Endocrine Abstracts

Introduction
Testosterone replacement for hypogonadism comes in a variety of galenical forms. Side effects include prostatic enlargement and polycythaemia. Furthermore careful scrutiny for prostatic carcinoma is essential. We audited 205 male patients from one clinical centre to assess dose, frequency and complications profile and the effectiveness of biochemical and haematological monitoring. Data of this type in a group of this size has not been previously published.
Method
Endocrine patients on testosterone replacement for hypogonadism were included. Details of the aetiology of hypogonadism were available in 204 cases and information regarding replacement medication in 203 cases.
Results
Within the period August 2000-2002, data were accumulated for haematological monitoring in 148 patients and for prostatic specific antigen (PSA) in 130 patients.
Elevated haemoglobin (greater than 17.5 grams per decilitre) was seen in 12 patients - age range 32-70 years. Additional risk factors for polycythaemia were identified in 75% of this group, including obesity, diuretic treatment, lung and cardiovascular disease. Treatment forms included 75% on intramuscular depot injection, 17% on subcutaneous implants and 8% on patches.
Prostatic carcinoma was confirmed by histological examination in 3.1% (4 patients aged 41-70 years). 2 tumours were intracapsular and none involved lymph node metastasis. PSA was elevated due to benign prostatic hypertrophy in 3.1% (aged 51-54 years) and 1 patient with elevated PSA awaited definitive diagnosis (57 years). Treatment in this PSA monitored group was by intramuscular depot in 67%, patches in 22% and implants in 11%.
Conclusions
This is the first systematic assessment of monitoring of testosterone replacement therapy. It underlines the importance of annual blood sampling for prostatic complications, particularly early diagnosis of carcinoma, and polycythaemia in all patients over the age of 40 years.
Depot injections of testosterone was associated with a higher incidence of complications than any other form of androgen replacement therapy.