Testosterone Replacement Therapy Has Beneficial Effects on Cardiovascular Risk Factors and Liver Function in Hypogonadal Men

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 554-583-Male Reproductive Endocrinology & Case Reports
Clinical
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-573
Preethi Rao*1, Jonathan C Brooke2, Debbie Walter2, Amrita Dhutia2, David McLaren2, Muraleedharan Vakkat2 and Thomas Hugh Jones1
1Barnsley Hospital NHS Foundation Trust, Barnsley, United Kingdom, 2University of Sheffield, Sheffield, United Kingdom
Low testosterone levels are associated with cardiovascular morbidity and an increased risk of non-alcoholic steatohepatitis (NASH). NASH is closely associated with insulin resistance and atherosclerosis. We studied the effect of long-term testosterone replacement therapy (TRT) on liver function and cardiovascular risk factors in hypogonadal men.

A long-term retrospective analysis was carried out of 505 hypogonadal men receiving TRT as part of normal clinical practice with a mean follow-up of 4.94 years. 82.8% of the patients were on testosterone gels and the rest were on testosterone injection. Levels of testosterone, estradiol and PSA were monitored at 3, 6 and 12 months and yearly thereafter. BMI, waist circumference, blood pressure (BP), hemoglobin (Hb), hematocrit (HCT), lipid profile and liver function tests were also recorded. Changes in medications for diabetes and cholesterol were documented. Data from the most recent appointments represented the primary endpoint.

Mean age was 59.9+14.4 years and mean baseline testosterone was 7.09+2.53nmol/l. 46.1% of the cohort had type 2 diabetes mellitus; 33.9% were on metformin, 20.0% on insulin and 56.0% were on statins. TRT was associated with a significant decrease in AST between baseline and the primary endpoint (28.5 vs. 25.8u/l; -2.68u/l, p=0.014). ALT was also significantly lowered (35.2 vs. 30.4u/l; -4.77u/l, p=0.004). Patients with raised liver transaminases at baseline (>40u/L) had the greatest response to TRT. Hemoglobin levels were significantly higher at the primary endpoint (14.30 vs. 15.06g/dl; +0.76g/dl, p<0.001) but HbA1C levels were significantly reduced (7.24% vs. 6.90%; -0.34%, p=0.009). Diabetes medication was increased in 52 patients and decreased in 28. TRT reduced total cholesterol levels (over and above the effect of statins in 56.0% of the cohort) at the primary endpoint (4.48 vs. 4.18mmol/l; -0.30mmol/l, p<0.001) and non-fasting triglycerides were also significantly lowered (2.39 vs. 2.10mmol/l; -0.29mmol/l, p=0.006). LDL levels significantly fell at the primary endpoint (2.36mmol/l vs. 2.16mmol/l; -0.20mmol/l, p=0.014) and a modest fall in HDL levels was observed (1.10 vs. 1.05; -0.049mmol/l, p=0.035). No significant changes in BMI, waist circumference or BP were identified.

This is the first study to demonstrate the long-term beneficial effects of TRT on cardiovascular risk factors and liver function tests after 5 years. This is the largest and most comprehensive study of TRT to date, representing over 2467 patient years of TRT.

Disclosure: THJ: Consultant, Bayer Healthcare, Researcher, Bayer Healthcare, Speaker, Bayer Healthcare, Consultant, Eli Lilly & Company, Consultant, Pro Strakan, Researcher, Pro Strakan, Speaker, Pro Strakan, Consultant, Merck, Consultant, Clarus. Nothing to Disclose: PR, JCB, DW, AD, DM, MV

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm