Abstract
ABSTRACTPurpose The 2018 American Urological Association guidelines on the Evaluation and Management of Testosterone Deficiency recommended that 300 ng/dL be used as the threshold for prescribing testosterone replacement therapy (TRT). However, it is not uncommon for men to present with signs and symptoms of testosterone deficiency, despite having testosterone levels greater than 300 ng/dL. There exists scant literature regarding the use of hCG monotherapy for the treatment of hypogonadism in men not interested in fertility. We sought to evaluate serum testosterone response and duration of therapy of hCG monotherapy for men with symptoms of hypogonadism, but total testosterone levels > 300 ng/dL.Materials and Methods We performed a multi-institutional retrospective case series of men receiving hCG monotherapy for symptomatic hypogonadism. We evaluated patient age, treatment indication, hCG dosage, past medical history, physical exam findings and serum testosterone and gonadotropins before and after therapy. Descriptive analysis was performed and Mann Whitney U Test was utilized for statistical analysis.Results Of the 20 men included in the study, treatment indications included low libido (45%), lack of energy (50%), and erectile dysfunction (45%). Mean testosterone improved by 49.9% from a baseline of 362 ng/dL (SD 158) to 519.8 ng/dL (SD 265.6), (p=0.006). Median duration of therapy was 8 months (SD 5 months). Fifty percent of patients reported symptom improvement.Conclusions Treatment of hypogonadal symptoms with hCG for men who have a baseline testosterone level > 300 ng/dL appears to be safe and efficacious with no adverse events.
Highlights
Hypogonadism is prevalent, currently affecting 38% of men over the age of 45, and 7% of men under the age of 40 [1, 2]
They were prescribed an average of 2000 IU Human chorionic gonadotropin (hCG) weekly, which is based on the bi/tri-weekly regimen of 1500 IU hCG generally prescribed to men with hypogonadotropic hypogonadism (HH) and infertility, educated on administering it subcutaneously and followed up consistently with proper documentation of follow-up testosterone (T) levels [1]
We retrospectively evaluated 20 men who were treated for symptoms of hypogonadism with human chorionic gonadotropin monotherapy
Summary
Hypogonadism is prevalent, currently affecting 38% of men over the age of 45, and 7% of men under the age of 40 [1, 2]. Adult-Onset Hypogonadism is defined as having low testosterone in conjunction with clinical signs or symptoms such as low energy, low libido, decreased lean body mass, erectile dysfunction, fatigue, depression, anemia and infertility [3,4,5,6]. It is primarily a clinical syndrome of the aging male [3], prevalence in younger generations has increased exponentially over the past decades, a trend that correlates with an increase in the prevalence of anabolic androgenic steroid use [1]. This recommendation was determined based on a compromise between the inclusion criteria testosterone (less than 350 ng/ dL) and the median testosterone levels (250 ng/dL) of most large testosterone therapy trials over the past decade, in part to minimize overtreatment of patients [8]
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