Wednesday, April 22, 2015

Is Testosterone Replacement Therapy "Feeding the Fire" of Prostate Cancer?


Testosterone replacement therapy (TRT) is the administration of testosterone to men with abnormally low testosterone, termed hypogonadism, or "low T," Men with symptoms of low testosterone, can often benefit from TRT. Common symptoms of hypogonadism in post-pubertal men commonly include decreased muscle mass, decreased energy, depressed mood, decreased libido, decreased spontaneous erections, and erectile dysfunction [Wang et al., 2008, Basaria, 2014].

While TRT has been used for decades the last decade has seen a dramatic increase in the use of TRT. The percentage of men in the Unites States over 40 years of age prescribed TRT increased from less than 1% in 2001 to nearly 3% in 2011 [Baillargeon et al., 2013]. The increase in TRT and lack of data from large, long term randomized controlled trials (RCT) has raised concern for unrecognized adverse health risks, including potential increases in cardiovascular disease and prostate cancer (PC).

Changes in androgen use over time. From Baillargeon et al., 2013.

There is large body of both historic and modern data supporting a role for androgens in PC pathogenesis and progression.

In 1941, Huggins and Hodges proposed that PC growth was driven by androgens, after observing benefits of castration in PC patients [Huggins et al., 1941]. Current laboratory data demonstrate that many PC cell lines depend on testosterone for growth and spread.  [Kyprianou et al., 1990, Webber et al., 1996, Schwab et al., 2000]. In animal models, testosterone promotes PC tumor growth [Bladou et al., 1996, Ahmad et al., 2008].

The data supporting the androgen hypothesis has led to the dogma that TRT in PC patients is like "feeding the fire." Historically, there is data supporting this concept. In 1982 Fowler et al. reported on 52 men with metastatic PC patients who recieved testosterone. 38% of men had elevations in prostatic acid phosphatase (a blood test used to monitor PC), 2 men had measurable metastatic progression, and ther were 4 deaths [Fowler et al., 1982]. Importantly, these patients had advanced disease, and many had prior androgen deprivation [Fowler et al., 1982]. Thus, it would not be appropriate to apply these observations to men with clinically localized disease who receive early primary treatment and PSA monitoring.

 

There is currently no reliable data indicating an increase in PC in men without PC undergoing TRT.

The majority of studies on TRT and PC are small, and to date, there have been no prospective studies on TRT with sufficient patient numbers to determine increased PC risk. By one estimate, 6,000 patients receiving 5 years of TRT would be needed to detect a 30% increase in PC incidence [Bhasin et al., 2003]. In a systematic review of 40 prospective studies, there was no study which demonstrated an association between TRT and PC risk in men without prior PC. In addition, a meta-analysis of 19 studies, there was no significant increase in PC or significant PSA increases necessitating prostate biopsy. [Calof et al., 2005].

 

TRT in patients with localized PC appears safe, based on limited data

Using Medicare data, Kaplan and colleagues reported on 149,354 men, including 1,181 men who received TRT after a diagnosis with PC. Overall, TRT was not associated with PC deaths [Kaplan et al., 2014]. Similarly, Pastuszak and colleagues reported on 103 men who after prostatectomy were treated with TRT. There was an overall increase serum PSA, but no evidence of increased cancer recurrence over 36 months [Pastuszak et al., 2013]. In a smaller study, Morgentaler et al. examined 13 patients with untreated PC, enrolled in an active surveillence program and receiving TRT. After a median follow-up of 2.5 years, 2 men had worse pathology on subsequent biopsy, but no cases of disease or PSA progression were seen [Morgentaler et al., 2011].

 

Summary

Overall, there remains no clear answer to the question "Does testosterone promote prostate cancer development in humans?" Thus, TRT in men with prostate cancer remains controversial. There is clear evidence that androgens can promote PC in animal models. It is clear that the influence of testosterone on PC disease progression is of paramount importance to both patients and providers as they weight the potential benefits of TRT. Currently, there is a growing amount of evidence that TRT is safe in well-selected men with clinically localized PC. However, these results are based on TRT in a small number of patients. Furthermore, the heterogeneity in PC progression and aggressiveness may give rise to heterogeneity in the responsiveness of tumors to TRT. Thus, until the results of future RCTs are available, TRT should only be offered to select patients who are carefully monitored and well-informed about the potential risks and benefits.

 

This blog was written by Jason E. Michaud M.D., Ph.D., urology resident at the Brady Urological Institute, currently in his laboratory research year.

