Introduction
Improvements in healthcare have dramatically lengthened lifespans among industrialized nations to the point that, in the United States alone, it is forecasted that the number of older adults will increase from the current 46 million to about 100 million by 2050 (Yabluchanskiy & Tsitouras, 2019). Unfortunately, with the increased lifespan, frailty among older men is a health concern since it could lead to an increase in disability, hospitalization, institutionalization, and, eventually, mortality (Yabluchanskiy & Tsitouras, 2019).
Hormone Replacement Therapy (HRT) can help restore and balance hormonal levels in older men, including testosterone, growth hormone, luteinizing hormone, and follicle-stimulating hormone, among others, to combat age-related issues and improve the overall quality of life. HRT has been so beneficial for older men that global testosterone sales increased from $150 million in 2000 to $1.8 billion in 2011, with the United States and Canada leading the way (Yabluchanskiy & Tsitouras, 2019).
Research Proposition
The objective of this study is to investigate the relationship between HRT and quality of life in older men. Similar to other drug protocols, patients must evaluate the risks and benefits of HRT before starting treatment. A thematic literature review and analysis on the improvement of the quality of life in terms of increase of muscle mass, increase of bone density, and overall health status in older men on HRT will be performed, with the independent variables being HRT therapy versus no-HRT therapy to test the following hypothesis: HRT significantlyimproves the quality of life of older men compared to non-HRT older men.
Literature Review
The history, advantages, and hazards of hormone replacement therapy (HRT) are all thoroughly covered in the paper by Cagnacci and Venier (2019). This article is helpful for the research proposal because it provides historical context and insights into how HRT’s perception and use have changed over time. These historical backgrounds and perspectives may inform the formulation of the research hypothesis and shape the design of the study assessing the impact of HRT on the lives of older adults.
The case report by Gaibor et al. (2023) examines potential hypercoagulable risk factors that may contribute to the development of acute portal vein thrombosis (PVT). This article sheds light on a previously understudied aspect of hypercoagulability and its implications for the quality of life of this population, which is pertinent to the proposed research hypothesis regarding the potential effects of hormone replacement therapy on the health of older men.
The importance of anabolic hormones in preserving physical function and muscle mass in older men is discussed in the article by Giannoulis et al. (2012). This article is helpful for the study proposal hypothesis because it offers insightful information on the potential advantages of HRT in improving the quality of life for older men by addressing the physiological changes associated with aging and frailty.
The study by Vinson et al. (2023) examines the relationship between HRT and COVID-19 results in solid organ transplant recipients. The authors associate HRT with a decreased risk of adverse outcomes in older patients. These findings can help guide the research proposal’s hypothesis by outlining potential processes by which HRT might enhance the quality of life for older men compared to those who do not receive it.
The study by Raj et al. (2018) shows two cases of people who used HRT for an extended period of time and developed several growing meningiomas. This article emphasizes the necessity to weigh potential risks and advantages in older men having hormone replacement therapy. It offers crucial insights into the impact of HRT on health outcomes, making it pertinent to the study proposal hypothesis.
The research by Okpechi et al. (2021) provides a comprehensive analysis of the intricate relationships between sex hormones, immune response modulation, aging, and their potential impact on SARS-CoV-2 infection. The article is a helpful resource for understanding the potential advantages of HRT in older men and its impact on their quality of life, as it provides an insightful understanding of the complex interactions between sex hormones, immune function, aging, and COVID-19.
From infancy to maturity, males with 47, XXY (Klinefelter syndrome) participate in the study by Samango-Sprouse et al. to examine the effects of HRTs on neuromotor abilities. This article is helpful for the proposed study hypothesis, as it discusses the effects of hormone replacement treatment on neuromotor abilities and provides evidence of its beneficial effects on motor function in males with the 47, XXY karyotype.
The article by Ranger et al. (2021) explores the association between the use of HRT following a cancer diagnosis and the risk of cardiovascular disease, cancer-specific mortality, additional cancer diagnoses, and all-cause mortality. This article is helpful in the research proposal hypothesis because it offers information regarding the effect of HRT on cancer survival and overall mortality in a longitudinal cohort of patients.
The paper by Rosenthal et al. (2020) provides a thorough analysis of the research that supports the use of HRT as a method to delay the aging process of the skin. This article is a valuable resource for understanding the potential impact of HRT on the quality of life of older people because it thoroughly examines the advantages and safety of bioidentical hormone replacement therapy.
