Endocrine Abstracts

Background: Optimization of sex hormone replacement therapy (SHRT) is essential in long-term management of patients with hypogonadism. However, approaches to formulations of therapy, dose change (if any), monitoring of adequacy of therapy and safety are not standardised.

Objectives: The survey aimed to establish the approach to management of SHRT for male and female hypogonadism.

Methods: Online survey, live for 4 weeks (1/11/2021) disseminated through SfE website and social media platforms to members.

Results: 40 responses; 27/40 (68%) consultants, 12/40 (30%) speciality trainees and 1 endocrine nurse specialist. For hypogonadal men, 25/40 (63%) respondents preferred transdermal testosterone (T) as first line replacement, 15/40 (38%) who preferred intramuscular T. 60% preferred trough T levels to assess adequacy of replacement while 25% (10/40) preferred measurement of T level after gel application;4 (10%) chose monitoring using calculated free T. While T safety was monitored with measurement of haematocrit 47% (39/40) and Prostate specific antigen (PSA) in 37/40 (45%), only 2 % (2/40) chose digital rectal examination. For women with hypogonadism, the preferred method of hormone replacement was transdermal HRT in 35%, oral combined HRT in 33% and conventional 4 weekly cycle of cOCP in 23% with only half of respondents rely on serum oestradiol to assess biochemical adequacy. In men, the adequacy of monitoring was performed clinically by assessing sexual function 38/40, energy levels 34/40, psychological status 27/40, muscle strength 17/40 and bone density in 2/40. In women, while sexual function (30/40), energy levels (29/40), psychological status (27/40), and bone density in 24/40 are used to assess clincial adequacy. The majority never used T preparation but 28% (11/40) use T for hypogonadal women.

Conclusion: A clear variation in clinical practice does exist when it comes to hormone replacement therapy in men and women highlighting the need for a national consensus for treatment standardisation