Testosterone replacement therapy is used for the treatment of age-related male hypogonadism, and prostate-specific antigen (PSA) is a primary screening tool for prostate cancer. The systematic review and meta-analysis aimed to determine the effect of testosterone replacement therapy on PSA levels.Medline, Cochrane Library, EMBASE, and Google Scholar databases were searched until February 28, 2014, and inclusion criteria were as follows: randomized controlled trial; intervention group received testosterone/androgen replacement therapy; control group did not receive treatment; and no history of prostate cancer. The primary outcome was change of PSA level between before and after treatment. Secondary outcomes were elevated PSA level after treatment, and the number of patients who developed prostate cancer.After initially identifying 511 articles, 15 studies with a total of 739 patients that received testosterone replacement and 385 controls were included. The duration of treatment ranged from 3 to 12 months. Patients treated with testosterone tended to have higher PSA levels, and thus a greater change than those that received control treatments (difference in means of PSA levels = 0.154, 95% confidence interval [CI] 0.069 to 0.238, P < 0.001). The difference in means of PSA levels were significant higher for patients that received testosterone intramuscularly (IM) than controls (difference in means of PSA levels = 0.271, 95% CI 0.117-0.425, P = 0.001). Elevated PSA levels after treatment were similar between patients that received treatment and controls (odds ratio [OR] = 1.02, 95% CI 0.48-2.20, P = 0.953). Only 3 studies provided data with respect to the development of prostate cancer, and rates were similar between those that received treatment and controls.Testosterone replacement therapy does not increase PSA levels in men being treated for hypogonadism, except when it is given IM and even the increase with IM administration is minimal.

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The effect of testosterone replacement therapy on prostate ...

Pharmacological body alteration

Transgender hormone therapy, also called Hormone replacement therapy (HRT) or gender-affirming hormone therapy (GAHT), is a form of hormone therapy in which sex hormones and other hormonal medications are administered to transgender or gender nonconforming individuals for the purpose of more closely aligning their secondary sexual characteristics with their gender identity. This form of hormone therapy is given as one of two types, based on whether the goal of treatment is feminization or masculinization:

Some intersex people may also undergo hormone therapy, either starting in childhood to confirm the sex they were assigned at birth, or later in order to align their sex with their gender identity. Non-binary people may also engage in hormone therapy in order to achieve a desired balance of sex hormones or to pass as a desired gender. [1]

The formal requirements to begin gender-affirming hormone therapy vary widely depending on geographic location and specific institution. Gender affirming hormones can be prescribed by a wide range of medical providers including, but not limited to, primary care physicians, endocrinologists, and obstetrician-gynecologists.[2]

Historically, many health centers required a psychiatric evaluation and/or a letter from a therapist before beginning therapy. Many centers now use an informed consent model that does not require any routine formal psychiatric evaluation but instead focuses on reducing barriers to care by ensuring a person can understand the risks, benefits, alternatives, unknowns, limitations, and risks of no treatment.[3] Some LGBT health organizations (notably Chicago's Howard Brown Health Center[4] and Planned Parenthood[5]) advocate for this type of informed consent model.

The Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People (SOC) require that patients seeking gender-affirmation hormone therapy be evaluated for gender dysphoria by either a mental health professional or hormone provider who is qualified in the area of transgender care. The Standards also require that the patient give informed consent, in other words, that they consent to the treatment after being fully informed of the risks involved.[6] Before beginning gender-affirming hormone therapy, the patient must be evaluated for significant medical and mental health concerns. If present, these must be addressed and reasonably well-controlled.[6]

The World Professional Association for Transgender Health (WPATH) Standards of Care, 7th edition, note that both of these approaches to care are appropriate.[2]

Many international guidelines and institutions require persistent, well-documented gender dysphoria as a pre-requisite to starting gender-affirmation therapy. Gender dysphoria refers to the psychological discomfort or distress that an individual can experience if their sex assigned at birth is incongruent with that person's gender identity.[6] Signs of gender dysphoria can include comorbid mental health stressors such as depression, anxiety, low self-esteem, and social isolation.[7] It is important to note that not all gender nonconforming individuals experience gender dysphoria.