The possible advantages and drawbacks of testosterone replacement treatment (HRT) for older men over the age of 60 are examined in the review by Yabluchanskiy and Tsitouras (2019). The review is a valuable tool for analyzing the suggested research hypothesis on the influence of HRT on the quality of life of the elderly since it offers insightful information on the intricate relationship between testosterone replacement therapy and older men’s health.
Synthesis
HRT may improve the physical function and quality of life in older men, according to studies by Giannoulis et al. (2012) and Okpechi et al. (2021). According to Giannoulis et al., anabolic hormones, such as growth hormone and testosterone, help preserve muscle mass and counteract age-related muscle weakness. Okpechi et al. explore the intricate interactions between sex hormones, immunological response, aging, and COVID-19 results, putting forth the possibility of HRT as a treatment. These studies indicate that HRT has a positive impact on the overall well-being of older men.
Research by Gaibor et al. (2023) and Vinson et al. (2023) reveals potential dangers associated with hormone replacement treatment. In their paper, Gaibor et al. describe a case of portal vein thrombosis that HRT, abdominal surgery, or dietary supplements may have triggered. HRT’s impact on COVID-19 outcomes in organ transplant recipients is investigated by Vinson et al., who find that immunosuppressed individuals may experience uncertain consequences. These findings draw attention to hypercoagulable hazards and emphasize the necessity to balance the advantages of HRT with any potential concerns.
The complex interactions between hormone replacement treatment and health outcomes are highlighted by research by Raj et al. (2018), Samango-Sprouse et al. (2022), and Ranger et al. (2021). According to Raj et al., there may be a connection between the development of meningiomas and exogenous sex hormones from long-term HRT. Samango-Sprouse et al. hypothesize that HRT improves motor function in those with Klinefelter syndrome. Understanding the effects of HRT on overall mortality and cancer survival in older people is made possible by Ranger et al These studies highlight the numerous effects of HRT on health and quality of life.
Method
Overview of Research Approach
This study intends to examine and analyze the literature to better understand how hormone replacement therapy (HRT) affects older men’s quality of life. To acquire pertinent studies, evaluate their findings, and integrate the data to reach meaningful conclusions on the effect of HRT on the quality of life of older men, the research will comprise a systematic review of the existing body of literature. The goal of this study is to further the conversation on aging, healthcare, and overall well-being, leading to a deeper understanding of the nuanced characteristics that characterize later life.
Description of Studies and Sampling Plan
Reputable resources, such as PubMed, Scopus, and Google Scholar, will be utilized to identify the research selected for this literature review on the chosen theme. A comprehensive search strategy will be developed employing terminology related to hormone replacement therapy, aging men, quality of life, muscle strength, bone health, and overall health outcomes. To cover recent research, the search will be restricted to papers published from 2010 to the present.
Four criteria will be used to choose the studies. First, only research that has been published in trustworthy, peer-reviewed journals after undergoing a thorough peer-review process will be included. The fact that the findings of these studies could be extended to the research’s target demographic of males aged 60 and older is crucial. Third, the research must be pertinent to determining how HRT affects various aspects of older men’s well-being, including overall health, muscle mass, bone density, and quality of life (Cagnacci & Venier, 2019). Fourth, research comparing the outcomes of senior males receiving HRT therapy to those of men not receiving HRT will be considered.
Measurement Instruments
The main objective of this study, a thematic literature review and analysis, is to synthesize and analyze previous studies rather than to gather new data systematically. As a result, this research project will not involve any direct data collection. Instead, to measure multiple outcomes, including muscle mass, bone density, and quality of life in people receiving HRT or no-HRT medication, the research will rely on the assessment tools already used in the original trials.
Procedures
A total of five distinct procedures will be used in the investigation. The first step is study selection, which involves identifying a pool of potential studies through the initial search. The study topic and inclusion criteria will be taken into consideration while screening title and abstract submissions.
The second step is data extraction, which involves extracting pertinent information on participant characteristics, study design, HRT therapies, outcomes measured, and findings related to quality of life, muscle mass, bone density, and overall health from a subset of studies. The next step is quality assessment, which denotes that each chosen study will have its quality evaluated using the proper tools, such as the Critical Appraisal Skills Programme (CASP) checklist for qualitative studies and the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies for quantitative studies (Long et al., 2020). This evaluation technique helps determine the reliability and validity of qualitative findings, which aids in a thorough review of the research literature.
