(330) Testosterone Replacement Therapy in Hypogonadism: A Single Center Longitudinal Analysis of Treatment Patterns and Clinical Outcomes

Abstract

Abstract Introduction Male hypogonadism impacts the production of hormone production, which plays a key role in masculine growth. It has also been shown to impair certain male reproductive functions or delay development. Objective The goal of this study is to describe the characteristics and treatment outcomes for patients with a diagnosis of Hypogonadism (HG) presenting to an academic urology center. Methods An IRB was approved to conduct a longitudinal study on the outcomes of male hypogonadism at a high-volume tertiary referral center. Men diagnosed with hypogonadism were identified by ICD 10 code (E 29.1). Clinical, demographic, laboratory, and testosterone replacement therapy and outcomes were extracted from the EMR. Results This retrospective study included 537 patients with a median age of presentation of 52 years (IQR: 42-68). At the initial visit, 66% presented with low libido, 65% with erectile dysfunction (ED), and 6% with depression. On initial hormonal evaluation, median (IQR) measurements for testosterone, free testosterone, and estradiol were 294 (217.5-417), 6.1 (4.45-8.0), and 4 (2-17) respectively. 227 (56.5%) patients elected to begin Testosterone Replacement Therapy (TRT). Of these, five treatment types of TRT were observed: 114 (53%) patients elected for intramuscular TRT, 25 (12%) utilized a pellet implant, 74 (34%) utilized topical treatment TRT, 3 (1.4%) used pellet and topical, and 1 (0.5%) used topical and intramuscular. Following TRT, 143 (79%) patients endorsed an improvement in ED, 175 (84%) reported improved libido, 176 (84%) reported increased energy levels, and 88 (59%) showed improvement in muscle mass. Follow-up labs measuring testosterone, free testosterone, and estradiol demonstrated medians of 486 (IQR: 296.5-802.8), 15.3 (IQR: 6.9-88.7), and 16.45 (IQR: 3-28.85) respectively. Adverse events while on TRT were 32 (15%) polycythemia, 3 (1.4%) VTE’s, and 3 (1.4%) MI. Conclusions Sexual dysfunction is a prominent symptom encountered by men with hypogonadism. However, only 56.5% of hypogonadal men pursue TRT, with intramuscular injections being the most commonly prescribed formulation. In our longitudinal cohort, we report that polycythemia and cardiovascular events are uncommon sequela after TRT. Further randomized control trials are warranted to better understand cardiovascular events' association with TRT. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast Investor: Sprout.