The assessment of long-term use of testosterone replacement therapy in men with hypoganadism
Margaret Band, Sofia Llahana & Gerard Conway
Objectives: To assess the physiological benefits and side effects of testosterone replacement therapy (TRT) in routine use.
Methods: A search of a historic database of 427 men using TRT identified 135 men lost to follow-up, 19 men who had insufficient data and 273 current attendees who formed the study group. A retrospective review of clinical records focused on bone mineral density (BMD) as the beneficial outcome and raised haematocrit (HCT) and prostate specific antigen (PSA) as side effects. Analysis was carried out between the men using Sustanon and transdermal TRT which were the largest TRT subgroups.
Results: The types of TRT used were Sustanon (n=106), transdermal, including gel (107) and patch (7), Nebido (19), oral (14), buccal (6), implant (4). HCT was raised in 3.4% and PSA was raised in 5.3%. BMD results were available for 44 men using Sustanon and 63 men using transdermal TRT. Mean serum testosterone levels were significantly higher in the Sustanon group (21.76 nmol/l versus 15.65 nmol/l).
|Sustanon n=44||Transdermal n=63||P|
|Spine T score mean||−0.571||−1.258||0.015|
|Hip T score mean||−0.076||−0.612||0.010|
BMD assessed by spine and hip T scores was better in those men using Sustanon; this was independent of BMI. Men using transdermal TRT tended to be older and have used testosterone for longer although these parameters did not reach statistical significance. There was no significant difference between the Sustanon and transdermal groups with regard to HCT and PSA.
Conclusions: The prevalence of raised HCT and PSA was reassuringly low in this series. Sustanon appears to have a more beneficial effect on bone density than transdermal testosterone without increasing PSA and HCT this may be due to the mean testosterone levels being higher and the men being younger and being on testosterone for less time.