You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Medical and Non-Surgical Therapy1 Apr 20121494 PHARMACOKINETIC EVALUATION AND DOSING OF SUBCUTANEOUS TESTOSTERONE PELLETS Alexander W. Pastuszak, Harsha Mittakanti, Lissette Gomez, Joceline S. Liu, Larry I. Lipshultz, and Mohit Khera Alexander W. PastuszakAlexander W. Pastuszak Houston, TX More articles by this author , Harsha MittakantiHarsha Mittakanti Houston, TX More articles by this author , Lissette GomezLissette Gomez Houston, TX More articles by this author , Joceline S. LiuJoceline S. Liu Chicago, IL More articles by this author , Larry I. LipshultzLarry I. Lipshultz Houston, TX More articles by this author , and Mohit KheraMohit Khera Houston, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2016AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Subcutaneous testosterone (T) pellets are a viable treatment modality for hypogonadism. Optimal dosing, frequency of reimplantation, long-term safety, and post-implantation physiologic decay of hormone levels resulting from T pellets remain incompletely elucidated parameters. METHODS A retrospective review of 273 patients treated for hypogonadism using subcutaneous T pellets between 2008-2011 was performed. Sixty-five of these patients had a history of prostate cancer (CaP). Serum total T (TT), free T (FT), and estradiol (E) levels were analyzed as a function of time, number of pellets implanted (6-9 or 10-12), body mass index (BMI) (<25 or ≥25), number of implantations (up to 4 rounds, 501 insertions) and pre-implantation T levels (<300 or ≥300ng/dL). Linear regression analysis of the Log of hormone levels was used to determine curve fit equations, which were subsequently used to extrapolate decay curves for serum hormone levels. Hemoglobin (Hgb), hematocrit (Hct), and PSA levels were also assessed and analyzed as a function of time after implantation. RESULTS Mean±SD subject age was 56±12.6 years. Baseline TT was 328±202 ng/dL, FT 9.49±27.8 pg/mL and E 25.1±17.3 pg/mL. Extrapolated TT and FT peaks were significantly lower in men receiving 6-9 pellets than 10-12, though decay rates differed insignificantly. E levels rose significantly in men receiving 10-12, but not 6-9 pellets. Men with BMI≥25 attained lower TT peaks with slower decay than those with BMI<25 receiving 10-12 pellets, though 300ng/dL TT levels were reached at ∼100 days in both groups. No differences were seen in rates of decay for men receiving multiple implants, and no differences in T peaks or rates of decay were seen in men with pre T <300 or ≥300ng/dL. Increases in both Hgb (mean increase 0.42±0.94 g/dL, p<0.0001) and Hct (1.97±2.97%, p<0.0001) were observed, and one patient developed erythrocytosis requiring phlebotomy. No significant increases in PSA in men with or without CaP were observed, and no PSA recurrences were observed in men with CaP. CONCLUSIONS Men with lower BMI should receive fewer pellets and re-implantation should occur 100-120 days after prior implantation. More pellets result in increased aromatization of T to E. Serum testosterone levels prior to implantation and at re-implantation do not affect pellet decay kinetics. Importantly, T pellets appear safe, with small effects on Hgb and Hct, and without evidence of significant effects on PSA or progression or recurrence of CaP when used in men with a history of the disease. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e605 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexander W. Pastuszak Houston, TX More articles by this author Harsha Mittakanti Houston, TX More articles by this author Lissette Gomez Houston, TX More articles by this author Joceline S. Liu Chicago, IL More articles by this author Larry I. Lipshultz Houston, TX More articles by this author Mohit Khera Houston, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...