Endocrine Abstracts

Background: Male hypogonadism is a frequent reason for referrals to secondary care. Work up and approach to diagnosis and treatment varies among practicing physicians and proper work up and monitoring is crucial for safe and effective Testosterone replacement therapy (TRT).

Methods: Retrospective case reviews for all men who were prescribed TRT via secondary care endocrine unit between September 2021 and September 2022.

Results: 127 patients received at least 1 prescription of TRT over 1 year time. All patients had documented signs and symptoms consistent with hypogonadism. On initial work up only 68% (56/82) had their total testosterone performed before 11 am and only 74% (62/84) had their levels repeated. Interestingly, Sex hormone binding globulins (SHBG) were checked in only 57% (51/89) of patients while there was no documentation of free testosterone measurement in 90% (81/90). Prostate specific antigen (PSA) measurements were documented in 77% (71/92) and only 68% (62/91) had this repeated 3-6 months after TRT initiation. Haematocrit (HcT) was checked in 84% (76/91) of patients prior to TRT initiation but only 65% (59/91) had their HcT rechecked 3-6 months later. Of the 13 patients with a haematocrit of 0.54% or higher, 2 patients had no action taken, 4 patients’ TRT frequency was reduced, 3 patients’ TRT was stopped of which 1 was referred to haematology. 14% (12/85) had anaemia before TRT initiation of which 2 had anaemia corrected with TRT after 1 year of therapy.

Conclusion: Biochemical work up for hypogonadism should be optimised to consider sampling conditions. Estimation of free testosterone/SHBG is helpful to unmask patients with functional hypogonadism. A standard approach to TRT induced erythrocytosis is necessary to ensure safe and effective provision of care.