 


 





Ahmad, I., Sansom, O.J., and Leung, H.Y. (2008) Advances in Mouse Models of Prostate Cancer. Expert Rev Mol Med 10: e16.
Al-Khazaali, A., Arora, R., and Muttar, S. (2015) Controversial Effects of Exogenous Testosterone on Cardiovascular Diseases. Am J Ther:
Andriole, G., Bruchovsky, N., Chung, L.W., Matsumoto, A.M., Rittmaster, R., Roehrborn, C. et al. (2004) Dihydrotestosterone and the Prostate: The Scientific Rationale for 5alpha-Reductase Inhibitors in the Treatment of Benign Prostatic Hyperplasia. J Urol 172: 1399-1403.
Andriole, G.L., Crawford, E.D., Grubb, R.L., Buys, S.S., Chia, D., Church, T.R. et al. (2009) Mortality Results from a Randomized Prostate-Cancer Screening Trial. New England Journal of Medicine 360: 1310-1319.
Araujo, A.B., O'donnell, A.B., Brambilla, D.J., Simpson, W.B., Longcope, C., Matsumoto, A.M. et al. (2004) Prevalence and Incidence of Androgen Deficiency in Middle-Aged and Older Men: Estimates from the Massachusetts Male Aging Study. J Clin Endocrinol Metab 89: 5920-5926.
Baillargeon, J., Urban, R.J., Ottenbacher, K.J., Pierson, K.S., and Goodwin, J.S. (2013) Trends in Androgen Prescribing in the United States, 2001 to 2011. JAMA Intern Med 173: 1465-1466.
Basaria, S. (2014) Male Hypogonadism. Lancet 383: 1250-1263.
Bhasin, S., Singh, A.B., Mac, R.P., Carter, B., Lee, M.I., and Cunningham, G.R. (2003) Managing the Risks of Prostate Disease During Testosterone Replacement Therapy in Older Men: Recommendations for a Standardized Monitoring Plan. J Androl 24: 299-311.
Bladou, F., Vessella, R.L., Buhler, K.R., Ellis, W.J., True, L.D., and Lange, P.H. (1996) Cell Proliferation and Apoptosis During Prostatic Tumor Xenograft Involution and Regrowth after Castration. Int J Cancer 67: 785-790.
Botelho, F., Pina, F., Figueiredo, L., Cruz, F., and Lunet, N. (2012) Does Baseline Total Testosterone Improve the Yielding of Prostate Cancer Screening? Eur J Cancer 48: 1657-1663.
Bremner, W.J., Vitiello, M.V., and Prinz, P.N. (1983) Loss of Circadian Rhythmicity in Blood Testosterone Levels with Aging in Normal Men. J Clin Endocrinol Metab 56: 1278-1281.
Calof, O.M., Singh, A.B., Lee, M.L., Kenny, A.M., Urban, R.J., Tenover, J.L. et al. (2005) Adverse Events Associated with Testosterone Replacement in Middle-Aged and Older Men: A Meta-Analysis of Randomized, Placebo-Controlled Trials. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 60: 1451-1457.
D'amico, A.V., Moul, J.W., Carroll, P.R., Sun, L., Lubeck, D., and Chen, M.H. (2003) Surrogate End Point for Prostate Cancer-Specific Mortality after Radical Prostatectomy or Radiation Therapy. J Natl Cancer Inst 95: 1376-1383.
Dai, B., Qu, Y., Kong, Y., Ye, D., Yao, X., Zhang, S. et al. (2012) Low Pretreatment Serum Total Testosterone Is Associated with a High Incidence of Gleason Score 8-10 Disease in Prostatectomy Specimens: Data from Ethnic Chinese Patients with Localized Prostate Cancer. BJU Int 110: E667-672.
Endogenous, H., Prostate Cancer Collaborative, G., Roddam, A.W., Allen, N.E., Appleby, P., and Key, T.J. (2008) Endogenous Sex Hormones and Prostate Cancer: A Collaborative Analysis of 18 Prospective Studies. J Natl Cancer Inst 100: 170-183.
Fowler, J.E. and Whitemore, W.F. (1982) Considerations for the Use of Testosterone with Systemic Chemotherapy in Prostate Cancer. Cancer 49: 1373-1377.
Gann, P.H., Hennekens, C.H., Ma, J., Longcope, C., and Stampfer, M.J. (1996) Prospective Study of Sex Hormone Levels and Risk of Prostate Cancer. J Natl Cancer Inst 88: 1118-1126.
Garcia-Cruz, E., Piqueras, M., Ribal, M.J., Huguet, J., Serapiao, R., Peri, L. et al. (2012) Low Testosterone Level Predicts Prostate Cancer in Re-Biopsy in Patients with High Grade Prostatic Intraepithelial Neoplasia. BJU Int 110: E199-202.
Haider, A., Zitzmann, M., Doros, G., Isbarn, H., Hammerer, P., and Yassin, A. (2014) Incidence of Prostate Cancer in Hypogonadal Men Receiving Testosterone Therapy: Observations from 5-Year Median Followup of 3 Registries. J Urol 193: 80-86.
Handelsman, D.J. (2013) Global Trends in Testosterone Prescribing, 2000-2011: Expanding the Spectrum of Prescription Drug Misuse. Med J Aust 199: 548-551.
Harman, S.M., Metter Ej Fau - Tobin, J.D., Tobin Jd Fau - Pearson, J., Pearson J Fau - Blackman, M.R., and Blackman, M.R. (2001) Longitudinal Effects of Aging on Serum Total and Free Testosterone Levels in Healthy Men. Baltimore Longitudinal Study of Aging.
Howden, L., Meyer, J. (2011) Age and Sex Composition: 2010, 2010 Census Briefs, Vol. 2015. United States Census Bureau.
Huggins, C. (1947) The Etiology of Benign Prostatic Hypertrophy. Bulletin of the New York Academy of Medicine 23: 696-704.
Huggins, C. and Hodges, C.V. (1941) Studies on Prostatic Cancer: I. The Effect of Castration, of Estrogen and of Androgen Injection on Serum Phosphatases in Metastatic Carcinoma of the Prostate. 1941. Cancer Res 1: 293-297.
Imamoto, T., Suzuki, H., Fukasawa, S., Shimbo, M., Inahara, M., Komiya, A. et al. (2005) Pretreatment Serum Testosterone Level as a Predictive Factor of Pathological Stage in Localized Prostate Cancer Patients Treated with Radical Prostatectomy. Eur Urol 47: 308-312.
Kaplan, A.L., Trinh, Q.D., Sun, M., Carter, S.C., Nguyen, P.L., Shih, Y.C. et al. (2014) Testosterone Replacement Therapy Following the Diagnosis of Prostate Cancer: Outcomes and Utilization Trends. J Sex Med 11: 1063-1070.
Kyprianou, N., English, H.F., and Isaacs, J.T. (1990) Programmed Cell Death During Regression of Pc-82 Human Prostate Cancer Following Androgen Ablation. Cancer Res 50: 3748-3753.
Lane, B.R., Stephenson, A.J., Magi-Galluzzi, C., Lakin, M.M., and Klein, E.A. (2008) Low Testosterone and Risk of Biochemical Recurrence and Poorly Differentiated Prostate Cancer at Radical Prostatectomy. Urology 72: 1240-1245.
Leibowitz, R.L., Dorff, T.B., Tucker, S., Symanowski, J., and Vogelzang, N.J. (2010) Testosterone Replacement in Prostate Cancer Survivors with Hypogonadal Symptoms. BJU Int 105: 1397-1401.
Massengill, J.C., Sun, L., Moul, J.W., Wu, H., Mcleod, D.G., Amling, C. et al. (2003) Pretreatment Total Testosterone Level Predicts Pathological Stage in Patients with Localized Prostate Cancer Treated with Radical Prostatectomy. J Urol 169: 1670-1675.
Matsumoto, A.M. (2003) Fundamental Aspects of Hypogonadism in the Aging Male. Reviews in Urology 5: S3-S10.
