Endocrine Abstracts

Hypogonadism is more prevalent in populations with type 2 diabetes (T2D) and/or cardiovascular disease (CVD) and is associated with increase in all-cause and CVD mortality. Testosterone replacement therapy (TRT) improves visceral adiposity, insulin resistance, glycemia, lipids inflammatory cytokines and cardiac ischaemia. The long-term safety of TRT in men with CVD and/or T2D is not known and the British National formulary advises use with caution these groups.

This is a retrospective analysis of 182 patients of hypogonadal patients with diabetes and/or CVD on TRT. Mean age 58.3±0.83 years, weight 103±2.24 kg, total testosterone 7.34±0.29 nmol/l.

Prior to TRT 53% had T2D, 51.9% CVD (40% had CABG), 36.6% hypertension. 18.58% had a previous CV event defined as either myocardial infarction, cerebrovascular accident or TIA, amputation due to peripheral vascular disease (PVD). Of 73.2% had erectile dysfunction. Mean follow-up 32 months – total 574.5 patient years of TRT.

There were six deaths (3.3%) one attributable to CVD. Sixteen CV events occurred in 13 patients (7.1%). After 8–13 months of TRT total cholesterol (TC) decreased (4.67±0.14–4.15±0.11 mmol/l, P=0.002, n=65), No significant change in HDLcholesterol (1.04±0.03–1.02±0.04 mmol/l, P=0.45, n=52), HbA1c (7.28±0.13–7.3±0.17%, P=0.9, n=53), weight (99.7±2.51–99.2±2.37 kg, P=0.49, n=74). Diastolic BP (79.6±1.0–78.7+1.2 mmHg) or systolic BP (139.5±1.99–138.9±1.81, P=0.48, n=62). In 92.1% T2D medication was unchanged.

The CV deaths and events were lower than expected in this morbid population. No adverse effects on routinely assessed CV risk factors were found with a beneficial effect on TC. Only a small number of T2D cases needed a change in medication. This safety audit in association with current knowledge of the adverse effect of low testosterone on survival and benefits of TRT on CV risk factors support the need for larger clinical trials.