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Medscape
2 days ago
- Health
- Medscape
Adherence to Male Hypogonadism Treatment Guidelines Is Low
SAN FRANCISCO — Adherence to diagnostic and treatment guidelines for male hypogonadism is quite low, with significant differences among medical specialists, a new study found. Off-label use of testosterone replacement therapy (TRT) has risen in recent years, corresponding with the advent of direct-to-consumer (DTC) advertising for TRT and the emergence of 'low T' clinics, Petra Pederson, MD, PhD, chief resident in internal medicine at Scripps Clinic/Green Hospital, San Diego, said at the ENDO 2025: The Endocrine Society Annual Meeting. 'This led to our hypothesis that [DTC] advertising in the presence of online clinics creates patient expectations that make it challenging for clinicians to practice evidence- and guideline-based care,' she said. Pederson and colleagues conducted a two-part study of adherence to TRT prescribing guidelines at their institution. The first part involved a retrospective chart review of 269 men who were prescribed TRT from January 1, 2019, through June 30, 2023, examining adherence to the 2018 Endocrine Society clinical practice guideline (CPG). Of the 269 TRT prescriptions, 67.3% were from primary care providers (54% internal medicine and 13% family medicine) and 32.7% from specialists (25% urology and 8% endocrinology). The majority of patients (72.1%) stayed on treatment for at least 1 year, with an average treatment duration of 25 months. Criteria for adherence was defined as: Confirmation of the diagnosis of hypogonadism with two separate low (< 264 ng/dL) early morning total testosterone levels. Determination of the etiology of hypogonadism by measuring luteinizing hormone (LH) and follicle-stimulating hormone (FSH) with appropriate laboratory or imaging follow-up based on the results. On-treatment therapeutic monitoring with total testosterone levels drawn at 3-6 months and 12 months. On-treatment safety monitoring, with hematocrit at baseline and at 3-6 months, with dose reduction if necessary and discontinuation if > 54%. Overall, the proportion of clinicians, primary care, and specialists combined who followed all four criteria was just 5.9%. The difference between primary care (3.3%) and specialists (11.4%) was statistically significant ( P = .009). By individual criteria, 17.8% overall had no low testosterone level prior to treatment, 21% among the primary care group vs 10.2% for the specialists. This difference was also significant ( P = .023). Follow-up total testosterone measurement at 3-6 months was performed for only 50% overall, 44.1% by primary care, and 62.5% by the specialists. Hematocrit testing at 3-6 months was measured at 54% overall, 48.0% by the primary care, and 65.3% by specialists. Both specialty differences were again significant ( P = .01 and P = .06, respectively). Between the two specialties, endocrinologists were more likely than urologists to follow all four criteria, 23.8% vs 7.5%, respectively ( P = .054), and were much more likely to have LH and FSH drawn (85.7% vs 16.4% for LH; P < .001). 'We postulate that these striking differences between endocrinology and urology could be related to the fact that urologists were seeing more patients who present with sexual dysfunction compared to endocrinologists, and perhaps they have more pressure to prescribe,' Pederson said. Barriers: DTC Advertising, Misinformation, Test Inaccuracy The second part of the study involved a survey to which 51 Scripps providers responded. Of those, 74% were primary care (41% internal medicine and 33% family medicine), 18% endocrinologists, and 8% urologists. All 51 reported having seen one or more patients in the last 6 months who requested TRT. The specialists were significantly more likely to report being comfortable with the guidelines than were the primary care providers and to prescribe TRT more often. A total of 74.5% overall felt that DTC advertising and testosterone 'clinics' were significant public health issues. A similar majority (76.5%) felt there was a need for more educational tools. Barriers to providing guideline-based care identified by the providers included misinformation through advertising or social media, for-profit 'low T' clinics that contradict evidence-based guidelines, patient dissatisfaction when guidelines don't align with their expectations, vague and subjective symptoms, and test inaccuracy and variability. 