Mearini, L., Zucchi, A., Nunzi, E., Villirillo, T., Bini, V., and Porena, M. (2013) Low Serum Testosterone Levels Are Predictive of Prostate Cancer. World J Urol 31: 247-252.
Miner, M., Barkin, J., and Rosenberg, M.T. (2014) Testosterone Deficiency: Myth, Facts, and Controversy. Can J Urol 21 Suppl 2: 39-54.
Morgentaler, A., Lipshultz, L.I., Bennett, R., Sweeney, M., Avila, D., Jr., and Khera, M. (2011) Testosterone Therapy in Men with Untreated Prostate Cancer. J Urol 185: 1256-1260.
Morgentaler, A. and Rhoden, E.L. (2006) Prevalence of Prostate Cancer among Hypogonadal Men with Prostate-Specific Antigen Levels of 4.0 Ng/Ml or Less. Urology 68: 1263-1267.
Morote, J., Ramirez, C., Gomez, E., Planas, J., Raventos, C.X., De Torres, I.M. et al. (2009) The Relationship between Total and Free Serum Testosterone and the Risk of Prostate Cancer and Tumour Aggressiveness. BJU Int 104: 486-489.
Muller, M., Den Tonkelaar, I., Thijssen, J.H., Grobbee, D.E., and Van Der Schouw, Y.T. (2003) Endogenous Sex Hormones in Men Aged 40-80 Years. Eur J Endocrinol 149: 583-589.
Muller, R.L., Gerber L Fau - Moreira, D.M., Moreira Dm Fau - Andriole, G., Andriole G Fau - Castro-Santamaria, R., Castro-Santamaria R Fau - Freedland, S.J., and Freedland, S.J. (2012) Serum Testosterone and Dihydrotestosterone and Prostate Cancer Risk in the Placebo Arm of the Reduction by Dutasteride of Prostate Cancer Events Trial.
Mulligan, T., Frick, M.F., Zuraw, Q.C., Stemhagen, A., and Mcwhirter, C. (2006) Prevalence of Hypogonadism in Males Aged at Least 45 Years: The Him Study. International Journal of Clinical Practice 60: 762-769.
Neaves Wb Fau - Johnson, L., Johnson L Fau - Porter, J.C., Porter Jc Fau - Parker, C.R., Jr., Parker Cr Jr Fau - Petty, C.S., and Petty, C.S. (1984) Leydig Cell Numbers, Daily Sperm Production, and Serum Gonadotropin Levels in Aging Men.
Pastuszak, A.W., Pearlman, A.M., Lai, W.S., Godoy, G., Sathyamoorthy, K., Liu, J.S. et al. (2013) Testosterone Replacement Therapy in Patients with Prostate Cancer after Radical Prostatectomy. J Urol 190: 639-644.
Pierorazio, P.M., Ferrucci L Fau - Kettermann, A., Kettermann a Fau - Longo, D.L., Longo Dl Fau - Metter, E.J., Metter Ej Fau - Carter, H.B., and Carter, H.B. (2010) Serum Testosterone Is Associated with Aggressive Prostate Cancer in Older Men: Results from the Baltimore Longitudinal Study of Aging.
Rhoden, E.L. and Morgentaler, A. (2003) Testosterone Replacement Therapy in Hypogonadal Men at High Risk for Prostate Cancer: Results of 1 Year of Treatment in Men with Prostatic Intraepithelial Neoplasia. J Urol 170: 2348-2351.
Rove, K.O. and Crawford, E.D. (2014) Traditional Androgen Ablation Approaches to Advanced Prostate Cancer: New Insights. Can J Urol 21: 14-21.
Rubens R Fau - Dhont, M., Dhont M Fau - Vermeulen, A., and Vermeulen, A. (1974) Further Studies on Leydig Cell Function in Old Age.
Salonia, A., Gallina, A., Briganti, A., Abdollah, F., Suardi, N., Capitanio, U. et al. (2010) Preoperative Hypogonadism Is Not an Independent Predictor of High-Risk Disease in Patients Undergoing Radical Prostatectomy. Cancer 117: 3953-3962.
San Francisco, I.F., Rojas, P.A., Dewolf, W.C., and Morgentaler, A. (2014) Low Free Testosterone Levels Predict Disease Reclassification in Men with Prostate Cancer Undergoing Active Surveillance. BJU Int 114: 229-235.
Schroder, F.H., Hugosson, J., Roobol, M.J., Tammela, T.L.J., Ciatto, S., Nelen, V. et al. (2012) Prostate-Cancer Mortality at 11 Years of Follow-Up. New England Journal of Medicine 366: 981-990.
Schwab, T.S., Stewart, T., Lehr, J., Pienta, K.J., Rhim, J.S., and Macoska, J.A. (2000) Phenotypic Characterization of Immortalized Normal and Primary Tumor-Derived Human Prostate Epithelial Cell Cultures. Prostate 44: 164-171.
Shaneyfelt, T., Husein, R., Bubley, G., and Mantzoros, C.S. (2000) Hormonal Predictors of Prostate Cancer: A Meta-Analysis. Journal of Clinical Oncology 18: 847.
Shin, B.S., Hwang, E.C., Im, C.M., Kim, S.O., Jung, S.I., Kang, T.W. et al. (2010) Is a Decreased Serum Testosterone Level a Risk Factor for Prostate Cancer? A Cohort Study of Korean Men. Korean J Urol 51: 819-823.
Siiteri Pk Fau - Wilson, J.D. and Wilson, J.D. (1974) Testosterone Formation and Metabolism During Male Sexual Differentiation in the Human Embryo.
Spitzer, M., Huang, G., Basaria, S., Travison, T.G., and Bhasin, S. (2013) Risks and Benefits of Testosterone Therapy in Older Men. Nat Rev Endocrinol 9: 414-424.
Swerdloff, R. and Wang, C. (2011) Testosterone Treatment of Older Men: Why Are Controversies Created? The Journal of Clinical Endocrinology and Metabolism 96: 62-65.
Swyer, G.I.M. (1944) Post-Natal Growth Changes in the Human Prostate. Journal of Anatomy 78: 130-145.
Tenover, J.S., Matsumoto, A.M., Clifton, D.K., and Bremner, W.J. (1988) Age-Related Alterations in the Circadian Rhythms of Pulsatile Luteinizing Hormone and Testosterone Secretion in Healthy Men. J Gerontol 43: M163-169.
Vermeulen, A. and Kaufman, J.M. (1995) Ageing of the Hypothalamo-Pituitary-Testicular Axis in Men. Horm Res 43: 25-28.
Wang, C., Nieschlag, E., Swerdloff, R., Behre, H.M., Hellstrom, W.J., Gooren, L.J. et al. (2008) Investigation, Treatment and Monitoring of Late-Onset Hypogonadism in Males: Isa, Issam, Eau, Eaa and Asa Recommendations. Eur J Endocrinol 159: 507-514.
Webber, M.M., Bello, D., and Quader, S. (1996) Immortalized and Tumorigenic Adult Human Prostatic Epithelial Cell Lines: Characteristics and Applications. Part I. Cell Markers and Immortalized Nontumorigenic Cell Lines. Prostate 29: 386-394.
Wu, F.C., Tajar, A., Beynon, J.M., Pye, S.R., Silman, A.J., Finn, J.D. et al. (2010) Identification of Late-Onset Hypogonadism in Middle-Aged and Elderly Men. N Engl J Med 363: 123-135.
Xylinas, E., Ploussard, G., Durand, X., Fabre, A., Salomon, L., Allory, Y. et al. (2011) Low Pretreatment Total Testosterone (< 3 Ng/Ml) Predicts Extraprostatic Disease in Prostatectomy Specimens from Patients with Preoperative Localized Prostate Cancer. BJU Int 107: 1400-1403.
Yano, M., Imamoto, T., Suzuki, H., Fukasawa, S., Kojima, S., Komiya, A. et al. (2007) The Clinical Potential of Pretreatment Serum Testosterone Level to Improve the Efficiency of Prostate Cancer Screening. Eur Urol 51: 375-380.

