PD50-08 IMPROVEMENT OF ARTERIAL ENDOTHELIAL FUNCTION FOLLOWING INITIATION OF TESTOSTERONE REPLACEMENT THERAPY

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You have accessJournal of UrologySexual Function/Dysfunction: Medical, Hormonal & Non-surgical Therapy II1 Apr 2016PD50-08 IMPROVEMENT OF ARTERIAL ENDOTHELIAL FUNCTION FOLLOWING INITIATION OF TESTOSTERONE REPLACEMENT THERAPY Daniel Shoskes, Kathryn Dunlap, and Barbara Tucky Daniel ShoskesDaniel Shoskes More articles by this author , Kathryn DunlapKathryn Dunlap More articles by this author , and Barbara TuckyBarbara Tucky More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2798AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Isolated recent studies have suggested an increased risk of heart attack as early as 3 months following testosterone replacement therapy (TRT) initiation. Such a rapid risk increase would likely require rapid deterioration of arterial endothelial function since atherosclerosis would be unlikely to develop so quickly de novo. Our goal was to assess arterial endothelial function in hypogonadal men prior to and at least 3 months after initiation of TRT METHODS Adult men were consented for the study if they had symptoms of hypogonadism, a total testosterone < 350 ng/dl, and planned to begin TRT. Endothelial function was non-invasively assessed using the Endo-PAT2000 machine, an FDA approved test of cardiac risk. We measured the Augmentation Index (AI) (normal < 3%), a measure of arterial stiffness and Reactive Hyperemia Index (RHI), a measure of endothelial vasodilation (normal > 1.69). Prior studies suggest that a 10% level of day to day test variability is expected. Topical gels or Testopel were used for TRT and target testosterone confirmed post therapy. Endothelial function was reassessed at the next clinic visit, between 3 and 6 months after treatment started if the patients were compliant with therapy. Changes in continuous variables were assessed with the paired t test and significance set at p<0.05 RESULTS 23 patients were consented with a mean age of 52.7 (range 34-68) and starting testosterone 196.9 ng/dl (range 35-339). There was a history of diabetes in 4, hypertension in 10 and coronary artery disease in 5 men. Mean RHI was 1.67+/-0.37 (70% were abnormal) and mean AI was 2.57%+/-14.0 (39% were abnormal). No patient subsequently developed a clinical cardiac event. At follow up 20 patients were compliant with therapy and retested. Mean total testosterone increased from 203 to 511 (p<0.0001). Mean RHI improved from 1.70 to 2.14 (p=0.01). Mean AI improved from 2.9% to -1.75% (p=0.01). In 4 men RHI was unchanged and any lower values were within the 10% error of the test (1.3-6.3%). No man had worsening of AI. CONCLUSIONS Men with symptomatic hypogonadism often have abnormal arterial endothelial function. Following TRT, this endothelial function either remains unchanged or improves. This improvement would be expected to reduce the risk of subsequent cardiac events. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1188 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Daniel Shoskes More articles by this author Kathryn Dunlap More articles by this author Barbara Tucky More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...