- Email: [email protected]
Re: Effects of Testosterone Treatment in Older Men
Urological Survey 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57
Male and Female Sexual Function and Dysfunction; Andrology Re: Effects of Testosterone Treatment in Older Men P. J. Snyder, S. Bhasin, G. R. Cunningham, A. M. Matsumoto, A. J. Stephens-Shields, J. A. Cauley, T. M. Gill, E. Barrett-Connor, R. S. Swerdloff, C. Wang, K. E. Ensrud, C. E. Lewis, J. T. Farrar, D. Cella, R. C. Rosen, M. Pahor, J. P. Crandall, M. E. Molitch, D. Cifelli, D. Dougar, L. Fluharty, S. M. Resnick, T. W. Storer, S. Anton, S. Basaria, S. J. Diem, X. Hou, E. R. Mohler, III, J. K. Parsons, N. K. Wenger, B. Zeldow, J. R. Landis and S. S. Ellenberg; Testosterone Trials Investigators University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania N Engl J Med 2016; 374: 611e624. doi: 10.1056/NEJMoa1506119
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26886521 Editorial Comment: This article is significant in that the data continue to support use of testosterone replacement therapy (TRT) to treat sexual dysfunction in men with late onset hypogonadism (LOH), refuting attempts to vilify TRT and LOH.1 The mild depression scores of 6.6 noted at the study outset using the Patient Health Questionnaire-9 scale improved to the near normal range (less than 5) by study month 6. Importantly prostate cancer developed in only 1 patient in the TRT group. TRT does not appear to worsen urinary symptoms, supporting a recently reported metaanalysis.2 No increase in major adverse cardiac events was observed in the TRT group during the study. One can conclude that TRT is not causative of major adverse cardiac events, in contradistinction to previous reports.3,4 This understated but provocative study strongly supports use of TRT for men with hypogonadism and LOH. The lack of adverse events is equally reassuring. Data such as these should allay concerns and provide a strong rationale to judiciously use TRT in men with LOH. Allen D. Seftel, MD 1. Nguyen CP, Hirsch MS, Moeny D et al: Testosterone and “age-related hypogonadism”dFDA concerns. N Engl J Med 2015; 373: 689. 2. Kathrins M, Doersch K, Nimeh T et al: The relationship between testosterone-replacement therapy and lower urinary tract symptoms: a systematic review. Urology 2016; 88: 22. 3. Vigen R, O’Donnell CI, Baron AE et al: Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA 2013; 310: 1829. 4. Finkle WD, Greenland S, Ridgeway GK et al: Increased risk of non-fatal myocardial infarction following testosterone therapy prescription in men. PLoS One 2014; 9: e85805.
Suggested Reading Seftel A: How best to measure and test for androgen deficiency. J Urol 2016; Epub ahead of print. Le M, Flores D, May D et al: Current practices of measuring and reference range reporting of free and total testosterone in the United States. J Urol 2015; Epub ahead of print. Li H, Benoit K, Wang W et al: Association between use of exogenous testosterone therapy and risk of venous thrombotic events among exogenous testosterone treated and untreated men with hypogonadism. J Urol 2015; Epub ahead of print.
0022-5347/16/1962-0001/0 THE JOURNAL OF UROLOGY® Ó 2016 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2016.05.062 Vol. 196, 1-3, August 2016 Printed in U.S.A.
www.jurology.com Dochead: Urological Survey
LIT 5.4.0 DTD JURO13740_proof 17 May 2016 6:09 pm EO:
j
58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 1 113 114
2
115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171
MALE AND FEMALE SEXUAL FUNCTION AND DYSFUNCTION; ANDROLOGY
Re: Effects of Testosterone Replacement Therapy on Lower Urinary Tract Symptoms: A Systematic Review and Meta-Analysis T. P. Kohn, D. A. Mata, R. Ramasamy and L. I. Lipshultz Scott Department of Urology, Baylor College of Medicine, Houston, Texas, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, and Department of Urology, University of Miami Miller School of Medicine, Miami, Florida Eur Urol 2016; Epub ahead of print. doi: 10.1016/j.eururo.2016.01.043
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26874809 Editorial Comment: This is another recent report delineating the lack of negative impact of testosterone replacement therapy (TRT) on lower urinary tract symptoms (LUTS).1,2 In this analysis of 14 clinical trials testosterone replacement therapy did not worsen lower urinary tract symptoms in men being treated for late onset hypogonadism. The data are congruent with previous reports and do not show any worsening of LUTS when using TRT. The issue remains that the data to date have not included many patients with LUTS/AUA score above 19 as these men have been routinely excluded from TRT trials. This patient group with AUA scores above 19 would be worthwhile to study. Allen D. Seftel, MD 1. Seftel AD, Kathrins M and Niederberger C: Critical update of the 2010 Endocrine Society Clinical Practice Guidelines for Male Hypogonadism: a systematic analysis. Mayo Clin Proc 2015; 90: 1104. 2. Kathrins M, Doersch K, Nimeh T et al: The relationship between testosterone-replacement therapy and lower urinary tract symptoms: a systematic review. Urology 2016; 88: 22.