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    ReplyDelete
  19. Get rid of Cold Sores, unexpected Outbreak and Herpes Virus? then you don't have to keep waiting for treatment when the is a herbal medicine that cure this virus. I was searching online for Herbal Cure for Herpes Virus when I saw a testimony online about Dr. Akintunde and how he cured a lady of HSV1 with his.
    natural herbal medicine and tested Negative and in less than a month she was cured of this virus. So it took me time to believe that this was true, because my family Doctor tried all his best to get rid of this virus in my body system but yet no cure and I suffered from outbreak and Cold Sores always. I had to contact Dr. Akintunde after I have access his website and i had faith in God that I was going to be fine and free of this virus one day. Finally I contacted Dr. Akintunde on his WhatsApp number that I saw on the testimony post online, and after our conversation the Doctor only promise me that I was going to be cured and free of this virus after taking his natural herbal medicine because I was tired of my situation with this virus it was so distracting to my life and whole family. Later Dr. Akintunde send some Herbal medicine to me through UPS courier service, with instructions on how to used this medicine, to my biggest surprise first week of taking my herbal medication I saw great improvement and I still think that it's a dream but this is real, I now test Negative of this virus today and my blood pressure well regulated now, my family doctor after my test was extremely surprise to see my test result change to HSV1 Negative and no more symptoms, cold sores, sores throat and outbreak again. I wish to tell everyone about this, mostly if you have this virus then do yourself good to contact Dr. Akintunde and see what the Lord can do through this Herbal Doctor's medicine in less than a month. 100% free from herpes Virus. I and my family say "thank you" Sir, for helping my life. You are a blessing to this generation and God will reward you richly