The examination and synthesis of the results from the chosen studies will be the fourth step. The influence of HRT on the quality of life of individuals will be examined through a thematic analysis, which aims to uncover recurring themes and patterns. The studies will be categorized according to their conclusions, and a narrative synthesis will be given. If hormone replacement therapy markedly enhances the quality of life for older men relative to those not receiving HRT, the study’s findings will be drawn from an integrated analysis of the collected data. Based on the data from the examined studies, the possible hazards and advantages of HRT will also be explored.
Results
Data Recording
Since the present work is based on a systematic literature review using thematic qualitative analysis of the collected results, no primary data records are expected. However, to systematize and structure the collected data, Table 1 was created. The table provides information about the author, year of publication, sample size, methods, and results obtained by the authors.
Table 1 — Results of the comparative literature analysis performed
Reliability, Validity, and Bias Checks
Since statistical analyses were not part of this study, verifying the validity and internal reliability of the data was not feasible. Nevertheless, steps were taken to minimize the risks associated with bias and bias in qualitative results. First, all nine articles found above were selected based on inclusion criteria, among which was the requirement of the authority of the scientific journal in which the material was published.
Thus, all nine unique journals (Drugs & Aging, American Journal of Physical Medicine & Rehabilitation, Mayo Clinic Proceedings, Jama, Journal of Cachexia, Sarcopenia and Muscle, Clinical Trials, New England Journal of Medicine, JAMA Internal Medicine, Endocrine Reviews) were all in some way focused on clinical trials. In terms of authority, the average Hirsch index for these journals was 347, with the New England Journal of Medicine having the highest (1130) and Clinical Trials having the lowest (73). This indicates the credibility of the journals and therefore reduces the risks of biased and unreliable published research papers.
In addition, study reliability was necessary for the thematic analysis because, however valid the source material may be, poor quality analysis may distort the findings. To ensure increased validity and unbiased analysis, a systematic approach was used that included a rigorous method for conducting the thematic analysis. In more detail, the Results and Discussion sections of the original studies were carefully reviewed and divided into microthemes. Micro-themes from the different studies were combined into common themes, allowing the results of the nine research studies to be compared, summarized, and contrasted.
Exploratory Analysis
After a thematic analysis of all nine sources, a chart (Figure 1) was prepared to summarize the findings. The thematic analysis identified seven major themes, including muscle strength, cardiac function, bone function, sexual activity, cognitive function, injection type, and frequency of repeat hospitalizations. For all topics except bone tissue and injection type, conflicting results were found for the effects of HRT on the health attributes of older men. Bone health, as assessed through bone mineral composition, bone density, and direct bone strength, showed unequivocal improvement in two studies. In terms of injections, intramuscular and intracorporeal injections were shown to result in significantly better outcomes than subcutaneous and oral injections, as confirmed by two sources.
Discussion
This study aimed to investigate how hormone replacement therapy impacts the health of older men experiencing natural declines in testosterone levels. The study hypothesized that replacement therapy has a positive effect on the health of older men, improving key indicators.
Interpretation of Major Findings
The results of a thematic analysis of nine scientific sources published over the past 11 years demonstrated mixed effects of HRT on the health of older men. Of the seven attributes analyzed, only bone health and the efficacy of injection types showed unequivocally positive results. The authors of independent papers demonstrated that the bone tissue of older men became stronger, richer in terms of mineral composition, and denser when HRT was used compared to the placebo group. This implies that replacement therapy has positive effects on bone health, and bones do benefit from hormone use.
The main results of the thematic analysis also include that all other health attributes of older men did not show unequivocal positive effects. Nine independent sources showed conflicting results: for some HRT samples, the positive effects of the therapy were apparent, but other studies refuted them. About the sexual health of older men, for example, it was shown that “1-year replacement therapy… has significantly improved 10 of 12 measures of sexual activity” (Yabluchanskiy & Tsitouras, 2019, p. 4).
In addition, “Men in the testosterone group were more likely than those in the placebo group to report that their sexual desire had improved since the beginning of the trial” (Snyder et al., 2016, p. 615). However, at the same time, “the 3-year study… failed to confirm the beneficial effect of testosterone on overall sexual function or health-related quality of life” (Yabluchanskiy & Tsitouras, 2019, p. 4).