Re: Effect of Lifestyle Intervention on the Hormonal Profile of Frail, Obese Older Men R. Armamento-Villareal, L. E. Aguirre, C. Qualls and D. T. Villareal Department of Medicine, Baylor College of Medicine, Houston, Texas J Nutr Health Aging 2016; 20: 334e340. doi: 10.1007/s12603-016-0698-x
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26892583 Editorial Comment: This was a randomized, controlled, 1-year trial of lifestyle intervention in 40 frail, obese men 65 years or older. After 12 months of intervention diet alone resulted in a mean SD weight loss of 10.1 1.9 kg in the diet group and 9.1 0.9 kg in the diet-exercise group. Intervention resulted in a significant decrease in total estradiol compared to baseline among subjects in the diet and diet-exercise groups. Total testosterone (T) significantly increased (p <0.05) in response to diet (mean SD 71.0 21.0 ng/dl) and diet-exercise (49.9 15.5 pg/ml), resulting in mean SD values of 287.0 28.1 ng/dl in the diet group and 317.6 33.1 ng/dl in the diet-exercise group. Thus, diet and exercise augment total T levels. Therefore, diet and diet-exercise appear to help decrease estradiol and increase total T in men older than 65 years. Allen D. Seftel, MD
Re: A Pilot Study Using a Web Survey to Identify Characteristics that Influence Hypogonadal Men to Initiate Testosterone Replacement Therapy R. C. Rosen, A. D. Seftel, D. D. Ruff and D. Muram New England Research Institutes, Inc., Watertown, Massachusetts, Cooper University Hospital, Camden, New Jersey, and Eli Lilly and Company, Indianapolis, Indiana Am J Mens Health 2016; Epub ahead of print. pii: 1557988315625773
Dochead: Urological Survey
LIT 5.4.0 DTD JURO13740_proof 17 May 2016 6:09 pm EO:
172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228
MALE AND FEMALE SEXUAL FUNCTION AND DYSFUNCTION; ANDROLOGY
229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26819183 Editorial Comment: Men with hypogonadism (HG) who choose testosterone replacement therapy (TRT) may have distinct characteristics that provide insight as to why they may/may not initiate therapy. The aim of the current study was to identify trends in patient characteristics and attitudes in men diagnosed with HG who initiated TRT (TRT+) compared to men who were diagnosed with HG but did not initiate TRT (TRT-). The market research based online survey conducted between 2012 and 2013 included patients from a Federated Sample, a commercially available panel of patients with diverse medical conditions. College educated, heterosexual married men with comorbid erectile dysfunction living in suburban and urban areas were more likely to initiate treatment. The most bothersome symptoms reported were lack of energy, decreased strength and endurance, and deterioration in work performance. Lack of energy prompted men to seek help. Patients in the TRT+ group were more knowledgeable regarding HG compared to TRT- respondents, and most men obtained their information from a health care professional. These data are interesting and shed light on the patient rationale for seeking TRT. Allen D. Seftel, MD
Suggested Reading Seftel A: How best to measure and test for androgen deficiency. J Urol 2016; Epub ahead of print. Le M, Flores D, May D et al: Current practices of measuring and reference range reporting of free and total testosterone in the United States. J Urol 2015; Epub ahead of print. Li H, Benoit K, Wang W et al: Association between use of exogenous testosterone therapy and risk of venous thrombotic events among exogenous testosterone treated and untreated men with hypogonadism. J Urol 2015; Epub ahead of print.
