Punith Kempegowda
A small cohort of white and South Asian men experienced different biochemical responses to treatment with testosterone replacement therapy when analyzed according to race, according to findings published in Clinical Endocrinology.
Overall, we did not find any major differences in biochemical changes to hematocrit, hemoglobin, prostate specific antigen (PSA), and lipid profile between caucasians and South Asians following testosterone replacement therapy, Punith Kempegowda, MBBS, MSc, MD, MRCP, a Wellcome Trust clinical research fellow with the Institute of Metabolism and Systems Research, University of Birmingham, and specialist registrar in endocrinology, diabetes and general internal medicine at the University Hospitals Birmingham NHS Foundation Trust, United Kingdom, told Healio. However, there were fluctuations in biochemical parameters which may require adjusting of testosterone dose and frequency. Further, we found that these fluctuations could happen at any point during the replacement.
Testosterone replacement therapy is contraindicated for men with previous prostate or breast cancer, and biochemical monitoring is indicated before the initiation of therapy, Kempegowda and colleagues wrote in the study background.
Also, it is recommended to measure prostate specific antigen (PSA) in all men aged > 40 years prior to initiation and following 3 to 6 months of treatment, the researchers wrote. It is recommended to measure hematocrit and hemoglobin before and at regular intervals during testosterone replacement therapy, to monitor for erythrocytosis and secondary polycythemia. How patients ethnicity affects various biochemical levels in response to long-term testosterone replacement therapy is yet to be determined.
In a retrospective study, Kempegowda and colleagues analyzed data from 50 men treated with testosterone undecanoate from 2006 to 2017 at Birmingham Heartlands Hospital, including 31 white men (median age, 55 years; mean follow-up, 6.1 years) and 19 South Asian men (median age, 52 years; mean follow-up, 6.5 years). Researchers assessed changes in total testosterone, PSA, hematocrit, hemoglobin, total cholesterol, LDL cholesterol during 8 years of treatment, and used Wilcoxon rank sum tests to assess differences between white and South Asian adults.
Within the cohort, 29 men had secondary hypogonadism and 21 had primary hypogonadism.
Researchers did not observe a between-group difference in testosterone levels; however, South Asian men had higher free and bioavailable testosterone vs. white men at year 1 (P = .0021 and P = .0049, respectively) and year 3 (P = .0078 and P = .0121, respectively), although all values were within their respective reference range.
PSA was higher among white men vs. South Asian men at 2 years (P = .0496) and 8 years (P = .0128). At 1 year, South Asian men had higher mean hematocrit levels vs. white men (P < .007), whereas total cholesterol levels were higher among white men vs. South Asian men at 1 year (P = .0028) and 7 years (P = .0481). LDL cholesterol levels were also higher for white men vs. South Asian men after 1 year of therapy (P = .0083).
The researchers noted that all changes were within the respective reference ranges, suggesting no apparent risk for prostate cancer or venous thromboembolism.
As the years went on, there was loss to follow-up, and by year 8, only 18 patients (nine Caucasians and eight South Asians) were still contributing in the dataset, the researchers wrote. Therefore, we advise these results are explored in other similar larger cohorts. It would also be interesting to compare these changes toother forms of testosterone replacement, particularly transdermal, which is currently the most common route for testosterone replacement. Also, future studies may wish to explore patient satisfaction with testosterone replacement therapy and perceived improvement in symptoms and signs of testosterone deficiency. by Regina Schaffer
For more information:
Punith Kempegowda, MBBS, MSc, MD, MRCP, can be reached at the University of Birmingham Institute of Metabolism and Systems Research, Edgbaston, Birmingham B15 2TT, United Kingdom; email: p.kempegowda@nhs.net.
Disclosures: The authors report no relevant financial disclosures.
Punith Kempegowda
A small cohort of white and South Asian men experienced different biochemical responses to treatment with testosterone replacement therapy when analyzed according to race, according to findings published in Clinical Endocrinology.
Overall, we did not find any major differences in biochemical changes to hematocrit, hemoglobin, prostate specific antigen (PSA), and lipid profile between caucasians and South Asians following testosterone replacement therapy, Punith Kempegowda, MBBS, MSc, MD, MRCP, a Wellcome Trust clinical research fellow with the Institute of Metabolism and Systems Research, University of Birmingham, and specialist registrar in endocrinology, diabetes and general internal medicine at the University Hospitals Birmingham NHS Foundation Trust, United Kingdom, told Healio. However, there were fluctuations in biochemical parameters which may require adjusting of testosterone dose and frequency. Further, we found that these fluctuations could happen at any point during the replacement.
Testosterone replacement therapy is contraindicated for men with previous prostate or breast cancer, and biochemical monitoring is indicated before the initiation of therapy, Kempegowda and colleagues wrote in the study background.
Also, it is recommended to measure prostate specific antigen (PSA) in all men aged > 40 years prior to initiation and following 3 to 6 months of treatment, the researchers wrote. It is recommended to measure hematocrit and hemoglobin before and at regular intervals during testosterone replacement therapy, to monitor for erythrocytosis and secondary polycythemia. How patients ethnicity affects various biochemical levels in response to long-term testosterone replacement therapy is yet to be determined.
In a retrospective study, Kempegowda and colleagues analyzed data from 50 men treated with testosterone undecanoate from 2006 to 2017 at Birmingham Heartlands Hospital, including 31 white men (median age, 55 years; mean follow-up, 6.1 years) and 19 South Asian men (median age, 52 years; mean follow-up, 6.5 years). Researchers assessed changes in total testosterone, PSA, hematocrit, hemoglobin, total cholesterol, LDL cholesterol during 8 years of treatment, and used Wilcoxon rank sum tests to assess differences between white and South Asian adults.
Within the cohort, 29 men had secondary hypogonadism and 21 had primary hypogonadism.
Researchers did not observe a between-group difference in testosterone levels; however, South Asian men had higher free and bioavailable testosterone vs. white men at year 1 (P = .0021 and P = .0049, respectively) and year 3 (P = .0078 and P = .0121, respectively), although all values were within their respective reference range.
PSA was higher among white men vs. South Asian men at 2 years (P = .0496) and 8 years (P = .0128). At 1 year, South Asian men had higher mean hematocrit levels vs. white men (P < .007), whereas total cholesterol levels were higher among white men vs. South Asian men at 1 year (P = .0028) and 7 years (P = .0481). LDL cholesterol levels were also higher for white men vs. South Asian men after 1 year of therapy (P = .0083).
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The researchers noted that all changes were within the respective reference ranges, suggesting no apparent risk for prostate cancer or venous thromboembolism.
As the years went on, there was loss to follow-up, and by year 8, only 18 patients (nine Caucasians and eight South Asians) were still contributing in the dataset, the researchers wrote. Therefore, we advise these results are explored in other similar larger cohorts. It would also be interesting to compare these changes toother forms of testosterone replacement, particularly transdermal, which is currently the most common route for testosterone replacement. Also, future studies may wish to explore patient satisfaction with testosterone replacement therapy and perceived improvement in symptoms and signs of testosterone deficiency. by Regina Schaffer
For more information:
Punith Kempegowda, MBBS, MSc, MD, MRCP, can be reached at the University of Birmingham Institute of Metabolism and Systems Research, Edgbaston, Birmingham B15 2TT, United Kingdom; email: p.kempegowda@nhs.net.
Disclosures: The authors report no relevant financial disclosures.
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Race may influence biochemical responses to testosterone therapy - Healio
