“Anyone who is potentially interested in fathering a child should understand the risk.” The therapy does not cause prostate cancer, “but it can accelerate pre-existing prostate cancer,” said Kurnot, who uses a prostatespecific antigen (PSA) test to help detect cancer. “Hormone-dependent cancers, such as prostate cancer, are easy to detect.” While men with prostate cancer are not candidates for testosterone replacement, it’s less clear as to whether former cancer patients should undergo the therapy. “Some newer studies say those who were adequately treated and whose cancer has not recurred may be eligible,” said Berkowitz. “It’s an area of ongoing investigation.”
The newest treatment option is pellets, known as Testopel, implanted in the buttock. Testopel is the most effective treatment currently available. “A topical [gel] might bring levels up 20 to 30 percent. With continuous dosing, a patient might go from 300 to 400,” said Emanuel. “With Testopel, a patient could go from the mid 300s to 700 or 800, even to the higher end of normal.” Testopel requires that patients see their doctor every three to six months, according to Richard A. Kurnot, M.D., a urologist with Chesapeake Urology Associates who has privileges at MedStar Montgomery Medical Center in Olney. “I bring them back in the first couple of months to check their blood cell count and liver enzymes,” he said. Testosterone replacement can cause polycythaemia, “a condition where the blood gets too thick. It can also be toxic to the liver.” Replacing testosterone can have “a detrimental effect on sperm production,” said Emanuel.
The effects of testosterone replacement therapy are felt in short order, according to Kurnot. “Patients can feel good within weeks—a whole lot better. It differs from patient to patient, but the sky’s the limit.” Men who begin testosterone replacement therapy may need to continue with it over the long term as it “actually shuts off the body’s own production of testosterone,” said Kurnot. “The higher levels of testosterone in the blood signal the brain that the body doesn’t need to create any more, and so it shuts down.” While testosterone replacement therapy may come across as the ultimate anti-aging formula, physicians claim that’s not so. “We are not using super-therapeutic amounts but, rather, bringing testosterone levels back to where they should be,” said Litvak. It is about “restoring health and a general sense of well-being.”
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the delivery mechanism of choice was, for many years, injection. “That would require office visits every three weeks,” said Emanuel. Patches came next, but caused skin irritation in some men. “Then there was a whole run of topical gels and, more recently, Axiron, which you rub into your armpit much like you do with an antiperspirant. The newest option is implantable pellets.” Known as Testopel, these cylindrical pellets are about an eighth of an inch wide and three-eighths of an inch long. “I numb a 2-by-2centimeter area on one buttock and make a 3-millimeter incision,” said Emanuel. “Then I use an insertion device to implant the pellet in the subcutaneous tissue.”
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Summer 2012 | Gazette Health 17