Similar conflicting results were found for each of the health attributes other than bone tissue and injection types, i.e., muscle strength, cognitive function, number of repeat hospitalizations, and cardiovascular health. This finding indicates a significant gap in knowledge regarding the universal effect and a weakness in providing cohort results. In other words, the inconsistency of the data may have been due to differences in sample characteristics, such as age, ethnicity, or cultural background, among the older men included in the clinical trials.
Interpretation of Minor Findings
Non-major findings of the present study include effects related to the efficacy of injection types and the number of repeat hospitalizations. For example, unambiguity was found with respect to injection types: independent authors showed that injections that promote faster absorption of hormones into the blood (intravenous and intramuscular) were expected to result in better treatment outcomes than subcutaneous and oral injections. This finding has a practical implication: the use of intravenous and intramuscular injections promotes faster and more effective hormone therapy. In other words, for older men whose testosterone levels are critically low and who are in greater need of HRT, the use of intravenous and intramuscular injections makes increased sense.
Another important metric is the number of repeat hospitalizations in older men after HRT use. In general, this metric corresponds to the efficacy of therapy, as a high rate of recurrences indicates poor efficacy of HRT and, consequently, an increased likelihood of complications and the need to seek alternative treatment options. Contradictory results were found regarding this metric. For a study with a smaller sample, no association was found between the frequency of repeat hospitalizations and the use of HRT (Al-Lami et al., 2019).
However, Baillargeon et al. (2016), using a sample size almost five times larger, demonstrated an inverse relationship between the variables: use of HRT led to a decreased risk of re-hospitalization. The contradictory nature of these findings may be due to differences in sample size and characteristics. In other words, as with the main effects, the inconsistency responds to the lack of universality of the data in older men and creates room for additional research.
Limitations
The present research paper has limitations, some of which may be addressed in future extensions. First, only nine research articles that fit the exclusion criteria and were published since 2010 were used for thematic analysis. A large number of earlier papers should have been taken into account, which may have affected the quality of the findings. Second, the sources used were written in English only, potentially reducing the amount of helpful material that could have been analyzed. Another area for improvement was the inability to conduct thematic analysis using paid software; all data were processed manually, and some valuable information may have been overlooked.
Future Research
In addition to addressing the current limitations of this paper, the study could be extended to obtain primary results and fill the identified knowledge gap. In particular, since the main problem with the body of published work is that it produces conflicting results, the creation of a cohort study is required. Forming a diverse, representative sample of older men that takes into account cultural, ethnic, and age backgrounds would be a feasible strategy for cohort analyses.
In addition, collecting primary data in the form of multiple health outcomes and subsequently conducting factorial and ANOVA tests would allow us to identify differences between groups and reach conclusions about whether there are any apparent effects of HRT. Another valid extension of the current work would be to conduct regression analyses of HRT effects as a function of age, which would enable the assessment of changes in health outcomes over time. Such studies, although of immense practical and clinical value, require considerable resources and computational power.
Conclusion
Increasing life expectancy has an adverse effect, specifically the development of chronic diseases and cardiovascular complications. We gauge that the cohort of older men was the focus of this paper: the trend towards growing older becomes the cause of a decline in the body’s hormonal levels, mainly testosterone, which entails serious threats to the overall health and well-being of the elderly male body. The most relevant strategy for the management of this condition is HRT, which aims to inject hormones into the patients’ bodies artificially.
This paper employed a qualitative paradigm to conduct a thematic analysis of the nine scientific papers collected, which described the effects of HRT on the health of older men. The results demonstrated complete ambiguity regarding the clinical effects, as independent providers provided conflicting information about the effects of HRT on cognitive function, sexual activity, muscle strength, and cardiovascular health. Only bone health was shown to improve unequivocally due to the use of replacement therapy.
In terms of minor outcomes, intravenous and intramuscular hormone injections have been shown to have better health effects than subcutaneous and oral injections. The frequency of repeat hospitalizations showed mixed findings, with some authors stating no association with HRT and others showing an inverse association. Thus, summarizing the overall conclusion of the research paper, the stated hypothesis must be rejected because the use of HRT did not lead to better health outcomes in older men.
References
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