Long-term Testosterone Therapy in Men with Hypogonadism: Study Overview and Key Insights
Men with type 2 diabetes often experience more severe erectile dysfunction and respond poorly to traditional treatments like PDE5 inhibitors. For these men, long-term testosterone therapy (TTh) has emerged as a promising alternative. A study led by Karim Sultan Haider, MD, focused on the long-term effects of TTh on men with hypogonadism, particularly those with type 2 diabetes. The results, presented at the 2021 Sexual Medicine Society of North America (SMSNA) Fall Meeting, highlight the significant improvements in erectile function and overall health for this cohort of patients.
Study Background
This research began in 2004 when testosterone undecanoate became available as a long-acting depot injection. Initially, the study measured blood parameters and conducted urological exams in men with testosterone deficiencies. As referrals increased from other medical specialties, including dermatology and orthopedics, the study expanded to include hypogonadal men with autoimmune diseases. Over time, the study has accumulated significant data on the long-term effects of TTh in hypogonadal men, particularly those with type 2 diabetes.
Key Findings
One of the most remarkable findings was the sustained improvement in erectile function after 12 years of treatment. Men receiving TTh not only experienced an initial boost in erectile function but also maintained these gains over time. Untreated men, by contrast, showed a decline in erectile function over the same period. The study demonstrated a 25-point difference in erectile function scores between treated and untreated men, marking the difference between severe dysfunction and no dysfunction. Additionally, the mortality rate in the treated group was significantly lower, with only 10 deaths compared to over 70 in untreated men, primarily from cardiovascular causes.
Clinical Implications
These findings reinforce the idea that testosterone therapy should not be overlooked or seen as a controversial option. Instead, it should be considered a viable treatment for hypogonadal men, especially those with comorbid conditions like type 2 diabetes. The long-term data suggests that maintaining physiological testosterone levels can offer broader health benefits beyond erectile function, including reduced mortality.
Impact on Clinical Practice
The study has influenced the clinical approach to hypogonadism and testosterone therapy. The research team has encouraged collaboration across medical disciplines, urging colleagues to monitor testosterone levels in patients who do not respond to standard treatments. The study underscores the importance of looking at testosterone deficiency as a multi-system issue, rather than a condition isolated to urology or endocrinology.
Take-home Message for Urologists
For practicing urologists, the message is clear: testosterone levels should be checked in any patient presenting with symptoms of hypogonadism. If confirmed, testosterone therapy should be offered as a treatment option. Furthermore, collaboration with other specialists is essential, as hypogonadism affects multiple systems in the body.
Broader Implications
This study, now running for over 16 years, provides a wealth of long-term data that supports testosterone therapy as a valuable treatment for hypogonadal men. Clinicians are encouraged to look beyond testosterone levels and consider other health metrics, such as cardiovascular risk factors and glucose levels, to provide comprehensive care to their patients.
Men with type 2 diabetes often experience more severe erectile dysfunction and respond poorly to traditional treatments like PDE5 inhibitors. For these men, long-term testosterone therapy (TTh) has emerged as a promising alternative. A study led by Karim Sultan Haider, MD, focused on the long-term effects of TTh on men with hypogonadism, particularly those with type 2 diabetes. The results, presented at the 2021 Sexual Medicine Society of North America (SMSNA) Fall Meeting, highlight the significant improvements in erectile function and overall health for this cohort of patients.
Study Background
This research began in 2004 when testosterone undecanoate became available as a long-acting depot injection. Initially, the study measured blood parameters and conducted urological exams in men with testosterone deficiencies. As referrals increased from other medical specialties, including dermatology and orthopedics, the study expanded to include hypogonadal men with autoimmune diseases. Over time, the study has accumulated significant data on the long-term effects of TTh in hypogonadal men, particularly those with type 2 diabetes.
Key Findings
One of the most remarkable findings was the sustained improvement in erectile function after 12 years of treatment. Men receiving TTh not only experienced an initial boost in erectile function but also maintained these gains over time. Untreated men, by contrast, showed a decline in erectile function over the same period. The study demonstrated a 25-point difference in erectile function scores between treated and untreated men, marking the difference between severe dysfunction and no dysfunction. Additionally, the mortality rate in the treated group was significantly lower, with only 10 deaths compared to over 70 in untreated men, primarily from cardiovascular causes.
Clinical Implications
These findings reinforce the idea that testosterone therapy should not be overlooked or seen as a controversial option. Instead, it should be considered a viable treatment for hypogonadal men, especially those with comorbid conditions like type 2 diabetes. The long-term data suggests that maintaining physiological testosterone levels can offer broader health benefits beyond erectile function, including reduced mortality.
Impact on Clinical Practice
The study has influenced the clinical approach to hypogonadism and testosterone therapy. The research team has encouraged collaboration across medical disciplines, urging colleagues to monitor testosterone levels in patients who do not respond to standard treatments. The study underscores the importance of looking at testosterone deficiency as a multi-system issue, rather than a condition isolated to urology or endocrinology.
Take-home Message for Urologists
For practicing urologists, the message is clear: testosterone levels should be checked in any patient presenting with symptoms of hypogonadism. If confirmed, testosterone therapy should be offered as a treatment option. Furthermore, collaboration with other specialists is essential, as hypogonadism affects multiple systems in the body.
Broader Implications
This study, now running for over 16 years, provides a wealth of long-term data that supports testosterone therapy as a valuable treatment for hypogonadal men. Clinicians are encouraged to look beyond testosterone levels and consider other health metrics, such as cardiovascular risk factors and glucose levels, to provide comprehensive care to their patients.
