Long-term testosterone treatment in elderly men with hypogonadism and erectile dysfunction reduces obesity parameters and improves metabolic syndrome and health-related quality of life.
BACKGROUND
Late-onset hypogonadism (LOH) is diagnosed when declining testosterone concentrations in the aging male cause unwanted symptoms such as erectile dysfunction (ED), reduced bone density and muscle strength, and increased visceral obesity. Testosterone deficiency is also associated with insulin resistance and the metabolic syndrome (MetS). Restoring testosterone to physiological concentrations has beneficial effects on many of these symptoms; however, it is not known whether these effects can be sustained in the long term.


OBJECTIVE
To investigate whether treatment with testosterone undecanoate (TU) has a long-term and sustained effect on parameters affected by the MetS in men with LOH and ED, to determine whether long-term testosterone treatment can improve the overall health-related quality of life in these men, and to establish the safety of long-term testosterone treatment.


METHODS
Two hundred sixty-one patients (mean age 59.5 ± 8.4 years) diagnosed with LOH and ED were treated with long-acting TU in a prospective, observational, and longitudinal registry study. Men received intramuscular injections of 1,000 mg TU at day 1, at week 6, and every 3 months thereafter.


METHODS
Parameters affected by the MetS, including obesity parameters (body weight, waist circumference, and body mass index [BMI]), total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides, glucose, HbA1c (glycated hemoglobin), and blood pressure, as well as total testosterone levels and health-related quality of life, were assessed.


RESULTS
We found TU significantly improved obesity parameters (body weight, waist circumference, and BMI) and lowered total cholesterol, LDL cholesterol, triglycerides, fasting blood glucose, HbA1c , and blood pressure over the 5-year study. HDL cholesterol was increased. TU treatment resulted in a sustained improvement in erectile function and muscle and joint pain, which contributed to an improvement in long-term health-related quality of life. Furthermore, we found a relationship between health-related quality of life and waist circumference. Finally, we found no evidence that long-term treatment with TU increases the risk of prostate carcinoma.


CONCLUSIONS
Long-term TU in men with LOH and ED reduces obesity parameters and improves metabolic syndrome and health-related quality of life.
Department of Urology and Onco-Urology, Klinikum Braunschweig, Braunschweig, Germany.
Dany-Jan
DJ
Yassin
Gheorghe
G
Doros
Peter G
PG
Hammerer
Aksam A
AA
Yassin
D000368:Aged; D000728:Androgens / Q000627:therapeutic use*; D001823:Body Composition; D015992:Body Mass Index; D001835:Body Weight; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000378:metabolism; D007172:Erectile Dysfunction / Q000188:drug therapy*; D006801:Humans; D007006:Hypogonadism / Q000188:drug therapy*; D008297:Male; D024821:Metabolic Syndrome / Q000188:drug therapy; D008875:Middle Aged; D009765:Obesity / Q000188:drug therapy; D010410:Penile Erection / Q000187:drug effects; D011446:Prospective Studies; D011788:Quality of Life; D013739:Testosterone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014280:Triglycerides / Q000378:metabolism; D055105:Waist Circumference
D000728:Androgens; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D014280:Triglycerides; D013739:Testosterone; C010792:testosterone undecanoate
Blood Pressure; Body Mass Index; Cholesterol; Erectile Dysfunction; Glucose; Late-Onset Hypogonadism; Lower Urinary Tract Symptoms; Metabolic Syndrome; Obesity; Prostate Cancer; Testosterone; Testosterone Replacement Therapy