    Email: drakintundehomecare@gmail.com

    WhatsApp number: +234 703 524 5593

    ReplyDelete
  20. I glorify the lord Almighty on your behalf sir Dr Chukwu Madu herbal home, let the grace continue with you. Am so happy right now am cured totally from Cancer with the help of your herb DR Chukwu Madu herbal home.
    You have been curing people with your powerful herbs thank you so much for your truth and straight forwardness towards your patients ,I read about your great herbal home on the Internet and how you cure people of their different virus and I contacted you without time wasting when you told me I will be totally cured soon and I hoped on you ,and you never let me down. My name DESMOND WALTER from Texas. Am greatfull Doc. Viewers join me say thank you to this great herbalist from Nigeria part of African who cures people of their Virus with his great herbs, even if you have some days to live contact him and be saved forever iam very sure of Dr Chukwu Madu herbal home.[ dr.chukwumaduherbalhome@gmail.com] or talk with him directly on WhatsApp via [+2347030936239] am all good DOC.

    ReplyDelete
  21. I glorify the lord Almighty on your behalf sir Dr Chukwu Madu herbal home, let the grace continue with you. Am so happy right now am cured totally from Cancer with the help of your herb DR Chukwu Madu herbal home.
    You have been curing people with your powerful herbs thank you so much for your truth and straight forwardness towards your patients ,I read about your great herbal home on the Internet and how you cure people of their different virus and I contacted you without time wasting when you told me I will be totally cured soon and I hoped on you ,and you never let me down. My name DESMOND WALTER from Texas. Am greatfull Doc. Viewers join me say thank you to this great herbalist from Nigeria part of African who cures people of their Virus with his great herbs, even if you have some days to live contact him and be saved forever iam very sure of Dr Chukwu Madu herbal home.[ dr.chukwumaduherbalhome@gmail.com] or talk with him directly on WhatsApp via [+2347030936239] am all good DOC.