The World Professional Association for Transgender Health (WPATH) and the Endocrine Society formulated guidelines that created a foundation for health care providers to care for transgender patients.[8] UCSF guidelines are also used.[9][citation needed] There is no generally agreed-upon set of guidelines, however.[citation needed]

Adolescents experiencing gender dysphoria may opt to undergo puberty-suppressing hormone therapy at the onset of puberty. The Standards of Care set forth by WPATH recommend individuals pursuing puberty-suppressing hormone therapy wait until at least experiencing Tanner Stage 2 pubertal development.[6] Tanner Stage 2 is defined by the appearance of scant pubic hair, breast bud development, and/or slight testicular growth.[10] WPATH classifies puberty-suppressing hormone therapy as a "fully reversible" intervention. Delaying puberty allows individuals more time to explore their gender identity before deciding on more permanent interventions and prevents the physical changes associated with puberty.[6]

The preferred puberty-suppressing agent for both individuals assigned male at birth and individuals assigned female at birth is a GnRH Analogue.[6] This approach temporarily shuts down the Hypothalamic-Pituitary-Gonadal (HPG) Axis, which is responsible for the production of hormones (estrogen, testosterone) that cause the development of secondary sexual characteristics in puberty.[11] It is important for adolescents undergoing puberty-suppressing hormone therapy to be monitored by a medical professional.

Feminizing hormone therapy is typically used by gender-nonconforming persons, such as transgender women, who desire the development of feminine secondary sex characteristics. Individuals who identify as non-binary may also opt-in for feminizing hormone treatment to better align their body with their desired gender expression. [12] Feminizing hormone therapy usually includes medication to suppress testosterone production and induce feminization. Types of medications include estrogens, antiandrogens (testosterone blockers), and progestogens.[13] Most commonly, an estrogen is combined with an antiandrogen to suppress and block testosterone.[14] This allows for demasculinization and promotion of feminization and breast development. Estrogens are administered in various modalities including injection, transdermal patch, and oral tablets.[15]

The desired effects of feminizing hormone therapy focus on the development of feminine secondary sex characteristics. These desired effects include: breast tissue development, redistribution of body fat, decreased body hair, reduction of muscle mass, and more.[14] The table below summarizes some of the effects of feminizing hormone therapy in transgender women:

Footnotes and sources

Masculinizing hormone therapy is typically used by gender-nonconforming persons, such as transgender men, who desire the development of masculine secondary sex characteristics. Masculinizing hormone therapy usually includes testosterone to produce masculinization and suppress the production of estrogen.[29] Treatment options include oral, parenteral, subcutaneous implant, and transdermal (patches, gels). Dosing is patient-specific and is discussed with the physician.[30] The most commonly prescribed methods are intramuscular and subcutaneous injections. This dosing can be weekly or biweekly depending on the individual patient.[citation needed]

Unlike feminizing hormone therapy, individuals undergoing masculinizing hormone therapy do not usually require additional hormone suppression such as estrogen suppression. Therapeutic doses of testosterone are usually sufficient to inhibit the production of estrogen to desired physiologic levels.[11]

The desired effects of masculinizing hormone therapy focus on the development of masculine secondary sex characteristics. These desired effects include: increased muscle mass, development of facial hair, voice deepening, increase and thickening of body hair, and more.[31]

Hormone therapy for transgender individuals has been shown in medical literature to be generally safe, when supervised by a qualified medical professional.[32] There are potential risks with hormone treatment that will be monitored through screenings and lab tests such as blood count (hemoglobin), kidney and liver function, blood sugar, potassium, and cholesterol.[30][13] Taking more medication than directed may lead to health problems such as increased risk of cancer, heart attack from thickening of the blood, blood clots, and elevated cholesterol.[30][33]

The Standards of Care published by the World Professional Association for Transgender Health (WPATH) summarize many of the risks associated with feminizing hormone therapy (outlined below).[6] For more in-depth information on the safety profile of estrogen-based feminizing hormone therapy visit the feminizing hormone therapy page.

The Standards of Care published by the World Professional Association for Transgender Health (WPATH) summarize many of the risks associated with masculinizing hormone therapy (outlined below).[6] For more in-depth information on the safety profile of testosterone-based masculinizing hormone therapy visit the masculinizing hormone therapy page.