Re: Six Months of Daily Treatment with Vardenafil Improves Parameters of Endothelial Inflammation and of Hypogonadism in Male Patients with Type 2 Diabetes and Erectile Dysfunction: A Randomized, Double-Blind, Prospective Trial D. Santi, A. R. Granata, A. Guidi, E. Pignatti, T. Trenti, L. Roli, R. Bozic, S. Zaza, C. Pacchioni, S. Romano, J. R. Nofer, V. Rochira, C. Carani and M. Simoni Unit of Endocrinology and Metabolism, Department of Biomedical, Metabolic and Neural Sciences, and Center for Genomic Research, University of Modena and Reggio Emilia, and Department of Medicine, Division of Endocrinology, Metabolism and Geriatrics, Department of Laboratory Medicine and Pathological Anatomy, and Diabetic Service, Azienda USL of Modena, Modena, and PerkinElmer and SHIMADZU Italia, Milan, Italy, and Center for Laboratory Medicine, University Hospital Mu¨nster, Mu¨nster, Germany Eur J Endocrinol 2016; 174: 513e522. doi: 10.1530/EJE-15-1100
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26792933 Editorial Comment: In this prospective, investigator initiated, randomized, placebo controlled, double-blind, clinical trial 54 male patients affected by type 2 diabetes mellitus diagnosed within the last 5 years and erectile dysfunction (ED) were enrolled, regardless of testosterone levels. Of the patients 26 and 28 were assigned to the treatment and placebo groups, respectively. The study consisted of an enrollment phase, a treatment phase (consisting of 10 mg vardenafil or placebo twice daily for 24 weeks) and a followup phase (24 weeks). Erectile function improved during treatment as measured by the International Index of Erectile Function 15. At the end of treatment flow mediated dilatation (FMD) and serum interleukin 6 had significantly improved (p ¼ 0.040 and p ¼ 0.019, respectively). FMD correlated with serum testosterone levels. Testosterone increased significantly with vardenafil treatment and returned to the eugonadal range only in hypogonadal men without changes in gonadotropins. The improvement in FMD and the decrease in serum interleukin 6 are noteworthy and suggest that vardenafil may have an important role in men with type 2 diabetes mellitus and ED beyond the improvement in ED. Allen D. Seftel, MD
Dochead: Urological Survey
LIT 5.4.0 DTD JURO13740_proof 17 May 2016 6:09 pm EO:
3
291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349 350 351 352
Male and Female Sexual Function and Dysfunction; Andrology Re: Effects of Testosterone Treatment in Older Men P. J. Snyder, S. Bhasin, G. R. Cunningham, A. M. Matsumoto, A. J. Stephens-Shields, J. A. Cauley, T. M. Gill, E. Barrett-Connor, R. S. Swerdloff, C. Wang, K. E. Ensrud, C. E. Lewis, J. T. Farrar, D. Cella, R. C. Rosen, M. Pahor, J. P. Crandall, M. E. Molitch, D. Cifelli, D. Dougar, L. Fluharty, S. M. Resnick, T. W. Storer, S. Anton, S. Basaria, S. J. Diem, X. Hou, E. R. Mohler, III, J. K. Parsons, N. K. Wenger, B. Zeldow, J. R. Landis and S. S. Ellenberg; Testosterone Trials Investigators University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania N Engl J Med 2016; 374: 611e624. doi: 10.1056/NEJMoa1506119
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26886521 Editorial Comment: This article is significant in that the data continue to support use of testosterone replacement therapy (TRT) to treat sexual dysfunction in men with late onset hypogonadism (LOH), refuting attempts to vilify TRT and LOH.1 The mild depression scores of 6.6 noted at the study outset using the Patient Health Questionnaire-9 scale improved to the near normal range (less than 5) by study month 6. Importantly prostate cancer developed in only 1 patient in the TRT group. TRT does not appear to worsen urinary symptoms, supporting a recently reported metaanalysis.2 No increase in major adverse cardiac events was observed in the TRT group during the study. One can conclude that TRT is not causative of major adverse cardiac events, in contradistinction to previous reports.3,4 This understated but provocative study strongly supports use of TRT for men with hypogonadism and LOH. The lack of adverse events is equally reassuring. Data such as these should allay concerns and provide a strong rationale to judiciously use TRT in men with LOH. Allen D. Seftel, MD 1. Nguyen CP, Hirsch MS, Moeny D et al: Testosterone and “age-related hypogonadism”dFDA concerns. N Engl J Med 2015; 373: 689. 2. Kathrins M, Doersch K, Nimeh T et al: The relationship between testosterone-replacement therapy and lower urinary tract symptoms: a systematic review. Urology 2016; 88: 22. 3. Vigen R, O’Donnell CI, Baron AE et al: Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA 2013; 310: 1829. 4. Finkle WD, Greenland S, Ridgeway GK et al: Increased risk of non-fatal myocardial infarction following testosterone therapy prescription in men. PLoS One 2014; 9: e85805.