    ReplyDelete
  22. Suffering from herpes virus is a terrible experience because i was told it has no cure,the good news am happily sharing now is the great power behind herbal medication i got diagnosed of herpes virus in the year  2016 and in 2018 i started having outbreaks and it became more terrible for me to bare,One blissful morning i came across a blog comment posted by a man call Thompson on how he was cured of herpes simplex virus type 2 with the herbal medication of Dr CHUKWU MADU Herbal Home) who is a specialist in curing all kinds of std virus and chronic disease with herbs,i immediately copied out his contact mail that was dr.chukwumaduherbalhome@gmail.com Or Via WhatsApp  +2347030936239 and i explain all my problems to him, he was very honest with me and also kept his promise to get me cured with his herbs if i follow the prescriptions he gives along with the medication which i did exactly as he prescribed, to God be the glory My herpes simplex virus i have been suffering from got cured in just 2 weeks after completing the dose of his herbal cure. once again thank you so much sir for restoring my health back and most especially my skin. Please for any who has health problem of any kind should mail him on the email provided above. Give him a chance and see what he can do. JANE lisaru from MALAYSIA.
    .

    ReplyDelete
  23. Class College Education training Beauty teaching university academy lesson  teacher master student  spa manager  skin care learn eyelash extensions tattoo spray

    ReplyDelete
  24. i want to inform the public how i was cured of HERPES Simplex Virus by a Doctor called Dr.EBHOTA. i visited different hospital but they gave me list of drugs like Famvir, Zovirax, and Valtrex which is very expensive to treat the symptoms and never cured me. I was browsing through the Internet searching for remedy on HERPES and i saw comment of people talking about how Doctor EBHOTA cured them. I Was scared because i never believed in the Internet but i was convince to give him a try because i was having no hope of been cured of HERPES so i decided to contact him on his email, i searched his email on net and i saw a lot of people testifying about his goodness. when i contacted him he gave me hope and send a Herbal medicine to me that i took and it seriously worked for me, am a free person now without problem, my HERPES result came out negative. You can contact him on
    his Email: drebhotasolution@gmail.com or whatsapp him on +2348089535482 and get all your problem solved.
    1Sickness of any kind
    2 Help to CURE Hepatitis B, HIV/AIDs CANCER and BIPOLAR
    3 Divorce, Breakup problem and To Re-unit
    4 Pregnancy problem
    5 Financial problem and Job promotion
    6 To get a good and rich life partner
    7 To Lose your wath
    8 to enlargement of pennis
    9. CANCER
    10. ALS (Lou Gehrig's disease)
    11 Hepatitis B
    12 chronic pancreatic
    13 emphysema
    14 COPD (chronic obstructive pulmonary disease)   

    ReplyDelete
  25. WHAT A GREAT MIRACLE THAT I HAVE EVER SEE IN MY LIFE. My names are Clara David I’m a citizen of USA, My younger sister was sicking of
    breast cancer and her name is Sandra David I and my family have taking her
    to all kind of hospital in USA still yet no good result. I decided to go to
    the internet and search for cancer cure so that was how I find a lady
    called peter Lizzy she was testifies to the world about the goodness of a
    herbal man who has the roots and herbs to cure all kind of disease and the
    herbal man email was there. So I decided to contact the herbal man @herbalist_sakura for my younger sister help to cure her breast cancer. I contacted him and told him
    my problem he told me that I should not worry that my sister cancer will be
    cure, he told me that there is a medicine that he is going to give me that
    I will cook it and give it to my sister to drink for one week, so I ask how
    can I receive the cure that I am in USA, he told me
    That I will pay for the delivery service. The courier service can
    transport it to me so he told me the amount I will pay, so my dad paid for
    the delivery fee. two days later I receive the cure from the courier
    service so I used it as the herbal man instructed me to, before the week
    complete my sister cancer was healed and it was like a dream to me not
    knowing that it was physical I and my family were very happy about the
    miracle of Doctor so my dad wanted to pay him 5 million us dollars the
    herbal man did not accept the offer from my dad, but I don't know why he
    didn't accept the offer, he only say that I should tell the world about him
    and his miracle he perform so am now here to tell the world about him if
    you or your relative is having any kind of disease that you can't get from
    the hospital please contact dr.sakuraspellalter@gmail.com or whats app him
    +2348110114739 you can follow him up on Instagram @herbalist_sakura for the cure, he will help you out with the
    problem. And if you need more information about the doctor you can mail me
    davidclara223@gmail.com

