title: Subcutaneous implantable testosterone pellets overcome noncompliance in adolescents with Klinefelter syndrome.
abstract: For adolescents with hypogonadism, failure to comply with a testosterone  replacement therapy (TRT) regimen can be a barrier to obtaining adequate and  consistent serum testosterone (T) levels. We evaluated 4 young men with  hypogonadism secondary to Klinefelter syndrome to determine if implantable  pellets represented a viable treatment option for such patients. Four patients  (aged 14-20 years) had previously received TRT but were not compliant.  Patients initially received 4 to 10 subcutaneous T pellets with subsequent  doses implanted at 3- to 4-month intervals. In all 4 patients, total and free  T levels were improved at follow-up, although fluctuations between levels were  inconsistent. All patients reported improvement in their energy and  concentration, and parents noted improved stability of mood. The mean baseline  total T level of 108.3 ng/dL increased in all patients at the time of second  pellet implantation. Average total T levels were 325 to 587 ng/dL over the  course of therapy. There was significant variability of serum T levels while  patients were on therapy. All patients eventually received an increased number  of pellets at some point in their care. Subcutaneous implantation of T pellets  is a viable option for TRT in young men with Klinefelter syndrome in whom  compliance is an issue. However, the requirement for repeat implantation every  3 months, increased cost of therapy and monitoring, dramatic shifts in serum  total and free T concentrations, and seemingly unpredictable response requires  close monitoring and careful follow up and suggests this modality of therapy  may not be appropriate for a substantial number of hypogonadal patients, but  this strategy warrants consideration in noncompliant patients.
authors.affiliation: Scott Department of Urology, Baylor College of Medicine, 6620 Main St, Houston, TX 77030, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Moskovic
authors.forename: Robert E
authors.initials: RE
authors.lastname: Freundlich
authors.forename: Parvin
authors.initials: P
authors.lastname: Yazdani
authors.forename: Larry I
authors.initials: LI
authors.lastname: Lipshultz
authors.forename: Mohit
authors.initials: M
authors.lastname: Khera
mesh_terms: D000293:Adolescent; D004343:Drug Implants; D020249:Hormone Replacement Therapy; D006801:Humans; D007006:Hypogonadism / Q000188:drug therapy* / Q000209:etiology; D007713:Klinefelter Syndrome / Q000150:complications*; D008297:Male; D010349:Patient Compliance; D013739:Testosterone / Q000008:administration & dosage* / Q000097:blood; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D004343:Drug Implants; D013739:Testosterone