Letters to the Editor NOT referring to a recent journal article

Effect of Testosterone Supplementation on Symptoms in

Men with Hypogonadism

Idiopathic age-related hypogonadism affects nearly 40% of

men aged

45 yr

[1]

. Typically, hypogonadal symptoms

include diminished libido, fatigue, poor concentration,

erectile dysfunction, and depressed mood in the presence

of low serum testosterone levels. Numerous studies demon-

strate testosterone supplementation therapy (TST) to be

effective in increasing serum testosterone levels, with a

correlated clinical improvement in quality of life, weight, and

waist circumference

[2,3]

. Nevertheless, only one random-

ized study exists to date that evaluates the effect of TST on

hypogonadal symptoms

[4]

. Unfortunately, the randomized

trial analyzed the effect of oral testosterone (seldom used

today) in only elderly men (aged

60 yr).

We sought to compare satisfaction and treatment

efficacy in men aged 35–75 yr with symptomatic hypogo-

nadism (total testosterone

300 ng/dl and improvement of

three or more symptoms on the Androgen Decline in Aging

Male [ADAM] questionnaire) before and after receiving

testosterone injections and gels (

Table 1

). Serum levels of

testosterone and sex hormone-binding globulin and ADAM

and quantitative ADAM (qADAM) questionnaires

[5]

were

collected both before treatment (at least two morning blood

draws) and during follow-up. Comparisons were made

between baseline and posttreatment variables, and multi-

variable analysis was conducted to define predictors of

successful response to TST (age, comorbidities, TST modali-

ty, and hormone levels). The main outcome measures were

changes in testosterone levels, hypogonadal symptoms, and

predictors of response with TST in hypogonadal patients.

We prospectively followed a total of 42 men on

testosterone injections and testosterone gels (

=21 in

each group) from 2013 to 2014. These men were then age-

matched with 42 eugonadal men (testosterone

300 ng/dl

and reported fewer than three symptoms on the ADAM

questionnaire) with similar comorbidity profiles (assessed

with the Charlson comorbidity index) who were not on TST

(controls) and followed during the same time period.

Median serum total and free testosterone increased from

pretreatment levels in all men, regardless of therapy type

(testosterone injections: 294 to 693 ng/dl, 6.0 to 19.5 pg/ml;

testosterone gels: 263 to 412 ng/dl, 6.0 to 9.2 pg/ml;

0.05). Compared with controls, men taking TST reported

fewer symptoms on the ADAM questionnaire after treat-

ment (5.0 vs 3.1;

0.05) and higher qADAM scores (26.1

vs 30.5;

0.05). When the types of hypogonadal

symptoms were evaluated, both sexual symptoms (libido

EUROPEAN UROLOGY 67 (2015) 176–180

available at www.sciencedirect.com

journal homepage: www.europeanurology.com

Table 1 – Baseline characteristics of hypogonadal men on testosterone supplementation therapy compared with age-matched eugonadal

controls

TST

Control

value

–

Age, yr

51.2 (44–60)

53.7 (45–62)

0.33

Follow-up, mo

6.0 (3–10)

10.4 (7–11)

0.02

Pretreatment total T, ng/dl

281 (235–324)

352 (233–411)

0.07

Posttreatment total T, ng/dl

541 (317–766)

364 (328–378)

0.01

Pretreatment estradiol, ng/dl

2 (2–2)

0.32

Posttreatment estradiol, ng/dl

3 (2–6)

3 (2–3)

0.08

Pretreatment calculated free T, ng/dl

5.1 (5–7)

6.5 (5.5–7)

0.43

Posttreatment calculated free T, ng/dl

15.7 (6–21)

5.9 (5–6)

0.005

Pretreatment ADAM, score 0–10

5 (3.25–7.0)

1 (0.5–3)

0.001

Posttreatment ADAM, score 0–10

3 (1–5)

2 (0.5–2)

0.007

Pretreatment qADAM, score 10–50

26.1 (23–28)

34 (33.5–35.5)

0.001

Posttreatment qADAM, score 10–50

30.5 (27–35)

34 (33–37.5)

0.001

Data presented are medians (interquartile range).

values were calculated using the Mann-Whitney test.

ADAM = Androgen Decline in Aging Male questionnaire; qADAM = quantitative Androgen Decline in Aging Male questionnaire; T = testosterone;

TST = testosterone supplementation therapy.

0302-2838/