    ReplyDelete
  26. WHAT A GREAT MIRACLE THAT I HAVE EVER SEE IN MY LIFE. My names are Clara David I’m a citizen of USA, My younger sister was sicking of
    breast cancer and her name is Sandra David I and my family have taking her
    to all kind of hospital in USA still yet no good result. I decided to go to
    the internet and search for cancer cure so that was how I find a lady
    called peter Lizzy she was testifies to the world about the goodness of a
    herbal man who has the roots and herbs to cure all kind of disease and the
    herbal man email was there. So I decided to contact the herbal man @herbalist_sakura for my younger sister help to cure her breast cancer. I contacted him and told him
    my problem he told me that I should not worry that my sister cancer will be
    cure, he told me that there is a medicine that he is going to give me that
    I will cook it and give it to my sister to drink for one week, so I ask how
    can I receive the cure that I am in USA, he told me
    That I will pay for the delivery service. The courier service can
    transport it to me so he told me the amount I will pay, so my dad paid for
    the delivery fee. two days later I receive the cure from the courier
    service so I used it as the herbal man instructed me to, before the week
    complete my sister cancer was healed and it was like a dream to me not
    knowing that it was physical I and my family were very happy about the
    miracle of Doctor so my dad wanted to pay him 5 million us dollars the
    herbal man did not accept the offer from my dad, but I don't know why he
    didn't accept the offer, he only say that I should tell the world about him
    and his miracle he perform so am now here to tell the world about him if
    you or your relative is having any kind of disease that you can't get from
    the hospital please contact dr.sakuraspellalter@gmail.com or whats app him
    +2348110114739 you can follow him up on Instagram @herbalist_sakura for the cure, he will help you out with the
    problem. And if you need more information about the doctor you can mail me
    davidclara223@gmail.com

    ReplyDelete
  27. FINALLY FREE FROM CANCER DISEASE.
    what a miracle i never believe there is cure because my doctor tested me cancer positive and she told me there is no cure, i’m very happy today that i’m having a free life without this CANCER virus, i can remember some months ago when i was crying all through the night and day that i can’t get cured from this CANCER, i found this herbal man called Dr adazal on internet when i was doing research on cure for shingle i contacted him to found out if i can get help from this cancer virus, i was so surprise when he told me that he have the herbs cure to it and he sent me the herbal in less down 5 days i was so happy when i get someone giving me hope that he can cured me i took the herbal for just 2 weeks, when i went for test after taking the herbal i found out that i am cured i was so happy and surprise, i want to use this opportunity to inform you that there is cured to cancer virus you can also contact him for his help as soon as possible so that you can get rid of this cancer once and for all you can reach him through this email: dr,adazalherbalcure@gmail.com or whatsApp him on +2348073688335 You can also contact him on any disease and virus in this he all have the herbal cure to it.
    1 HIV/AIDS
    2 HERPES
    3 CANCER
    4 ALS
    5 HEPATITIS
    6 DIABETES
    7 LOVE SPELL
    8 INFECTIONS
    9 HIGN BLOOD PRESSURE,.....
    THANKS TO DR adazal FOE THE GOOD WORK IN LIFE YOU ARE TRULY A BLESS.  

    ReplyDelete
  28. FINALLY FREE FROM HERPES VIRUS
    I thought my life had nothing to offer anymore because lifebecame meaningless to me because I had Herpes virus, thesymptoms became very severe and bold and made my familyrun from and abandoned me so they won't get infected. I gaveup everything, my hope, dreams,vision and job because thedoctor told me there's no cure. I consumed so many drugs butthey never cured me but hid the symptoms inside me makingit worse. I was doing some research online someday when Icame across testimonies of some people of how DR Ebhotacured them from Herpes, I never believed at first and thoughtit was a joke but later decided to contact him on the detailsprovided and when I messaged him we talked and he sent mehis herbal medicine and told me to go for a test after twoweeks. Within 7 days of medication the symptomsdisappeared and when I went for a test Lo and behold I wasNEGATIVE by the Doctor Who tested me earlier. Thank you DREbhota because I forever owe you my life and I'll keep ontelling the world about you. If you are going through samesituation worry no more and contact DR Ebhota viadrebhotasolution@gmail. com or WhatsApp him via +2348089535482.he also special on cureing 1. HIV/AIDS2. HERPES 3. CANCER 4.ALS 5. HEPATITIS B 6.DIABETES 7. HUMAN PAPILOMA VIRUS DISEASE(HPV)8. ALZHEIMER 9. LUPUS (Lupus Vulgaris or LupusErythematosus 

    ReplyDelete
  29. herbs that increase testosterone is the safe and natural way to support healthy testosterone levels for men

