Transdermal androgen therapy to augment EPO in the treatment of anemia of chronic renal disease.
BACKGROUND
Hypogonadism and anemia are common comorbid conditions in dialysis patients. Testosterone replacement may improve such clinical parameters as anemia, sarcopenia, and low libido. Additionally, by increasing hemoglobin levels, testosterone replacement may allow for a dose reduction in recombinant human erythropoietin (rHuEPO), thereby reducing cost.


METHODS
This phase IV, single-center, placebo-controlled, double-blind study assessed the effect of transdermal testosterone on serum testosterone levels, rHuEPO dose required to maintain hemoglobin level, bone mineral content, lean body mass and fat content, cholesterol level, sexual function, and mood. Forty hypogonadal male hemodialysis patients who were administered rHuEPO were randomly assigned to 100 mg of topical 1% testosterone gel (Testim; Auxilium Pharmaceuticals, Norristown, PA) or placebo, applied daily for 6 months.


RESULTS
Forty men with a mean age of 56 years and baseline serum testosterone level less than 300 ng/dL (< 10.4 nmol/L) participated in this trial. In men assigned to administration of transdermal testosterone, there was an increase beyond that in the placebo group in mean serum testosterone (77.1 ng/dL [2.7 nmol/L]), dihydrotestosterone (DHT; 0.8 nmol/L), and estradiol levels (6.3 pg/mL [23.0 pmol/L]) and a decrease in mean serum luteinizing hormone levels (-3.1 IU/L). Compared with subjects administered placebo, participants on testosterone replacement therapy did not show an appreciable change in rHuEPO dose (mean difference adjusted for baseline values, 12.6 U/kg/wk; P = 0.73), bone mineral density, lean body mass or fat content, cholesterol level, sexual function, or mood.


CONCLUSIONS
Daily administration of 100 mg of topical 1% testosterone gel for 6 months failed to significantly increase serum testosterone or DHT levels in hypogonadal men with end-stage renal disease. Treatment with transdermal testosterone did not impact on rHuEPO requirement or clinical parameters in this small placebo-controlled study. Greater serum testosterone levels may be required to show clinical benefit in men with end-stage renal disease.
Brockenbrough
Andrew T
AT
Division of Nephrology, Center for Research in Reproduction and Contraception, Department of Medicine, University of Washington Medical School, Seattle, WA, USA. abrocken@u.washington.edu
Dittrich
Mary O
MO
Page
Stephanie T
ST
Smith
Ted
T
Stivelman
John C
JC
Bremner
William J
WJ
D000279:Administration, Cutaneous; D000728:Androgens / Q000008:administration & dosage*; D000740:Anemia / Q000188:drug therapy* / Q000209:etiology*; D004311:Double-Blind Method; D004921:Erythropoietin / Q000008:administration & dosage*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins; D013739:Testosterone / Q000008:administration & dosage*
D000728:Androgens; D011994:Recombinant Proteins; D004921:Erythropoietin; D013739:Testosterone