FRI403 The Unintended Consequences Of Applying Topical Testosterone Directly To The Scrotum

Abstract

Abstract Disclosure: J.G. Melendez-Rivera: None. S.J. Steven: None. Background: Topical testosterone is commonly used to treat hypogonadism in men. A concern associated with its use is the unintentional transfer to partners and children by direct contact with the application site. While prior studies and case reports have demonstrated the effects of direct skin contact with traditional application sites including the axillary regions and the abdomen, scarce data is available regarding the effects of transfer from application to the scrotum. Clinical Case: A 44-year-old woman presented with gradually worsening hirsutism and deepening voice over the past two years along with sudden cessation of menses. Initial laboratory studies revealed elevated testosterone of 1,776 ng/dL [10-55 ng/dL], elevated free testosterone of 14.4 pg/mL [0-4.2 pg/mL], normal androstenedione of 80 ng/dL [41-262 ng/dL) and normal DHEA-S of 57.7 ug/dL [57.3-279.2 ug/dL]. Transvaginal ultrasound revealed no ovarian masses or hyperplasia and CT abdomen and pelvis with and without contrast revealed no adrenal masses or hyperplasia. Ovarian and adrenal vein sampling were unremarkable. Anabolic steroid panel demonstrated a significantly elevated testosterone-to-epitestosterone ratio of 83.5 [<4] confirming an exogenous source of testosterone. Although the woman initially reported that her husband was applying topical testosterone, she reported that he was “obsessive” about being sure to wash the area of application prior to intimacy. Further questioning revealed that her husband was actually applying high concentration topical testosterone directly to his scrotum with sexual intercourse occurring up to five times daily. Conclusion: This case illustrates the dangers of applying topical testosterone directly to the scrotum. Prior studies have demonstrated that it may result in higher levels of serum testosterone in a shorter period of time which makes it seem like an attractive option for men desiring rapid resolution of their hypogonadal symptoms. Despite these perceived benefits, it can be detrimental to the health of their female partners who may experience extraordinarily elevated testosterone levels as a result of direct intravaginal absorption of topical testosterone. Presentation: Friday, June 16, 2023