Ronny B W Tan1, Andre T Guay2, Wayne J G Hellstrom3. 1. Department of Urology, Tan Tock Seng Hospital, Singapore. 2. Tufts School of Medicine, Center for Sexual Function/Endocrinology, Lahey Clinic, Peabody, MA, USA. 3. Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA. Electronic address: whellst@tulane.edu.
Abstract
INTRODUCTION: There is a growing interest in the treatment of late-onset hypogonadism, another name for the study of testosterone deficiency in an older age group. Initial attempts at testosterone replacement have also brought attention to the possible adverse effects on the patients' cardiovascular risk factors and their prostate health. The "female" hormone estradiol is no longer considered as the feminizing hormone, as it has been identified to have an effect on the sexual and general well-being of adult males. Urologists and endocrinologists alike have started to pay attention to the serum T/E2 (testosterone : estradiol) ratio that appears to be more important than the respective individual hormonal levels. Therein lies the possible role of aromatase inhibitors (AIs) in restoring the normal balance of serum testosterone and estradiol levels for the adequate treatment of late-onset hypogonadism, while limiting the potential adverse effects. Currently, other established clinical indications of AIs include the treatment of breast cancer in female patients and developmental growth problems in pediatric patients. AIM: This review evaluates the role of AIs as a treatment option for late-onset hypogonadism and the evidence for its other clinical uses in men, including its possible adverse effects. METHODS: A literature review was performed with regards to the use of aromatase inhibitors in adult males, the role of estrogens in adult males, as well as adverse effect of AIs on bone health in adult males. MAIN OUTCOME MEASURES: To evaluate the evidence for the use of AIs in adult males to treat late-onset hypogonadism, obesity-related hypogonadotropic hypogonadism, gynecomastia, and male subfertility. To evaluate the evidence for the possible adverse effects on the bone health of adult males with the use of AIs. RESULTS: Currently there is no literature to recommend the use of AIs in adult males to treat late-onset hypogonadism, obesity-related hypogonadotropic hypogonadism, gynecomastia, or male subfertility, although some positive effects have been reported. The adverse effects on bone health seen in females treated with AIs are not seen in males. CONCLUSIONS: With the better understanding of the T/E2 ratio in adult males, the lack of scientific data to show that bone health is adversely affected by AI usage in adult males, the positive effects of AIs on the treatment of conditions like late-onset hypogonadism and male subfertility encourages conducting large-scale, multicenter, randomized controlled trials for the clinical use of AIs in adult males. Tan RBW, Guay AT, and Hellstrom WJG. Clinical use of aromatase inhibitors in adult males. Sex Med Rev 2014;2:79-90.
INTRODUCTION: There is a growing interest in the treatment of late-onset hypogonadism, another name for the study of testosterone deficiency in an older age group. Initial attempts at testosterone replacement have also brought attention to the possible adverse effects on the patients' cardiovascular risk factors and their prostate health. The "female" hormone estradiol is no longer considered as the feminizing hormone, as it has been identified to have an effect on the sexual and general well-being of adult males. Urologists and endocrinologists alike have started to pay attention to the serum T/E2 (testosterone : estradiol) ratio that appears to be more important than the respective individual hormonal levels. Therein lies the possible role of aromatase inhibitors (AIs) in restoring the normal balance of serum testosterone and estradiol levels for the adequate treatment of late-onset hypogonadism, while limiting the potential adverse effects. Currently, other established clinical indications of AIs include the treatment of breast cancer in female patients and developmental growth problems in pediatric patients. AIM: This review evaluates the role of AIs as a treatment option for late-onset hypogonadism and the evidence for its other clinical uses in men, including its possible adverse effects. METHODS: A literature review was performed with regards to the use of aromatase inhibitors in adult males, the role of estrogens in adult males, as well as adverse effect of AIs on bone health in adult males. MAIN OUTCOME MEASURES: To evaluate the evidence for the use of AIs in adult males to treat late-onset hypogonadism, obesity-related hypogonadotropic hypogonadism, gynecomastia, and male subfertility. To evaluate the evidence for the possible adverse effects on the bone health of adult males with the use of AIs. RESULTS: Currently there is no literature to recommend the use of AIs in adult males to treat late-onset hypogonadism, obesity-related hypogonadotropic hypogonadism, gynecomastia, or male subfertility, although some positive effects have been reported. The adverse effects on bone health seen in females treated with AIs are not seen in males. CONCLUSIONS: With the better understanding of the T/E2 ratio in adult males, the lack of scientific data to show that bone health is adversely affected by AI usage in adult males, the positive effects of AIs on the treatment of conditions like late-onset hypogonadism and male subfertility encourages conducting large-scale, multicenter, randomized controlled trials for the clinical use of AIs in adult males. Tan RBW, Guay AT, and Hellstrom WJG. Clinical use of aromatase inhibitors in adult males. Sex Med Rev 2014;2:79-90.
Authors: Bingqing Yu; Min Nie; Xueyan Wu; Jiangfeng Mao; Xi Wang; Wanlu Ma; Wen Ji; Qibin Huang; Rui Zhang Journal: Zhejiang Da Xue Xue Bao Yi Xue Ban Date: 2020-05-25
Authors: Simona Dinicola; Vittorio Unfer; Fabio Facchinetti; Christophe O Soulage; Nicholas D Greene; Mariano Bizzarri; Antonio Simone Laganà; Shiao-Yng Chan; Arturo Bevilacqua; Lali Pkhaladze; Salvatore Benvenga; Annarita Stringaro; Daniele Barbaro; Marialuisa Appetecchia; Cesare Aragona; Maria Salomè Bezerra Espinola; Tonino Cantelmi; Pietro Cavalli; Tony T Chiu; Andrew J Copp; Rosario D'Anna; Didier Dewailly; Cherubino Di Lorenzo; Evanthia Diamanti-Kandarakis; Imelda Hernández Marín; Moshe Hod; Zdravko Kamenov; Eleni Kandaraki; Giovanni Monastra; Mario Montanino Oliva; John E Nestler; Maurizio Nordio; Ali C Ozay; Olga Papalou; Giuseppina Porcaro; Nikos Prapas; Scott Roseff; Monica Vazquez-Levin; Ivana Vucenik; Artur Wdowiak Journal: Int J Mol Sci Date: 2021-09-30 Impact factor: 5.923