pretreatment levels in all men regardless of therapy
with CC, testosterone injections and testosterone
gels (247 to 504, 224 to 1,104 and 230 to 412 ng/dl,
respectively, p
<
0.05). The largest increase was seen
in men on testosterone injections (956 ng/dl) with a
more modest increase in men on CC (272 ng/dl) and
those on testosterone gels (243 ng/dl). Final mean
serum total testosterone in men on CC (525 ng/dl)
was lower than in men who received testosterone
injections (1,014 ng/dl, p
<
0.01) but similar to that
in men who used testosterone gels (412 ng/dl,
p
¼
0.31). As expected, testosterone in men who did
not receive TST (310 ng/dl) was signi±cantly lower
than in men on TST (p
<
0.05).
Serum estradiol levels were greater in men
treated with testosterone injections than in men
on CC and testosterone gels, and those without
TST (6.0 vs 2.0, 2.0 and 2.0 ng/dl, respectively, each
p
<
0.01). The ratio of testosterone to estradiol
was similarly greater in men on testosterone in-
jections (200 ng/dl) and men on CC (181 ng/dl) than
in those not on TST (145 ng/dl, p
<
0.01 and 0.03,
respectively).
Despite different serum testosterone levels men
who received all 3 therapies as well as men without
TST reported similar levels of hypogonadal symp-
toms. Quantitative ADAM scores were similar
in men on CC, testosterone injections, testosterone
gels and no TST (35, 39, 36 and 34, respectively,
p
>
0.05, see ±gure). Based on qADAM results men
on testosterone injections reported greater libido
than men on CC, testosterone gels and no TST (4 vs
3, 3 and 3, p
¼
0.047, 0.04 and
<
0.01, respectively).
On qADAM the remaining symptoms of hypo-
gonadism were similar in men on CC and TST.
DISCUSSION
This study revealed no difference in hypogonadal
symptoms among men on CC, testosterone inject-
ables and testosterone gels despite highly increased
serum testosterone in men using injectable testos-
terone.
This
suggests
that
supraphysiological
testosterone levels do not directly correlate with
decreases in hypogonadal symptomology. Symptom
resolution may be a better guide than serum
Serum total testosterone (
T
) and qADAM scores in men on different TSTs
Age matched pair comparisons of men who did and did not receive TST
Median
±
IQR TST
Median
±
IQR CC
Median
±
IQR No TST
p Value (Mann-Whitney U test)
Injection
Gel
Injection vs Gel/CC/TST
Gel vs CC/TST
CC vs TST
Age
40.5
±
9.2
43.9
±
13.7
40.9
±
9.4
40.5
±
10.4
0.23/0.83/0.90
0.17/0.27
0.69
Testosterone (ng/dl):
Pretreatment
223.5
±
182.5
230.0
±
151.0
247.0
±
66.5
e
0.65/0.71/
d
0.78/
ee
Posttreatment
1,104.0
±
866.5
412.0
±
339.0
503.5
±
306.8
310.0
±
136.0
<
0.01/
<
0.01/
<
0.01
0.31/0.064
<
0.01
D
956
±
879
243.0
±
375.5
271.5
±
325.8
e
<
0.01/
<
0.01/
e
0.60/
ee
Estradiol (ng/dl)
6.0
±
5.8
2.0
±
1.0
2.0
±
1.0
2.0
±
0.0
<
0.01/
<
0.01/
<
0.01
0.52/0.18
0.58
Testosterone/estradiol
200.0
±
116.4
175.0
±
114.5
181.0
±
119.5
144.5
±
91.2
0.15/0.36/
<
0.01
0.50/0.19
0.03
qADAM (range 10
e
50)
39
±
83
6
±
93
5
±
83
4
±
9
0.53/0.45/0.16
1.00/0.30
0.27
Libido (range 1
e
5)
4.0
±
1.0
3.0
±
2.0
3.0
±
2.0
3.0
±
1.5
0.04/0.04/
<
0.01
0.68/0.36
0.14
TESTOSTERONE SUPPLEMENTATION VERSUS CLOMIPHENE CITRATE FOR HYPOGONADISM
877