Suggested Reading Seftel A: How best to measure and test for androgen deficiency. J Urol 2016; Epub ahead of print. Le M, Flores D, May D et al: Current practices of measuring and reference range reporting of free and total testosterone in the United States. J Urol 2015; Epub ahead of print. Li H, Benoit K, Wang W et al: Association between use of exogenous testosterone therapy and risk of venous thrombotic events among exogenous testosterone treated and untreated men with hypogonadism. J Urol 2015; Epub ahead of print.
0022-5347/16/1962-0001/0 THE JOURNAL OF UROLOGY® Ó 2016 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2016.05.062 Vol. 196, 1-3, August 2016 Printed in U.S.A.
www.jurology.com Dochead: Urological Survey
LIT 5.4.0 DTD JURO13740_proof 17 May 2016 6:09 pm EO:
j
58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 1 113 114
2
115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171
MALE AND FEMALE SEXUAL FUNCTION AND DYSFUNCTION; ANDROLOGY
Re: Effects of Testosterone Replacement Therapy on Lower Urinary Tract Symptoms: A Systematic Review and Meta-Analysis T. P. Kohn, D. A. Mata, R. Ramasamy and L. I. Lipshultz Scott Department of Urology, Baylor College of Medicine, Houston, Texas, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, and Department of Urology, University of Miami Miller School of Medicine, Miami, Florida Eur Urol 2016; Epub ahead of print. doi: 10.1016/j.eururo.2016.01.043
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26874809 Editorial Comment: This is another recent report delineating the lack of negative impact of testosterone replacement therapy (TRT) on lower urinary tract symptoms (LUTS).1,2 In this analysis of 14 clinical trials testosterone replacement therapy did not worsen lower urinary tract symptoms in men being treated for late onset hypogonadism. The data are congruent with previous reports and do not show any worsening of LUTS when using TRT. The issue remains that the data to date have not included many patients with LUTS/AUA score above 19 as these men have been routinely excluded from TRT trials. This patient group with AUA scores above 19 would be worthwhile to study. Allen D. Seftel, MD 1. Seftel AD, Kathrins M and Niederberger C: Critical update of the 2010 Endocrine Society Clinical Practice Guidelines for Male Hypogonadism: a systematic analysis. Mayo Clin Proc 2015; 90: 1104. 2. Kathrins M, Doersch K, Nimeh T et al: The relationship between testosterone-replacement therapy and lower urinary tract symptoms: a systematic review. Urology 2016; 88: 22.
Re: Effect of Lifestyle Intervention on the Hormonal Profile of Frail, Obese Older Men R. Armamento-Villareal, L. E. Aguirre, C. Qualls and D. T. Villareal Department of Medicine, Baylor College of Medicine, Houston, Texas J Nutr Health Aging 2016; 20: 334e340. doi: 10.1007/s12603-016-0698-x
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26892583 Editorial Comment: This was a randomized, controlled, 1-year trial of lifestyle intervention in 40 frail, obese men 65 years or older. After 12 months of intervention diet alone resulted in a mean SD weight loss of 10.1 1.9 kg in the diet group and 9.1 0.9 kg in the diet-exercise group. Intervention resulted in a significant decrease in total estradiol compared to baseline among subjects in the diet and diet-exercise groups. Total testosterone (T) significantly increased (p <0.05) in response to diet (mean SD 71.0 21.0 ng/dl) and diet-exercise (49.9 15.5 pg/ml), resulting in mean SD values of 287.0 28.1 ng/dl in the diet group and 317.6 33.1 ng/dl in the diet-exercise group. Thus, diet and exercise augment total T levels. Therefore, diet and diet-exercise appear to help decrease estradiol and increase total T in men older than 65 years. Allen D. Seftel, MD
Re: A Pilot Study Using a Web Survey to Identify Characteristics that Influence Hypogonadal Men to Initiate Testosterone Replacement Therapy R. C. Rosen, A. D. Seftel, D. D. Ruff and D. Muram New England Research Institutes, Inc., Watertown, Massachusetts, Cooper University Hospital, Camden, New Jersey, and Eli Lilly and Company, Indianapolis, Indiana Am J Mens Health 2016; Epub ahead of print. pii: 1557988315625773
Dochead: Urological Survey
LIT 5.4.0 DTD JURO13740_proof 17 May 2016 6:09 pm EO:
