Endocrine Abstracts

The possibility of optimal testosterone replacement is hotly debated. Conventional testosterone ester injections give widely fluctuating testosterone levels and may be painful. Testosterone patches currently available in the UK frequently cause intolerable skin irritation and are conspicuously large. The only safe oral preparation testosterone undecanoate rarely provides sustained sufficient circulating testosterone concentrations. Testosterone pellets have been used since shortly after the preparation of the pure hormone and despite advocacy by Handelsman and others on account of this favourable pharmacodynamic profile lasting for several months, are less widely used than would seem warranted.
We routinely offer this treatment to men with established hypogonadism as well as a small number of women requiring it for a variety of conditions including low libido. The main attraction is the infrequency of administration, usually every 4 to 6 months. The main stated objection is the occurrence of injection and pellet extrusion.
We present results of an audit of our last 2 years experience in which 70 men and 3 women received a total of 352 implants (usually 600 milligrammes for men and 100 milligrammes for women) performed mainly by 3 trained Endocrine Nurse Specialists and occasionally by 2 experienced doctors. In total there were 18 episodes of infections and 19 episodes of pellet extrusion (extruded pellets without reported infection equals 13, extruded pellets with infection requiring antibiotics equals 6, infections without extrusion of pellets equals 12). There was thus a 5 per cent chance of infection requiring antibiotics and 5.3 per cent chance of extrusion of pellets for each implant performed. We believe this represents an acceptably low incidence, testified to by the large number of patients choosing and remaining on this treatment.