Endocrine Abstracts

Aims: Treatment regimes for low testosterone are well established but reasons for treatment change and patient preferences are less well known. We looked at the type of testosterone replacement, subsequent modification of replacement and reason for that change.

Methods: Data were collected from the electronic case notes of 50 patients on testosterone replacement for at least 6 months attending endocrine clinics in a University Teaching Hospital.

Results: Median age was 52 years (range: 19–88). Forty-two percent (n=21) had primary gonadal failure, 42% secondary gonadal failure, 16% late onset hypogonadism.

Transdermal preparations were used in 52% of cases for first line therapy of which Andropatch accounted for 77%, gel preparations 23%. Oral preparations were used in 4% and implants in 2%. I.m. preparations were prescribed in 34% of cases; Testosterone enantate 6%, testosterone undecanoate 41% and testosterone propionate 53%. Three cases (6%) were unspecified. Two thirds of patients changed their treatment and a third of those changed medications at least twice. Recent clinic letters show transdermal preparations now account for 38% of treatments; Andropatch 5% and gel preparations 95%. Oral and implant preparations are no longer in use and unspecified treatments account for only 2% of cases. I.m. preparations have increased to 60% of the total; Testosterone undecanoate 90% and testosterone propionate 10%. Patient inconvenience, ‘messy’ or ‘difficult to apply’, caused 21% of medication changes. Thirty-three percent of patients found their original treatment choice resulted in disappointing outcomes or no change in symptoms. Low testosterone was cited as a cause in 13% of cases. Six percent were changed due to raised haematocrit and 6% for unspecified side effects. Twenty-one percent were not recorded.

Conclusion: Our audit has identified a tendency to start patients on transdermal preparations but a high proportion will eventually require i.m. injections, and in particular testosterone undecanoate, for satisfactory control.