Goal

Testosterone has a spectrum of effects on the male body. This review seeks to determine, from published studies, the evolution over time of the effects induced by testosterone replacement therapy from the first manifestation until the maximum effects are obtained.

Design

Data from the literature on testosterone replacement.

The results

Effects on sexual interest become apparent after 3 weeks and stabilize after 6 weeks, with no further increase expected. Erection / ejaculation changes can last up to 6 months. The effects on quality of life will last within 3 to 4 weeks, but the maximum benefit lasts longer. Effects on depressed mood can be detected after 3 to 6 weeks, with a maximum after 18 to 30 weeks. Effects on erythropoiesis are evident after 3 months and peak after 9-12 months. The specific antigen and volume of the prostate increases slightly and stabilizes after 12 months; Greater growth should be related to aging rather than therapy. Effects on lipids occur after 4 weeks and are greatest after 6 to 12 months. Insulin sensitivity may improve within a few days, but the effects on blood sugar control will not be seen for 3 to 12 months. Changes in body fat, muscle mass, and muscle strength occur within 12 to 16 weeks, level off for 6 to 12 months, but may continue marginally for several years. Effects on inflammation appear within 3 to 12 weeks. The effects on the bones are already detectable after 6 months and last at least 3 years.

conclusion

The evolution over time of the effect of testosterone shows significant variations, probably linked to the pharmacodynamics of the testosterone preparation. Genomic and non-genomic effects, androgen receptor polymorphism, and intracellular steroid metabolism also contribute to this diversity.

Getting in:

introduction

Treating men with hypogonadism with testosterone benefits both patients and clinicians. To their satisfaction, the patient undergoes major changes in their physical appearance and mental makeup. The attending physician observes the changes that the patient undergoes and is rarely fascinated by the many roles that testosterone in the broadest sense plays in the process of masculinization (1).

Although the effects of testosterone have been described in detail, relatively little time and attention has been paid to the length and duration of their onset. It seems relevant. Your doctor will be able to monitor the effects of testosterone more easily if you know when certain effects can be expected. Patients are happy to receive information on when the effects will occur. If patients have not been exposed to testosterone during normal puberty, they should be prepared and informed about the presence of sexual thoughts and dreams, increased erections and ejaculation, and when to expect them. . Additionally, this information is relevant to the design of testosterone replacement therapy clinical trials. It is important to know when the effect can be expected and when it has peaked.

The data to compile a schedule for various testosterone measurements is not readily available. They come from studies on the effects of testosterone in hypogonadic men or studies on androgen deficiency. The main source of information is the first category. Most of these studies were not specifically designed to address the onset or course of the effects of testosterone; However, several controlled studies with a different design and planned monitoring allow a reasonable estimate.

Studies were identified by computer searches of MEDLINE, Cochrane Library, EMBASE, and Current Contents over the past 35 years (1976-2011), searches of bibliographies of all articles obtained, and examining links to articles. reviews found during the search to identify additional studies. . The research focused on studies published after 1975, as testosterone testing at that time was more widespread and more reliable. The following MESH keywords and terms were used in the computer database search in any combination: “body fat”, “lean weight / muscle / strength”, “physical”, “bone density / markers “,” Serum lipids / cholesterol “,” diabetes “, blood sugar”, “insulin resistance”, “inflammatory markers”, “endothelial functions”, “sexual functions”, “impotence / erectile / erectile dysfunction”, “libido “,” mood “,” depression “” cognitive function “,” polycythemia “,” prostate specific antigen (PSA) “,” prostate cancer / benign hypertrophy / prostatic hyperplasia (BPH) “” clinical trial ” , “randomized clinical trial” with any combination of “testosterone” “testosterone therapy”, “hormone replacement therapy” or “androgen therapy”. to the corresponding placebo or your control group, ii) description of the course over time of the effect of active treatment, and iii) randomization, protocol compliance and single / double blind. Only articles published in peer-reviewed medical journals were used; the summary was not used.

There is now some evidence that the spectrum of testosterone deficiency complaints may not be related to a specific threshold for testosterone levels, but that these thresholds vary with different symptoms of testosterone deficiency (2). In the male cohort, androgen-related loss of libido or endurance was more common when testosterone levels dropped below 15 nmol / L, while depression and type 2 diabetes (even in non-obese men ) were significantly more common in men with testosterone. . concentrations below 10 nmol / L. Symptoms associated with androgen deficiency in this study can be divided into three independent groups: psychosomatic disorders, metabolic disorders and sexual health problems. Patients in one of these three groups have different characteristics in terms of androgen levels, age and body mass index. The complaints therefore do not only apply to androgen levels, but age and body mass index also play a role in the manifestation of signs and symptoms of androgen deficiency (2). To further complicate the relationship between testosterone levels on the one hand and testosterone deficiency symptoms on the other hand, there is a multifactorial effect on certain androgen-related functions (2). Erectile dysfunction can serve as an example of a complex dysfunction, where arterial endothelial function, neuronal integrity, testosterone levels, and psychological factors play a crucial role (3, 4), which almost hampers the direct link between testosterone levels and erectile dysfunction. In one study, only testosterone levels below 8 nmol / L contributed to the symptom of erectile dysfunction (2).

Since the clinical manifestations of testosterone deficiency do not occur at the final threshold of circulating testosterone, but vary depending on the target organ, associated symptoms and background conditions, it is even more difficult to determine the evolution over time of the reversal of these symptoms. Deficiency is not just due to testosterone recovery.