    ReplyDelete
  30. I want to share this wonderful testimony to the Good people all over the world on how I was able to Enlarge my Penis by Dr. Aziba. I was living a shameful life from my young age, just last month as I was browsing on the internet about Penis size  and Enlargement Products, I saw a testimony of a Man called Tim James testifying of how he was able to get his penis Enlarged by Dr. Aziba and I decided to also Email Dr. Aziba for my small penis size and he quickly respond to me and gave me the normal instructions which i did and then he shipped the product to me here in the united state which i received in just 3 working days and today i am very happy because i started seeing positive changes in my penis size in just 7 days of use.  Dr Aziba herbal product is the best recommended for you and to whom ever suffering from this shame or having any other diseases as well should Contact this great herbal doctor via his Email : Priestazibasolutioncenter@gmail.com and WhatsApp Him on +2348100368288

    ReplyDelete
  31. I want to share this wonderful testimony to the Good people all over the world on how I was able to Enlarge my Penis by Dr. Aziba. I was living a shameful life from my young age, just last month as I was browsing on the internet about Penis size  and Enlargement Products, I saw a testimony of a Man called Tim James testifying of how he was able to get his penis Enlarged by Dr. Aziba and I decided to also Email Dr. Aziba for my small penis size and he quickly respond to me and gave me the normal instructions which i did and then he shipped the product to me here in the united state which i received in just 3 working days and today i am very happy because i started seeing positive changes in my penis size in just 7 days of use.  Dr Aziba herbal product is the best recommended for you and to whom ever suffering from this shame or having any other diseases as well should Contact this great herbal doctor via his Email : Priestazibasolutioncenter@gmail.com and WhatsApp Him on +2348100368288

    ReplyDelete
  32. Herbal medicine is 100% guaranteed to cure Penis Enlargement and long lasting The main reason why lots of people are finding it difficult to Enlarge penis and last long during xxx is because they so believe in medical report and drugs made of chemicals which cause damages to the body system. so I'm recommending fellow m to contact Dr Aziba WhatsApp via +2348100368288 or Email : priestazibasolutioncenter@gmail.com for Natural Herbal Penis Enlargement Product






    Herbal medicine is 100% guaranteed to cure Penis Enlargement and long lasting The main reason why lots of people are finding it difficult to Enlarge penis and last long during xxx is because they so believe in medical report and drugs made of chemicals which cause damages to the body system. so I'm recommending fellow m to contact Dr Aziba WhatsApp via +2348100368288 or Email : priestazibasolutioncenter@gmail.com for Natural Herbal Penis Enlargement Product






    Herbal medicine is 100% guaranteed to cure Penis Enlargement and long lasting The main reason why lots of people are finding it difficult to Enlarge penis and last long during xxx is because they so believe in medical report and drugs made of chemicals which cause damages to the body system. so I'm recommending fellow m to contact Dr Aziba WhatsApp via +2348100368288 or Email : priestazibasolutioncenter@gmail.com for Natural Herbal Penis Enlargement Product

    ReplyDelete
  33. I'm very excited to inform everyone that I'm completely cured from my HSV 1&2 recently. I have used Oregano oil, Coconut oil, Acyclovir, Val acyclovir, Famciclovir , and some other products and it's really help during my outbreaks but I totally got cured from my HSV 2 with a strong and active herbal medicine ordered from a powerful herbalist and it completely fought the virus from my nervous system and I was tested negative after three weeks of usage. I'm here to let y'all know that HSV 1& 2 has a complete cure, I got rid of mine with the help of Dr Moses Buba and his herbal exploit, AFTER I engage with other wrong doctors. Contact him via email: buba.herbalmiraclemedicine@gmail.com or Call/WhatsApp him at +2349060529305
    thank you..

    ReplyDelete
  34. I'm very excited to inform everyone that I'm completely cured from my HSV 1&2 recently. I have used Oregano oil, Coconut oil, Acyclovir, Val acyclovir, Famciclovir , and some other products and it's really help during my outbreaks but I totally got cured from my HSV 2 with a strong and active herbal medicine ordered from a powerful herbalist and it completely fought the virus from my nervous system and I was tested negative after three weeks of usage. I'm here to let y'all know that HSV 1& 2 has a complete cure, I got rid of mine with the help of Dr Moses Buba and his herbal exploit, AFTER I engage with other wrong doctors. Contact him via email: buba.herbalmiraclemedicine@gmail.com or Call/WhatsApp him at +2349060529305
    thank you..

    ReplyDelete
  35. I was diagnosed as HEPATITIS B carrier in 2013 with fibrosis of the
    liver already present. I started on antiviral medications which
    reduced the viral load initially. After a couple of years the virus
    became resistant. I started on HEPATITIS B Herbal treatment from
    ULTIMATE LIFE CLINIC (www.ultimatelifeclinic.com) in March, 2020. Their
    treatment totally reversed the virus. I did another blood test after
    the 6 months long treatment and tested negative to the virus. Amazing
    treatment! This treatment is a breakthrough for all HBV carriers.

    ReplyDelete