video Transcription

Video Summary

The speaker discusses testosterone replacement therapy (TRT), tracing testosterone's role through life, its decline after age 30, and consequences like reduced libido, muscle mass, and cognitive issues. They address safety concerns, including a 2015 FDA alert linking testosterone to cardiovascular risks, but highlight recent large studies (TRAVERSE, T4DM) showing no increased major cardiovascular events in men with low testosterone and underlying cardiovascular disease. TRT also reduces progression from prediabetes to diabetes and improves sexual function, mainly libido. However, erectile dysfunction responds less to TRT alone and benefits more from combined therapy with PDE inhibitors. TRT can raise hematocrit and PSA levels, requiring regular monitoring to prevent risks like thrombosis or prostate complications. TRT is contraindicated in untreated obstructive sleep apnea, as it may worsen symptoms. Emerging perspectives suggest low-dose TRT might increase prostate cancer risk, while high doses could be protective. Overall, TRT appears safe and beneficial when carefully managed and monitored.

Keywords

testosterone replacement therapy

cardiovascular risk

prediabetes to diabetes progression

sexual function improvement

hematocrit and PSA monitoring

erectile dysfunction combined therapy