Racial differences in hypogonadal improvement and prostate-specific antigen levels in hypogonadal men treated with testosterone replacement therapy

Robert M Coward,Jay Simhan,Culley C Carson Iii

doi:10.1590/s1677-55382010000600008

Abstract

To observe hypogonadal men undergoing testosterone replacement therapy (TRT) and assess racial differences in hypogonadal improvement and prostate-specific antigen (PSA) levels. In a retrospective analysis, 75 hypogonadal men were followed for an average 34 months after initiating TRT. Total testosterone and PSA levels were assessed every 6 months, and patients diagnosed with prostatitis or prostate cancer during treatment were excluded. For 16 African American men, the average age at diagnosis of hypogonadism was 53.5 years, compared with 57.8 years in 59 Caucasian men (p=NS). Pre- and post-treatment testosterone was 219 ng/dL and 310 ng/dL in African American men, and 247 ng/dL and 497 ng/dL in Caucasian men (p=NS). Symptomatic response was 81% in African American men and 93% in Caucasian men (p=NS). Baseline PSA level was 1.32 ng/mL in African American men and 1.27 ng/mL in Caucasian men, and there was no significant difference in PSA between racial groups at 6-month intervals, although there was a small decreasing trend in the PSA of African Americans compared with Caucasians. Hypogonadal African American men have a similar normalization of testosterone and symptomatic response as hypogonadal Caucasian men, and PSA levels remain stable over time in both groups. In this hypogonadal cohort, in contrast to studies of eugonadal men, higher PSA levels in African Americans were not observed.

Highlights

Testosterone deficiency syndrome (TDS) is a condition characterized by serum androgen deficiency that adversely affects the function of multiple organ systems and negatively impacts quality of life
When the pre-treatment total testosterone level of 247 ng/dL for the Caucasian cohort was compared with the pre-treatment level of 219 ng/dL in African Americans, there was no significant difference (p = NS)
Total testosterone levels remained eugonadal at 3 years after initiating testosterone replacement therapy (TRT), with 355.3 ng/dL in Caucasian men and 326.3 ng/dL in African American men

Summary

Introduction

Testosterone deficiency syndrome (TDS) is a condition characterized by serum androgen deficiency that adversely affects the function of multiple organ systems and negatively impacts quality of life. The majority of cases of TDS occur in aging men, for which the syndrome is commonly referred to as late-onset hypogonadism or andropause, TDS can occur in younger men. An extrapolation from the Massachusetts Male Aging Study found a prevalence of TDS of almost half a million new cases per year in men in their fifth, sixth and seventh decades of life, and as a result of the expanding population of the elderly, the incidence of TDS is on the rise [3]. Racial differences of the prevalence and incidence of TDS are unknown because epidemiologic series on the subject have been primarily comprised of Caucasian men

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