'We're planning to address this at our institution with a quality improvement initiative,' Pederson said. She acknowledged that the American Urological Association guidelines use a low testosterone cutoff of < 300 ng/dL, 'so we might underestimate guideline adherence with our criteria.' And she noted that a small number of primary care providers accounted for a disproportionate number of the prescriptions in their sample, which could limit generalizability. In response to a question from the audience about why the guideline adherence was so low even among specialists, Pederson responded, 'I think that they're experiencing some of the same challenges that PCPs are experiencing, which is the pressure from their patients, and also maybe issues related to tests and accuracy. And I just think the difficulty of getting patients to do all these follow-up tests when they're looking for a simple fix.' Improvements Are Underway, Patient Education Is Key Asked to comment, the Endocrine Society's CPG lead author Shalender Bhasin, MB, professor of medicine at Harvard Medical School and director of the Research Program in Men's Health: Aging and Metabolism at Brigham and Women's Hospital, Boston, told Medscape Medical News that these findings align with those of a study his group conducted a decade ago in the Veterans Administration (VA), but that the VA has since implemented system-wide improvements. 'I think it's gotten much better. In the VA, it was very low, and it has gotten substantially better because at the VA now there's one policy. Also, the assays have gotten better.' Bhasin also pointed out that the prescribing of testosterone has fluctuated over time, dropping in 2013 after an FDA advisory about cardiovascular risk but then rising again around 2017 following the TRAVERSE trial results showing cardiovascular safety. The subsequent rise has been slower, but, Bhasin noted, 'testosterone sales are growing, and at the same time, many men with testosterone deficiency remain undiagnosed, so it's both overuse and underuse.' Also asked to comment, session moderator Ismat Shafiq, MD, of the University of Rochester, Rochester, New York, told Medscape Medical News that patients will commonly have low total testosterone due to overweight or obesity and/or sleep apnea but will have normal free testosterone. 'If that's the case, we can properly educate our patients and work on managing their weight and sleep problems. That can reverse the hypogonadism and make them feel better, rather than giving them testosterone.' And if they have both low total and free testosterone, the cause could be something reversible, such as a prolactinoma or pituitary macroadenoma. 'If we check the prolactin level and we treat them, the hypogonadism will resolve. Primary hypothyroidism, too, if treated, can resolve the hypogonadism,' Shafiq said. 'Diagnosing the patient appropriately can identify causes that can be treatable and that can improve their quality of life and improve their testosterone level too, rather than jumping into giving them testosterone.' She also noted that many patients mistakenly believe that more testosterone is better. 'We need to educate them. In my experience, most of the patients listen and understand because nobody wants to take extra medicine all the time, unless it's really needed for them to improve their quality of life.' Pederson and Shafiq reported having no disclosures. Bhasin reported receiving research grant support from AbbVie and Metro International Biotech for investigator-initiated research, with the grants managed by Brigham and Women's Hospital. He has served as a consultant to Besins and Versanis and has an equity interest in XYone Therapeutics.
Reuters
4 days ago
- Health
- Reuters
Health Rounds: GLP-1 obesity drugs may boost low testosterone
July 16 (Reuters) - GLP-1 anti-obesity medications are linked with improvements in testosterone levels and health outcomes for men with obesity or type 2 diabetes, researchers reported in San Francisco at ENDO 2025, opens new tab, the Endocrine Society's annual meeting. Weight loss from lifestyle changes or bariatric surgery is known to boost testosterone levels, but the impact of anti-obesity medications has not been widely investigated, study leader Dr. Shellsea Portillo Canales of SSM Health St. Louis University Hospital in Missouri said in a statement. Portillo Canales and colleagues tracked 110 men with obesity – many also with type 2 diabetes – who were being treated with semaglutide, dulaglutide or tirzepatide, the active ingredients in Novo Nordisk's Wegovy and Ozempic or Eli Lilly's Trulicity, Mounjaro, and Zepbound. The average age was 54. None of the men were receiving other testosterone-boosting medications. During 18 months of treatment, the proportion of men with testosterone levels in the normal range rose from 53% to 77%. Testosterone plays a critical role in male sexual functioning but can also impact bone mass, fat distribution, muscle mass, strength and red blood cell production. In the current study, the greater the weight loss, the greater the improvement in testosterone levels, the researchers found. While the study cannot prove GLP-1 drugs caused low testosterone levels to normalize, it does show a direct correlation, Portillo Canales noted. Popular GLP-1 anti-obesity medications are effective for weight loss even when treatment is inconsistent, new findings suggest. Patients often face challenges in accessing these medications – such as Novo Nordisk's Wegovy and Ozempic and Eli Lilly's Zepbound and Mounjaro - due to supply shortages and insurance coverage obstacles, study leader Kaelen Medeiros of privately held weight-loss company Calibrate in New York said in a statement. Medeiros and colleagues looked at how interruptions to GLP-1 medication access over the course