Outcomes of Long-Term Testosterone Replacement in Older Hypogonadal Males: A Retrospective Analysis
Ramzi R. Hajjar,
Fran E. Kaiser and
John E. Morley
Department of Internal Medicine, Division of Geriatric Medicine,
St. Louis University Health Sciences Center, St. Louis, Missouri
63104
Address all correspondence and requests for reprints to: Dr. John E. Morley, Department of Internal Medicine, Division of Geriatric Medicine, St. Louis University Health Sciences Center, 1402 S. Grand Boulevard, Room M238, St. Louis, Missouri 63104.
To determine the complications, toxicities, and compliance oflong term
testosterone replacement in hypogonadal males, weretrospectively
assessed 45 elderly hypogonadal men receivingtestosterone replacement
therapy and 27 hypogonadal men takingtestosterone. Hypogonadism was
defined as a bioavailable testosteroneserum concentration of 72 ng/dL
or less. Both groups receivedbaseline physical examinations and blood
tests. The testosterone-treatedgroup received 200 mg testosterone
enanthate or cypionate imevery 2 weeks, and follow-up examinations and
blood samplingswere performed every 3 months. The control group had a
singlefollow-up blood test and physical examination.
There was no significant difference in the initial blood testsin the
two groups. At 2 yr follow-up, only the hematocrit showeda
statistically significant increase in the testosterone-treatedgroup
compared to the control group (P < 0.001). A
decreasein the urea nitrogen to creatinine ratio and an increase in
theprostate-specific antigen concentration was not statistically
significant.Eleven (24%) of the testosterone-treated subjects
developedpolycythemia sufficient to require phlebotomy or the
temporarywithholding of testosterone, one third of which occurred less
than1 yr after starting testosterone treatment. There was no
significantdifference in the incidence of new illness in the two
groupsduring the 2-yr follow-up. Alhough self-assessment of libidowas
dramatically improved in the testosterone-treated group
(P< 0.0001), approximately one third of the
subjects discontinuedtherapy.
In conclusion, testosterone replacement therapy appears to bewell
tolerated by over 84% of the subjects. Long term testosterone
replacementto date appears to be a safe and effective means of
treatinghypogonadal elderly males, provided that frequent follow-up
bloodtests and examinations are performed.
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