Transgender hormone therapy may limit fertility potential.[34] Should a transgender individual choose to undergo sex reassignment surgery, their fertility potential is lost completely.[35] Before starting any treatment, individuals may consider fertility issues and fertility preservation. Options include semen cryopreservation, oocyte cryopreservation, and ovarian tissue cryopreservation.[34][35]

A study due to be presented at ENDO 2019 (the Endocrine Society's conference) reportedly shows that even after one year of treatment with testosterone, a transgender man can preserve his fertility potential.[36]

Many providers use informed consent, whereby someone seeking hormone therapy can sign a statement of informed consent and begin treatment without much gatekeeping. For other providers, eligibility is determined using major diagnostic tools such as ICD-10 or the Diagnostic and Statistical Manual of Mental Disorders (DSM). Psychiatric conditions can commonly accompany or present similar to gender incongruence and gender dysphoria. For this reason, patients are assessed using DSM-5 criteria or ICD-10 criteria in addition to screening for psychiatric disorders. The Endocrine Society requires physicians that diagnose gender dysphoria and gender incongruence to be trained in psychiatric disorders with competency in ICD-10 and DSM-5. The healthcare provider should also obtain a thorough assessment of the patient's mental health and identify potential psychosocial factors that can affect therapy.[37]

The ICD-10 system requires that patients have a diagnosis of either transsexualism or gender identity disorder of childhood. The criteria for transsexualism include:[38]

Individuals cannot be diagnosed with transsexualism if their symptoms are believed to be a result of another mental disorder, or of a genetic or chromosomal abnormality.[citation needed]

For a child to be diagnosed with gender identity disorder of childhood under ICD-10 criteria, they must be pre-pubescent and have intense and persistent distress about being the opposite sex. The distress must be present for at least six months. The child must either:

The DSM-5 states that at least two of the following criteria must be experienced for at least six months' duration for a diagnosis of gender dysphoria:[39]

In addition, the condition must be associated with clinically significant distress or impairment.[39]

Some organizations but fewer than in the past require that patients spend a certain period of time living in their desired gender role before starting hormone therapy. This period is sometimes called real-life experience (RLE). The Endocrine Society stated in 2009 that individuals should either have a documented three months of RLE or undergo psychotherapy for a period of time specified by their mental health provider, usually a minimum of three months.[40]

Transgender and gender non-conforming activists, such as Kate Bornstein, have asserted that RLE is psychologically harmful and is a form of "gatekeeping", effectively barring individuals from transitioning for as long as possible, if not permanently.[41]

Gender-affirming care is health care that affirms people to live authentically in their genders, no matter the gender they were assigned at birth or the path their gender affirmation (or transition) takes. It allows each person to seek only the changes or medical interventions they desire to affirm their own gender identity, and hormone therapy (HRT or gender-affirming hormone therapy) may be a part of that. [42]

Some transgender people choose to self-administer hormone replacement medications, often because doctors have too little experience in this area, or because no doctor is available. Others self-administer because their doctor will not prescribe hormones without a letter from a psychotherapist stating that the patient meets the diagnostic criteria and is making an informed decision to transition. Many therapists require at least three months of continuous psychotherapy and/or real-life experience before they will write such a letter. Because many individuals must pay for evaluation and care out-of-pocket, costs can be prohibitive.

Access to medication can be poor even where health care is provided free. In a patient survey conducted by the United Kingdom's National Health Service in 2008, 5% of respondents acknowledged resorting to self-medication, and 46% were dissatisfied with the amount of time it took to receive hormone therapy. The report concluded in part: "The NHS must provide a service that is easy to access so that vulnerable patients do not feel forced to turn to DIY remedies such as buying drugs online with all the risks that entails. Patients must be able to access professional help and advice so that they can make informed decisions about their care, whether they wish to take the NHS or private route without putting their health and indeed their lives in danger."[43] Self-administration of hormone replacement medications may have untoward health effects and risks.[44]

A number of private companies have attempted to increase accessibility for hormone replacement medications and help transgender people navigate the complexities of access to treatment.

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Transgender hormone therapy - Wikipedia

Everything You Need to Know About TRT

Its commonly accepted that as you grow older, Father Time forces you to slow down and lose strength as body fat collects around your midriff, and you begin to morph into the stereotypical male whos past his prime and has seen better days. Worse, your thinking can become cloudy and your memory may develop gaps as you begin the steady slide of cognitive decline.

Adding to this misery, the aches and pains of rising inflammation start to become more common. The dynamism of your physical prime starts to fade. Eventually, old injuries take center stage as the pain begins to grow. The slow creep of time begins to overtake your body as it seems to betray you. As time marches on, you feel as if you are becoming a shell of the man you once were.