of two years impacted weight-loss outcomes in 6,392 clients of Calibrate's online metabolic health program. Along with the drugs, the program also included intensive lifestyle interventions and coaching on diet, exercise, sleep and emotional health. Overall, 72.5% of participants experienced at least one disruption in their GLP-1 treatment and 11.1% had multiple disruptions, Medeiros reported at ENDO 2025. Participants who faced access issues reported a 13.7% weight loss within 12 months and a 14.9% loss within 24 months, on average. Those without treatment interruptions reported a 17% weight loss in 12 months and 20.1% in 24 months, on average. Even those who received no more than four treatments over 12 months also achieved clinically significant weight loss, with more than 10% change in body weight on average. 'While unpredictable GLP-1 medication access is frustrating, the good news is that our research shows effective weight loss can still be achieved if paired with appropriate lifestyle changes and coaching support,' Medeiros said. People who experience a fracture after age 80 might benefit from medications to treat bone deterioration or weakness caused by osteoporosis, researchers reported at the Endocrine Society meeting in San Francisco. Whether to start osteoporosis drugs at that age has been debated for fear that very elderly patients could be more susceptible to the side effects. Researchers at the Cleveland Clinic reviewed medical records on 88,676 patients aged 80 and older who had suffered a fracture due to osteoporosis. Half of them had subsequently been treated with either Merck & Co.'s Fosamax, Roche and GlaxoSmithKline's Boniva, Amgen's Prolia, or Eli Lilly's Evista or Forteo. The others did not receive any osteoporosis drugs. Over the next five years, after accounting for patients' other health conditions, the hospitalization rate was 19% lower and the mortality rate was 15% lower in the group treated with bone-strengthening medications. 'The results of our study support the need to enhance the individualized initiation of treatment of osteoporosis, even in people who are older than 80,' study leader Dr. Gianina Flocco said in a statement. 'Treating people to reduce the burden of osteoporosis complications, like fractures leading to disability or death, would play a significant role in improving health span in the growing older population.'
Hans India
4 days ago
- Health
- Hans India
Study finds intermittent dieting may improve diabetes outcomes among obese
Dietary approaches like intermittent energy restriction, time-restricted eating, and continuous energy restriction can all improve blood sugar levels and body weight in people with obesity and type 2 diabetes, according to a study. Although researchers identified improved HbA1c levels, and adverse events were similar across the three groups, the IER group showed greater advantages in reducing fasting blood glucose, improving insulin sensitivity, lowering triglycerides, and strengthening adherence to the dietary interventions. IER typically involves periods of reduced calorie intake. It differs from intermittent fasting (IF) as it involves periods of complete or near-complete food abstinence. The research directly compared 5:2 intermittent energy restriction with 10-hour time-restricted eating in patients with obesity and type 2 diabetes. 'The findings provide scientific evidence for clinicians to choose appropriate dietary strategies when treating such patients,' said Haohao Zhang, Ph.D., chief physician at The First Affiliated Hospital of Zhengzhou University in Zhengzhou, China. The study involved 90 patients who were randomly assigned in a 1:1:1 ratio to the IER, TRE, or CER group, with consistent weekly caloric intake across all groups. A team of nutritionists supervised the 16-week intervention. Of those enrolled, 63 completed the study. There were 18 females and 45 males, with an average age of 36.8 years, a mean diabetes duration of 1.5 years, a baseline BMI of 31.7 kg/m², and an HbA1c of 7.42 per cent. At the end of the study, there were no significant differences in HbA1c reduction and weight loss between the IER, TRE, and CER groups. However, the absolute decrease in HbA1c and body weight was greatest in the IER group. Compared to TRE and CER, IER significantly reduced fasting blood glucose and triglycerides and increased the Matsuda index, a measure of whole-body insulin sensitivity. Uric acid and liver enzyme levels exhibited no statistically significant changes from baseline in any study group. Two patients in the IER group and the TRE group, and three patients in the CER group, experienced mild hypoglycemia. The IER group had the highest adherence rate (85 per cent), followed by the CER group at 84 per cent and the TRE group at 78 per cent. Both the IER and CER groups showed statistically significant differences compared with the TRE group. Zhang said these findings highlight the feasibility and effectiveness of dietary interventions for people who have obesity and type 2 diabetes. The study is presented at the ongoing ENDO 2025, the Endocrine Society's annual meeting in San Francisco, US.
