A Case Report Of 96 Months TST For LOH Patients And Meta Analysis Of The Effect Of Long-term TST On The Prostate

With the rapid speed of our country's aging process,the health problem of male aging has received increasing attention.The male aging is always associated with declines in serum testosterone level,which brings about many symptoms such as sexual dysfunction,cognitive decline,osteoporosis,anxiety,fatigability,and decline in muscle mass and physical strength.All of these symptoms are unified as Late Onset Hypogonadism(LOH).Testosterone supplement therapy(TST)is now considered as the most efficient treatment for LOH.However,many people concerned about the relationship between androgen and prostate.Rao claimed in his review that though testosterone supplementation may increase the level of prostate specific androgen(PSA),it doesn't increase the morbidity of prostate cancer.Recent studies have also shown that testosterone supplement will not affect PSA level or prostate volume.However,most of these studies had limited power to evaluate the effects of TST on the prostate because of the short term(less than 12 months)therapy duration.Thus,we design this study to investigate the efficacy and safety of long-term TST in LOH patients.Objective: 1.Investigate the efficacy of long-term TST in LOH patients 2.Investigate the safety of long-term TST on the prostateMethods: This article consists of two parts,the first part is a case report,and the other part is a Meta-analysis.1.We followed a LOH patient who was treated with TST for 96 months,evaluating the therapeutic effects and adverse events by analyzing total testosterone(TT)and PSA level.2.Randomized Controlled Trials(RCTs)about the effect of long-term TST on the prostate were searched through Pub Med,Medline,andEMBASE.PSA,Prostate Volume,IPSS,and Maximum Urine Flow Rate(MUFR)were selected as outcome indicator to evaluate the effect of TST on the prostate.Calculating standard mean difference(SMD)and P value to compare the difference between experimental and control groups.Furthermore,a subgroup analysis was conducted to compare the effect of TST on the prostate via different routes of administration.Results: 1.Case report: A 46-year old male patient with erectile dysfunction(IIEF-5 score of 7)and low serum testosterone level(TT=2.79ng/ml)was diagnosed as LOH.After two months of TST,the TT level raise to normal(3.45ng/ml)level,and substantial improvement was observed in patient's mood and physical symptoms.45 months after medication,sexual function was improved as well(IIEF-5 score of 21).Continuing testosterone supplement for another 51 months,the therapeutic effect was satisfying.During 96 months of medication,the total PSA and TT levels remain stable within normal range.2.Meta-analysis: Meta analysis of 10 studies including 770 participants had shown that long-term TST doesn't increase the risk of prostate events.Overall P values for the four determinants(PSA,Prostate volume,IPSS,MUFR)of prostate events were 0.98,0.42,0.18,0.81.Except when androgen was given in IM route,the IPSS significant decreased(95%CI-0.49 to-0.04 P<0.05).Conclusion: 1.Long-term TST significantly improving LOH patient's symptoms.2.Long-term TST does not increase the risk of prostate events.