Endocrine Abstracts

Background: Hypogonadism is associated with cardiometabolic risk. Studies suggest that hypogonadism increases the risk of all-cause and cardiovascular mortality. While some short-term studies have been performed in men with CVD, there are no data on long-term effects of testosterone replacement therapy (TRT) in men with CVD.

Methods: In a prospective, cumulative, observational registry study from a single urologist’s office, 300 men with testosterone ≤12.1 nmol/l received TU injections for upto 6 years. In this subgroup analysis, 68 men with a previous diagnosis of coronary artery disease (CAD; n=40) and/or a history of myocardial infarction (MI; n=40) were analyzed.

Results: Mean age was 60.76±4.94 years. 68 men were included for 2 years, 59 for 3 years, 54 for 4 years, 44 for 5 years, and 28 for 6 years. Declining numbers reflect the nature of the registry but not drop-out rates.

Weight (kg) decreased from 115.07±13.71 to 92.5±9.64. Waist circumference (cm) decreased from 112.07±7.97 to 99.89±6.86. BMI decreased from 37.27±4.45 to 30.14±3.21 (P<0.0001 for all). Mean weight loss was 17.05±0.57%. Fasting glucose decreased from 108.74±17.08 to 96.0±1.92 mg/dl, HbA1c from 7.81±1.17 to 6.2±0.62% (P<0.0001 for both). Total cholesterol decreased from 304.66±34.09 to 189.32±9.68, LDL from 184.28±37.51 to 134±27.91, triglycerides from 308.38±56.3 to 187.71±8.67 mg/dl (P<0.0001 for all). HDL increased slightly. The total cholesterol:HDL ratio declined from 5.16±1.55 to 3.15±0.87 (P<0.0001). Systolic BP decreased from 167.82±11.01 to 142.36±10.62, diastolic BP from 102.28±8.23 to 81.25±8.07 mmHg (P<0.0001 for both). Pulse pressure declined from 65.54±5.24 to 61.11±4.66 (P<0.0001).

The minimum number of injections was 9, maximum 26. In no patient TRT was discontinued or interrupted. There were no major cardiovascular events during the observation time.

Conclusion: TRT in hypogonadal men with CVD was well tolerated and resulted in significant and sustained improvements of cardiometabolic risk factors. Adherence to TRT was excellent.