172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228
MALE AND FEMALE SEXUAL FUNCTION AND DYSFUNCTION; ANDROLOGY
229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26819183 Editorial Comment: Men with hypogonadism (HG) who choose testosterone replacement therapy (TRT) may have distinct characteristics that provide insight as to why they may/may not initiate therapy. The aim of the current study was to identify trends in patient characteristics and attitudes in men diagnosed with HG who initiated TRT (TRT+) compared to men who were diagnosed with HG but did not initiate TRT (TRT-). The market research based online survey conducted between 2012 and 2013 included patients from a Federated Sample, a commercially available panel of patients with diverse medical conditions. College educated, heterosexual married men with comorbid erectile dysfunction living in suburban and urban areas were more likely to initiate treatment. The most bothersome symptoms reported were lack of energy, decreased strength and endurance, and deterioration in work performance. Lack of energy prompted men to seek help. Patients in the TRT+ group were more knowledgeable regarding HG compared to TRT- respondents, and most men obtained their information from a health care professional. These data are interesting and shed light on the patient rationale for seeking TRT. Allen D. Seftel, MD
Suggested Reading Seftel A: How best to measure and test for androgen deficiency. J Urol 2016; Epub ahead of print. Le M, Flores D, May D et al: Current practices of measuring and reference range reporting of free and total testosterone in the United States. J Urol 2015; Epub ahead of print. Li H, Benoit K, Wang W et al: Association between use of exogenous testosterone therapy and risk of venous thrombotic events among exogenous testosterone treated and untreated men with hypogonadism. J Urol 2015; Epub ahead of print.
Re: Six Months of Daily Treatment with Vardenafil Improves Parameters of Endothelial Inflammation and of Hypogonadism in Male Patients with Type 2 Diabetes and Erectile Dysfunction: A Randomized, Double-Blind, Prospective Trial D. Santi, A. R. Granata, A. Guidi, E. Pignatti, T. Trenti, L. Roli, R. Bozic, S. Zaza, C. Pacchioni, S. Romano, J. R. Nofer, V. Rochira, C. Carani and M. Simoni Unit of Endocrinology and Metabolism, Department of Biomedical, Metabolic and Neural Sciences, and Center for Genomic Research, University of Modena and Reggio Emilia, and Department of Medicine, Division of Endocrinology, Metabolism and Geriatrics, Department of Laboratory Medicine and Pathological Anatomy, and Diabetic Service, Azienda USL of Modena, Modena, and PerkinElmer and SHIMADZU Italia, Milan, Italy, and Center for Laboratory Medicine, University Hospital Mu¨nster, Mu¨nster, Germany Eur J Endocrinol 2016; 174: 513e522. doi: 10.1530/EJE-15-1100
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26792933 Editorial Comment: In this prospective, investigator initiated, randomized, placebo controlled, double-blind, clinical trial 54 male patients affected by type 2 diabetes mellitus diagnosed within the last 5 years and erectile dysfunction (ED) were enrolled, regardless of testosterone levels. Of the patients 26 and 28 were assigned to the treatment and placebo groups, respectively. The study consisted of an enrollment phase, a treatment phase (consisting of 10 mg vardenafil or placebo twice daily for 24 weeks) and a followup phase (24 weeks). Erectile function improved during treatment as measured by the International Index of Erectile Function 15. At the end of treatment flow mediated dilatation (FMD) and serum interleukin 6 had significantly improved (p ¼ 0.040 and p ¼ 0.019, respectively). FMD correlated with serum testosterone levels. Testosterone increased significantly with vardenafil treatment and returned to the eugonadal range only in hypogonadal men without changes in gonadotropins. The improvement in FMD and the decrease in serum interleukin 6 are noteworthy and suggest that vardenafil may have an important role in men with type 2 diabetes mellitus and ED beyond the improvement in ED. Allen D. Seftel, MD
Dochead: Urological Survey
LIT 5.4.0 DTD JURO13740_proof 17 May 2016 6:09 pm EO:
3
291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349 350 351 352