NDTV
4 days ago
- Health
- NDTV
High Blood Sugar Can Affect Your Sex Life, Research Reveals
A recent research presented at the ENDO 2025 revealed that high blood sugar levels can impact men's sexual health. The research, which has not yet been peer-reviewed, found that even slight elevations in blood sugar levels, below the diabetic threshold, can lead to a decline in sperm movement and erectile function. The researchers analysed the health records of 110 adult men with obesity or type 2 diabetes being treated with weight-loss medications and who were not on testosterone or hormonal therapy. Along with 10% weight loss, the proportion of men with normal levels of both total and free testosterone rose from 53% to 77%. As per the preliminary research presented this week at the Endocrine Society's annual meeting in San Francisco, high blood sugar can lower testosterone levels, which are crucial for male sexual function. Testosterone levels don't directly impact erectile function but rather correlate with libido assessment. The research found that high glucose levels can damage nerves and blood vessels, which are essential for achieving and maintaining erections, leading to erectile dysfunction. Lifestyle Changes And Prevention A balanced diet rich in whole foods and fibre can help stabilise blood sugar and reduce inflammation. Regular physical activity helps in improving insulin sensitivity, and it supports weight loss. Meditation and yoga can enhance mental and emotional well-being, playing a role in sexual performance. Medications like semaglutide, liraglutide and tirzepatide can help regulate blood sugar. "While it is well known that weight loss from lifestyle changes or bariatric surgery increases testosterone levels, the impact that anti-obesity medications may also have on these levels has not been widely studied," said Shellsea Portillo Canales, M.D., endocrinology fellow at SSM Health St. Louis University Hospital in St. Louis, Mo. "Our study is among the first to provide compelling evidence that low testosterone can be reversed with the use of commonly prescribed anti-obesity medications."
Yahoo
5 days ago
- Business
- Yahoo
Amylyx Pharmaceuticals Shares Promising Avexitide Data for Post-Bariatric Hypoglycemia at ENDO 2025, Phase 3 Enrollment Nears Completion
Amylyx Pharmaceuticals Inc. (NASDAQ:AMLX) is one of the best low priced pharma stocks to buy now. On July 13, Amylyx Pharmaceuticals announced new exploratory analyses from its Phase 2 PREVENT and Phase 2b clinical trials of avexitide for post-bariatric hypoglycemia/PBH at the Endocrine Society's annual meeting (ENDO 2025). Avexitide is an investigational, first-in-class glucagon-like peptide-1 (GLP-1) receptor antagonist and has received FDA Breakthrough Therapy designation for PBH. PBH is a complication that can arise after bariatric surgery, such as Roux-en-Y gastric bypass. A medical scientist in a lab coat gazing at a microscopic view of a drug in development. There are currently no FDA-approved treatments for PBH. Avexitide works by binding to the GLP-1 receptor on pancreatic islet beta cells, blocking the effect of excessive GLP-1 and thus mitigating hypoglycemia by decreasing insulin secretion and stabilizing glucose levels. Avexitide has generally been well-tolerated with a favorable safety profile across all trials. Amylyx expects to complete recruitment for the LUCIDITY trial this year, with topline data anticipated in H1 2026. Amylyx Pharmaceuticals Inc. (NASDAQ:AMLX) is a clinical-stage pharmaceutical company that discovers and develops treatment options for neurodegenerative diseases and endocrine conditions in the US. While we acknowledge the potential of AMLX as an investment, we believe certain AI stocks offer greater upside potential and carry less downside risk. If you're looking for an extremely undervalued AI stock that also stands to benefit significantly from Trump-era tariffs and the onshoring trend, see our free report on the . READ NEXT: and . Disclosure: None. This article is originally published at Insider Monkey. Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