RELATED: Nutritionists Share the Foods That Lower Testosterone

This is a terrifying reality as your sense of physical power gives way to a meeker existence. However, medical science has a way to get at the heart of these symptoms and give men a new lease on life.

In its molecular form, testosterone is the hormone that forms the foundation of masculinity.

At your physical peak (between 17 to 19 years of age), your testosterone is at its highest level of as much as 1,200 ng/dl (nanograms per deciliter). At the age of 35, your testosterone levels begin to drop at a rate of 1% a year.

Also, environmental factors such as exposure to plastics, toxins in the environment, and water pollution can interfere with testosterone production. Anyone with levels of around 350 ng/dl or lower can begin to experience symptoms of low testosterone.

Symptoms of low testosterone can include:

Making matters worse, these symptoms can go unnoticed as they develop over time. The slow and steady rise of these symptoms can sneak under your radar causing you to settle for a lower quality of life.

But there is a solution for you to consider.

Testosterone Replacement Therapy (TRT) is the medical treatment of testosterone deficiency to help men recover their physical masculinity and health.

By optimizing testosterone levels, you can reverse the negative effects of testosterone deficiency. This can result in a type of rebirth as TRT fights back the corrosive effects of low testosterone.

TRT has been clinically proven to:

There are a number of TRT therapies to help men normalize their testosterone - some natural and some external. Natural treatments can include supplements such as vitamin D and DHEA, among others, to support testosterone production. Also, getting quality sleep and stress management to lower cortisol levels, both of which are toxic to testosterone production.

External treatments include external testosterone in the form of injections, pills, time-released pellets inserted under the skin, and creams.

All of these different treatments need to be carefully considered in consultation with a medical professional. But, before treatment is prescribed, you need to know your T-levels.

Todays society has a stigma about TRT, labeling men who seek treatment as weak or less of a man. But testosterone deficiency is a real medical problem that can impact your long-term health. Just as women seek hormone treatment for estrogen levels or menopause, hormonal health is a major factor in the quality of life for men.

Other reasons concern the abuse of testosterone, especially among athletes and bodybuilders. Many men have a history of abusing testosterone even starting in adolescence to increase their muscle mass. The levels that they use can be as high as 5 to 10 times the recommended dosage and can have significant negative effects. This is clearly not the model used for medical treatment, reports Michael Werner, M.D, Medical Director and Founder at Maze Sexual & Reproductive Health.

A trained TRT medical professional will order a comprehensive round of lab work to assess the needs of a patient. These tests include:

These tests can take place over a few days or weeks as a medical professional factors in your goals for treatment along with an account of any symptoms before tailoring a treatment plan.

TRT is fairly inexpensive, costing around $40, and is covered by most insurance companies.

Dr. Werner goes on to explain, In my practice, once we achieve a T-level of 600-800 ng/dl, patients report that they experience a significant improvement in energy, libido, and positive mental outlook. While some patients report that they feel an improvement in the first week, it can take 3-4 months to notice an increase in energy levels, increased muscle mass, better workouts, motivation to exercise, increased drive to tackle difficult challenges, better quality sleep, loss of body fat, and stronger erections. However, it can take up to 9 months in some cases, so I recommend to anyone seeking TRT to commit to a full year to set themselves up to succeed. During this time, I would estimate that 90% of them have experienced a significant improvement of their symptoms and lives.

TRT requires regular medical supervision because treatment increases the level of red blood cell production. This can cause a thickening of the blood resulting in cardiovascular issues if allowed to go unnoticed (this is why you need to drink lots of water and your doctor may recommend occasionally donating blood).

You also need to go for regular checkups outside of TRT, particularly for cancer. Testosterone is an anabolic hormone that improves protein synthesis for muscle growth. But, since its an anabolic hormone that promotes growth, it can also accelerate the spread of cancer if present, but undiagnosed, which can have serious life-altering side effects.

The most crucial factor to weigh up is your commitment. TRT is not something that you do for a while, then skip and come back to. If youre receiving external testosterone in the form of weekly injections or pills, your body sensing high T-levels may stop producing testosterone altogether at some point. As a result, continued treatment will be needed to keep your T-levels normalized.

The benefits of TRT can be massive but its important that you consult with a trained physician about all aspects of treatment positive and negative, natural and medical to make an informed decision.

