BERKELEY, CA (UroToday.com) - Recent developments in the field of hypogonadism and testosterone replacement therapy (TRT) have led to an increased public awareness for this condition. While efforts to reach consensus on how to best identify men with substantial disease burden from low testosterone continue, hypogonadal men benefit from testosterone replacement therapy. However, to derive benefits from treatment, patients should continue therapy for at least 3 months. Testosterone has a significant effect on sexual function. Not surprisingly, sexual complaints are often what drive patients to seek medical care, and are also the yardstick patients use to judge the adequacy of therapeutic response. Sexual symptoms may take up to three months to improve, and reach a plateau at 12 weeks.[1, 2] Cognitive responses and physiologic changes in body mass (increase in lean body mass, and decrease in adipose tissue) may take longer than 12 weeks.
Evidence-based guidelines from specialty societies generally recommend follow-up at 3 – 6 months.[1, 4, 5] The patient’s response over time to testosterone replacement serves as the foundation for this recommendation. While this recommendation is well founded, it does not take into consideration patient motivation and expectations.
Our study of adherence and persistence to therapy after initiation of TRT (both topical and short acting parenteral therapy) has shown that by the first month many patients have either failed to initiate or have decided not to renew their initial prescription. By three months, the time point recommended by the guidelines for re-evaluation, nearly 50% of patients on topical TRT and 70% of patients on short acting parenteral TRT have discontinued therapy. These results, particularly if confirmed by others, would suggest that there is a need for interventions sooner than three months. Setting proper patient expectations at the outset, concerning the response to therapy, will hopefully allow better adherence and treatment outcomes. Re-evaluation shortly after initiation of therapy would allow more timely adjustment of dose to achieve optimal serum levels and allow clinicians to review and reinforce appropriate patient expectations and outcomes.
- Wang C, Nieschlag E, Swerdloff R, Behre HM, Hellstrom WJ, Gooren LJ, Kaufman JM, Legros J-J, Lunenfeld B, Morales A, Morley JE, Schulman C, Thompson IM, Weidner W, Wu FCW. Investigation, treatment, and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA, and ASA recommendations. European Urology 2009; 55:121-130
- Khera M, Bhattacharya RK, Blick G, Kushner H, Nguyen D, Miner MM. Improved sexual function with testosterone replacement in hypogonadal men: Real-world data from the Testim registry in the United States (TRiUS). J Sex Med 2011; 8:3204-3213.
- Rhoden EL, Morgentaler A. Symptomatic response rates to testosterone therapy and the likelihood of completing 12 months of therapy in clinical practice. J Sex Med 2010; 7:277-283.
- Snyder PJ, Peachey H, Hannoush P, Dlewati A, Sanatanna J, Rosen CJ, Strom BL. Effect of testosterone treatment on body composition and muscle strength in men over 65 years of age. J Clin Endocrinol Metab 1999; 84:2647-2653.
- Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, Montori VM. Testosterone therapy in men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2010; 96(6):2536-2559.
- Donatucci C, Cui Z, Fang Y, Muram D. Long-term treatment patterns of testosterone replacement medications. J Sex Med 2014 Jun 9. doi: 10.1111/jsm.12608. [Epub ahead of print].
David Muram, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN USA