Testosterone Recovery after Polytrauma and Scrotal Injury in Patients from Operation Enduring Freedom and Operation Iraqi Freedom

Abstract

We examined the long-term natural history of testosterone recovery in patients with complex battle injuries. We retrospectively reviewed the charts of patients who participated in Operation Enduring Freedom and Operation Iraqi Freedom, and underwent urological surgical consultation at Walter Reed Army Medical Center, Washington, D.C. or the National Naval Medical Center, Bethesda, Maryland, from 2001 to August 2011. Of the 192 patient charts reviewed 138 (72%) had testosterone values available. The study inclusion criterion of at least 2 testosterone measurements, including 1 made within 40 days of injury, was met by 84 patients (61%) with testosterone data available. Those treated with bilateral orchiectomy were not required to meet this criterion. Initial patient testosterone after injury in the testosterone recovery group was inversely proportional to the degree of scrotal injury. In patients in whom testosterone recovered to at least 250 ng/dl the recovery occurred a mean of 4.5 months after injury. Patients who required testosterone replacement had lower initial testosterone (p = 0.0063) and lower testosterone velocity (p <0.0001). Monitoring the velocity of testosterone recovery is a viable approach in male patients who receive significant genitourinary trauma. In patients in whom testosterone recovered the recovery occurred within a mean of 5 months after injury. It is reasonable to observe patients with scrotal injuries since testosterone may recover in many of them without intervention.