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Testosterone Therapy Replacement: Is It for You? - AskMen

Its an often-forgotten fact that being strong on the outside requires us to have a healthy, solid frame on the inside. Many gymgoers spend a great deal of time focusing on their aesthetics without paying proper attention to the all-important foundation, but it is essential to realize that big and beautiful muscles require support from solid, healthy bones. Skeletal density is essential for mobility, injury protection and mineral storage but as we age, our bones often need more attention, leading many to question whether its still ok to still lift weights as we hurtle through our 40s.

Maturity also brings the increased risk of a lack of bone density, leading to more fragile or brittle bones (osteoporosis).Linda A. Russell, MD,member of the Hospital for Special Surgery,and a New York City-based expert in rheumatology, perioperative medicine, and metabolic bone, explains how we can keep our bones strong, and whether its still OK tolift weights as we get older.

What happens to our bones as we age?

There are two major bone cell types, Russell says. The osteoclast, and the osteoblast. From the day that we are born, until around age 25 to 30, we make more bone than we lose. So, the bone strength gets better and better. And then somewhere around 25 and 30, we all sadly reach our peak bone density, and thats the strongest that our bones will ever be. Then, as we start the normal aging process, we start to lose more bone than we make and slowly the bone density begins to decline.

Can men just be given testosterone replacement therapy to reverse this process?

Men dont go through a menopause, Russell says. But they do have a slow lowering of their testosterone levels. We dont like to give elderly men TRT because it increases the risk of prostate cancer. I saw a young gentleman in his 30s, who had low testosterone levels and osteoporosis. We would probably supplement him (with testosterone), but with more elderly men we generally dont.

Is weightlifting a good way to maintain healthy bones naturally, even as we age?

You know, it really depends on the individual and how much of their time they devote to fitness, says Dr. Russell. The interesting thing is that weight-bearing exercises are wonderful for bones. So, if you participate in a regular weight-bearing exercise program, your bone health will be absolutely better. And we know that, for instance, if you go into space, astronauts lose lots of bone because there is no gravity. If you take someone who is

sick, and you put them in a hospital bed, within about two weeks theyll start losing bone. The more that you can have activities where you are against gravity, the better your bone health is going to be.

How important is the relationship between muscle mass and strong healthy bones?

Muscle is attached to bone. Muscle pulls on bone. The stronger the muscle, the greater the pull on the bone, and the better it is for the bone, says Russell. So, if you have somebody that is really well defined, they have a nice cardio program, and a nice weight-strengthening program, then thats going to be beneficial. If you take a 40-year-old, who is a couch potato, and has some adiposity (fat) around their middle, they are not going to be as healthy as someone whos hitting the gym five days a week. Strong muscle helps bone, age is important, but for me, being a rheumatologist and seeing people of all ages, its really their fitness that speaks more than their age.

Russell points out that a good workout program becomes even more essential as we reach our 40s, because muscle mass is already beginning to decline naturally. You lose about a third of a pound of muscle mass per year, she says. You can work hard so that this doesnt happen. You can exercise and do your weight training, but if youre just a guy that doesnt really exercise you will start losing muscle and if you looked at an MRI of the that muscle, it has more fat interspersed with the muscle. For someone that is very fit, there is very little fat in the muscle shown on an MRI.

What should men avoid to maintain healthy bones?

A risk factor for osteoporosis is having more than three alcoholic beverages per day, says Russell. There are probably a good number of people that drink at least that much alcohol per day. Its not ideal for bone.

In addition, Russell adds that it is important to get checked out by a doctor because problems with bones can often be caused by other medical issues. Rheumatoid arthritis is associated with bone loss, she says. A lot of liver diseases are also associated with bone loss. If you have rheumatoid arthritis and you are treated with medication, you reduce the chances of bone loss. But some medications are associated with bone loss, like prednisone, or medications used to treat prostate cancer because they are trying to lower the testosterone level. Tobacco is also very bad for bone health. Tobacco is directly toxic to the osteoblast, the cell that makes bone.

So, its good to keep lifting in my 40s and beyond?

At any age, studying proper lifting form and not trying to move a force that is too heavy for you is a good idea to prevent injury, bone and joint problems. And in terms of minerals, Dr. Russell points out that vitamin D and calcium are essential for bone health, and these can

often be consumed through a normal diet, so make sure you include proper nutrition within your training resume. But when it comes to lifting weights, you still have plenty of life in those old bones!

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Build and Maintain Healthy Bones No Matter Your Age - Muscle & Fitness