only for experttuttor PICO As evidence base research nursing

TESTOSTERONE REPLACEMENT THERAPY IN ADULT MALE OLDER 8

TESTOSTERONE REPLACEMENT THERAPY IN ADULT MALE OLDER THAN 39 YEARS OLD WITH LOW TESTOSTERONE SYNDROME

Introduction

Testosterone is a hormone found in humans, with much high levels in males than females, mainly produced by the testicles. It may perhaps be said that it is testosterone levels in a body of a person that distinguish men from women. It provides men their distinctive large muscles, deep voices, and body and facial hair, differentiating them from the women. It stimulates the genitals growth at puberty, occupies a function in production of sperm, fuels libido, and adds to usual erections. It as well fosters the construction of red blood cells, aids cognition, and boosts mood. In due course, the testicular “machinery” that builds testosterone increasingly becomes lesser efficient, and levels of testosterone begin to fall, by around 1% a year, commencing in the 40s. As men get above 39 years and beyond, they could begin to have low testosterone signs and symptoms for instance lower sex drive and vitality sense, erectile dysfunction, decrease energy, reduced bone density and muscle mass, and anemia.

The normal levels in blood range between 280 ng/dl to 1,100 ng/dl. When the testosterone levels fall below 280 ng/dl, the patient is diagnosed with hypogonadism. They are three type of hypogonadism:

-Primary hypogonadism: testicular origin. Low serum testosterone levels with high levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH)

-Secondary hypogonadism: hypothalamic-pituitary origin.low serum testosterone levels with low levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH)

-Mixed hypogonadism: a combination of both, which is increasingly common in the aging male population. low serum testosterone levels with normal levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH)

Hypogonadism can be diagnosed in the absence of low testosterone syndrome if the patient shown asymptomatic low serum testosterone levels. (Bouloux, 2005)

Significance of the topic to nursing practice

As the population ages there will be an equivalent increase in the number of elderly and middle aged men dealing with hypogonadism symptoms. As a result nurses must be conscious of the prospective benefits and threats of testosterone replacement therapy, variety of treatment options accessible and the support and monitoring that these patients need.

When Low testosterone syndrome is diagnosed?

Low testosterone syndrome is diagnosed when the labs results shown a low serum testosterone level less than 290 ng/dl accompanied with physical symptoms like lack of energy, decreased libido and sex drive, loss of muscle mass, lack of focus and concentration, notable increased in belly fat, depression and the complementary blood labs work shown imbalance in the lipid panel, insulin resistance, glucose intolerance, high glucose levels or anemia. All this signs and symptoms can be accompanied as well with a sudden change in cardiac rhythm, high blood pressure, and palpitations.

Treatment

Testosterone replacement therapy(TRT) is used for treatment of adult males for conditions connected  with an absence or deficiency of endogenous testosterone (hypogonadism) (Szeinbach, Seoane-Vazquez & Summers, 2012) Intra muscular injections vs topical testosterone gel and patches treatment are the two known types of testosterone replacement therapies. Every different route has own benefits, risks and side effects of each, make them different at all, qualifying each ones for different approaches.

Purpose of the Evidence Base Practice project

In this evidence base practice project we propose to phrase clinical questions according to the PICO (Patient, Intervention, Comparator and Outcome) format for evaluation of the research based evidence and development of the recommendations for effectiveness of the weekly  IM cypionate testosterone injection versus testosterone topical gel in males 39 years old and older diagnosed with lower testosterone syndrome for keeping the testosterone levels within normal ranges  between 280 ng/dl to 1,100 ng/dl with a sustaining increased libido and muscle mass. The purpose of the testosterone drug class review is to provide evidence informed

recommendations for the use of these therapies for treatment of patients 39 years and beyond diagnosed with low testosterone syndrome. This review will be useful for healthcare providers who prescribe testosterone replacement therapy or manage individuals that receive this intervention.

 Application to: Efficiency of TRT treatment for 39 years old and older with low testosterone syndrome diagnosis.

Primary Research Question

​ What is the present research evidence for the safety and efficacy of intra muscular injections vs topical testosterone gel treatment in adult men with testosterone deficiency?

PICO Statement

Participants/population:This review will evaluate studies that consist of men aged 39 years or older diagnosed with testosterone deficiency or men who have been diagnosed with hypogonadism and are obtaining with hypogonadism  and are obtaining testosterone replacement therapy.

Intervention(s), exposure(s): This review will consider studies that evaluate effectiveness of intra muscular vs topical replacement therapy.

Comparator(s)/control: Will compare the effects of intra muscular injections vs topical testosterone gel treatment used by men aged 39 years or older diagnosed with low testosterone syndrome.

Outcomes:

1-Efficacy: Keep the serum testosterone levels within normal ranges between 280 ng/dl to 1,100ng/dl with a sustaining increased of libido and muscle mass. 

2-Safety: Cardiovascular death, quality of life, stroke, myocardial infarction, erythrocytosis, severe unfavorable events, newly diagnosed illness (heart disease, diabetes, prostate cancer), site or skin  reactions 

Literature summary table for quantitative studies

Literature summary table for qualitative studies

References

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Szeinbach SL, Seoane-Vazquez E, Summers KH. (2012)Development of a men’s Preference for Testosterone Replacement Therapy (P-TRT) instrument. Patient Prefer Adherence.;6:631–641

Conaglen. H.M, Paul R.G, Yarndley T, Kamp J, Elston M.S, Conaglen J.V., (Feb 2014) Retrospective investigation of testosterone undecanoate depot for the long-term treatment of male hypogonadism in clinical practice., J Sex Med.;11(2):574-82. doi: 10.1111/jsm.12401

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