Endocrine Abstracts (2013) 32 P186 | DOI: 10.1530/endoabs.32.P186

The effect of testosterone replacement on endothelial dysfunction, inflammation and insulin resistance in male hypogonadotrophic hypogonadism

Alper Sonmez1, Abdullah Taslipinar1, Aydogan Aydogdu1, Serkan Tapan2, Coskun Meric1, Yalcin Basaran1, Erdim Sertoglu2, Mahmut I Yilmaz3, Muhittin A Serdar2, Taner Ozgurtas2, Erol Bolu1 & Mustafa Kutlu1

1Department of Endocrinology and Metabolism, School of Medicine, Gulhane Military Medical Academy, Ankara, Turkey; 2Department of Clinical Biochemistry, School of Medicine, Gulhane Military Medical Academy, Ankara, Turkey; 3Department of Nephrology, School of Medicine, Gulhane Military Medical Academy, Ankara, Turkey.

Objective: Metabolic disorders are common in patients with hypogonadism. Testosterone replacement therapy (TRT) significantly improves symptoms of testosterone deprivation such as mood, libido or musculoscelatal power. However, whether the metabolic and cardiovascular risk is improved is not clearly known. We aimed to search for the metabolic and cardiovascular effects of TRT.

Design: Prospective study, performed in the outpatient units of Gulhane Medical School.

Methods: Treatment naive young patients with congenital hypogonadotrophic hypogonadism (CHH; n=80, mean age 21.56±2.1 years) were treated with either testosterone esters (250 mg/3 weeks i.m.; n=59) or testosterone transdermal gel (50 mg daily; n=21) in a mean follow-up period of 6.0±2.4 months. The demographic parameters, fasting glucose, insulin, pentraxin 3 (PTX3) and asymmetric dymethyl arginine (ADMA) levels were measured both before and after treatment periods. The insulin sensitivity was estimated by HOMA-IR formula.

Results: The BMIs and waist circumferences were increased (P<0.001 and P=0.001 respectively) and the total and HDL cholesterol levels were decreased (P=0.002 and P<0.001 respectively) after the follow-up period. Both plasma ADMA and PTX-3 levels were increased (P<0.001 and P=0.02 respectively) while there were no significant alterations in the HOMAIR values. The alterations were similar in two different TRT regimens.

Conclusions: The study shows that, both daily transdermal and periodic injectable modalities worsen the surrogate markers of endothelial dysfunction and inflammation in young and treatment naïve subjects with CHH. Randomized prospective cohorts are warranted to see whether these short term unfavorable results will affect cardiometabolic outcomes of these patients.