PD45-08 COMPARISON OF CLOMIPHENE CITRATE AND TRANSDERMAL TESTOSTERONE REPLACEMENT THERAPY IN THEIR INFLUENCE ON HORMONAL AND METABOLIC CHANGES IN THE TREATMENT OF HYPOGONADISM

Abstract

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Medical and Non-Surgical Therapy II1 Apr 2015PD45-08 COMPARISON OF CLOMIPHENE CITRATE AND TRANSDERMAL TESTOSTERONE REPLACEMENT THERAPY IN THEIR INFLUENCE ON HORMONAL AND METABOLIC CHANGES IN THE TREATMENT OF HYPOGONADISM Daniel Lee, Adrien Bernstein, Alex Sarkisian, Matthew Wosnitzer, Ashley Winter, and Darius Paduch Daniel LeeDaniel Lee More articles by this author , Adrien BernsteinAdrien Bernstein More articles by this author , Alex SarkisianAlex Sarkisian More articles by this author , Matthew WosnitzerMatthew Wosnitzer More articles by this author , Ashley WinterAshley Winter More articles by this author , and Darius PaduchDarius Paduch More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2580AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent studies have highlighted the possible modulation of cardiovascular risk factors by testosterone replacement therapy (TRT). Increased estradiol levels are known to potentially improve BMI and cholesterol levels and may improve glycemic control. We sought to compare serum cholesterol levels, BMI, and fasting glucose levels in men receiving clomiphene citrate (CC) or TRT for hypogonadism. METHODS After institutional review board approval, a retrospective review was performed on 121 men who received 25-50 milligrams of CC daily and 137 who received transdermal TRT for the treatment of hypogonadism from 2008 to 2013. Potential increased cardiovascular risk was defined as the presence of any of the following: HDL<40, LDL>130, total cholesterol>240, triglycerides>200. RESULTS Overall, the median age was 39 years (IQR 33-48) and men underwent CC therapy for a median of 13 months (IQR 7.1-25.4) and TRT therapy for a median of 32.6 months (IQR 10.5-53.2). At baseline, there were no differences in the median BMI (p=0.57), and the BMI following treatment did not significantly change for either CC or TRT (p>0.05). Within 3 months of therapy, both TRT and CC have significantly higher levels of estradiol compared to baseline (20 to 30 for TRT, 22 to 42 for CC, both p<0.01), however the increase is much larger for those on CC than TRT (p<0.01). The median total testosterone increased to 508, 522, and 463 after 3, 6, and 12 months on TRT from a baseline of 272 (p<0.01), while the median total testosterone increased to 507, 647, and 481 from a baseline of 306 (p<0.01). Two-hundred one (77.9%) of the men had at least one cardiovascular risk factor at baseline; after one and two years of therapy, the rate remained above 70%. There were no significant changes noticed in total cholesterol, LDL, HDL, or triglyceride levels with either CC or TRT therapy (all p>0.05). There were also no significant differences noted in the level of fasting serum glucose, HgB A1c levels, or IGF-1 levels (all p>0.05). CONCLUSIONS Neither CC nor TRT therapy significantly altered BMI, cholesterol levels, or glycemic control in hypogonadal men. However, a high percentage of men in this population had significant cardiovascular risk factors because of increased cholesterol at baseline, which did not improve with CC treatment. Prospective trials will be needed to validate these findings and can be used to help counsel patients and guide management. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e904-e905 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Lee More articles by this author Adrien Bernstein More articles by this author Alex Sarkisian More articles by this author Matthew Wosnitzer More articles by this author Ashley Winter More articles by this author Darius Paduch More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...