Luteinizing Hormone Suppression Profiles in Men Treated With Exogenous Testosterone |
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| Affiliation: | 1. Sexual & Reproductive Medicine Program, Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA;2. Department of Psychiatry and Behavioral Sciences, Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA;1. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia;2. Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia;1. Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan;2. Department of Urology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwann;3. Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan;4. Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan;5. Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan;6. Program in Molecular Medicine, School of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan;7. Institute of Biopharmaceutical Science, School of Life Science, National Yang Ming Chiao Tung University, Taipei, Taiwan;8. Division of Urology, Department of Surgery, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan;1. Andrology, Women''s Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy;2. Department of Ob/Gyn, George Washington University School of Medicine, Intim Medicine Specialists, Washington, DC, USA;1. Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland;2. Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland;3. Laboratory of Brain Imaging, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland;4. Swartz Center for Computational Neuroscience, Institute for Neural Computations, University of California San Diego, San Diego, CA, USA;1. Department of Physiotherapy and Rehabilitation, Health Sciences Faculty, Ankara Yildirim Beyazit University, Ankara, Turkey;2. Department of Physiotherapy and Rehabilitation, Health Sciences Faculty, Hatay Mustafa Kemal University, Hatay, Turkey;3. Department of Urology, Istanbul Gaziosmanpasa Taksim Training and Research Hospital, Istanbul, Turkey;1. Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA;2. Department of Clinical Sciences, Florida State University College of Medicine, Tallahassee, FL, USA |
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| Abstract: | BackgroundDue to the negative feedback mechanism involved in the hypothalamic-pituitary-gonadal axis, testosterone therapy (TTh) may result in suppression of luteinizing hormone (LH) secretion, but clinical experience demonstrates the level of LH suppression is variable.AimWe sought to define the relationship between TTh and LH levels, specifically predictors of LH suppression in men on TTh.MethodsWe performed a retrospective analysis of a prospectively maintained database of patients with testosterone deficiency (TD) treated with TTh. Patient demographic and clinical data including vascular risk factor (VRF) status were collected. Serum total T and LH levels before TTh and after ≥3 months (m) were recorded. LH suppression was defined as serum LH level <1.0 IU/ml.Main Outcome MeasuresPredictors of LH suppression were searched though a series of logistic regression models assessing suppression status at the final observation, and then a series of Cox proportional hazards models assessing time to first suppression were performed.ResultsA total of 227 patients with mean age of 58±14 years at time of TTh initiation were included in our analysis. Just under half of subjects received transdermal T as the only modality (n = 101, 44%), while one third (n = 77, 34%) received intramuscular only, and the remainder (n = 49, 22%) received both modalities during follow-up. The mean baseline LH level was 10 ± 12 IU/ml. The percent of men who had baseline LH level above 1 IU/ml and at any given point of TTh was 84% and 78%, respectively, thus 22% of men had suppressed LH levels on TTh considering the definition of LH <1 IU/ml. Most men (73%) had a suppressed LH level of <1 IU/ml at least once during follow-up. In the final adjusted model for LH suppression, intramuscular route (OR = 2.44), baseline LH (OR = 0.94), estradiol (OR = 1.05) remained significant.Clinical ImplicationsLH suppression profiles may be relevant for dose titration during TTh and perhaps to minimize testicular atrophy.Strengths & LimitationsA strict definition for TD was applied using LCMS for T measurements and patients had long-term follow-up.ConclusionWhile 73% of patients had at least one LH <1 IU/ml during TTh, only 22% maintained suppressed throughout the treatment.Miranda EP, Schofield E, Matsushita K, et al. Luteinizing Hormone Suppression Profiles in Men Treated With Exogenous Testosterone. J Sex Med 2022;19:1359–1365. |
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