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Aromatase inhibitors and selective estrogen receptor modulators: Unconventional therapies for functional hypogonadism?
- Source :
-
Andrology [Andrology] 2020 Nov; Vol. 8 (6), pp. 1590-1597. Date of Electronic Publication: 2019 Dec 02. - Publication Year :
- 2020
-
Abstract
- Introduction: Functional hypogonadism increases in prevalence due to aging as well as an overall increase of obesity. Aromatase inhibitors (AIs) and selective estrogen receptor modulators (SERMs) could be an alternative for testosterone replacement therapy (TRT), but have not yet been established as common clinical practice.<br />Methods: We conducted a thorough search of the literature published between 2009 and 2018. Only RCTs published in English were included. We assessed the impact of AIs and SERMs on gonadal steroids, sexual function and semen parameters, body composition and glucose homeostasis, physical function, bone mineral density (BMD), anemia, as well as potential adverse effects.<br />Results: Twelve RCTs were included, with a total number of 645 patients. A total of 145 men were included in RCTs comparing AIs versus placebo or TRT and 476 men in RCTs with SERMs versus placebo or TRT. One RCT compared AIs versus SERMs in 24 men. Inclusion criteria were heterogenic. Most studies only included a small number of patients (range 11-256) and follow-up time was relatively short (6 weeks to 12 months). AIs as well as SERMs increased serum testosterone levels. Overall, there was no effect on sexual symptoms nor on semen parameters. Following aromatase inhibition, only minimal improvement of body composition and physical function was observed in some of the trials, but spinal BMD decreased. SERMs only induced a small improvement in body composition. The effect of SERMs on physical function and on BMD was not assessed. No major adverse effects occurred.<br />Conclusion: AIs are not recommended as treatment for functional hypogonadism because of insufficient efficacy as well as a decrease in BMD. SERMs might be an alternative for TRT, but more research is needed to evaluate their effect on hypogonadal signs and symptoms, as well as on their long-term safety profile.<br /> (© 2019 American Society of Andrology and European Academy of Andrology.)
- Subjects :
- Aromatase Inhibitors adverse effects
Biomarkers blood
Eunuchism blood
Eunuchism diagnosis
Eunuchism physiopathology
Hormone Replacement Therapy
Humans
Male
Randomized Controlled Trials as Topic
Selective Estrogen Receptor Modulators adverse effects
Testosterone blood
Testosterone therapeutic use
Treatment Outcome
Aromatase Inhibitors therapeutic use
Eunuchism drug therapy
Selective Estrogen Receptor Modulators therapeutic use
Testosterone deficiency
Subjects
Details
- Language :
- English
- ISSN :
- 2047-2927
- Volume :
- 8
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Andrology
- Publication Type :
- Academic Journal
- Accession number :
- 31696669
- Full Text :
- https://doi.org/10.1111/andr.12725