Switch Testosterone Gels in Unresponsive Hypogonadal Men

Depression Symptoms May Signal Hormone Deficiency

By John Schieszer

Larry Lipshultz, MD

ANAHEIM, Calif—Simply switching brands of testosterone replacement therapy gel (eg, from AndroGel to Testim, or vice versa) may effectively treat otherwise unresponsive hypogonadal men, according to data presented at the American Urological Association annual meeting. It may also be preferable to more invasive testosterone replacement therapy.

The study included 370 men who were being treated with testosterone gel. Of the 70 men who were not responding to their current treatment, 81% (mean age, 60 years) were switched from AndroGel to Testim and 19% (mean age, 51 years) were switched from Testim to AndroGel.

Before the switch, the men initially treated with AndroGel had a mean total serum testosterone level of 314 ng/dL and a mean free testosterone level of 10.2 pg/mL. Total testosterone levels were <300 ng/dL in 57% of these men. The men initially treated with Testim had a mean serum testosterone level of 444 ng/dL and a mean free testosterone level of 14.6 pg/mL. Total testosterone levels were <300 ng/dL in 18% of these men.

After the gel substitution, those switched to Testim had a mean increase of 174 ng/dL in serum testosterone and of 3.3 pg/mL in free testosterone. The men switched to AndroGel had a mean increase in serum testosterone level of 1.0 ng/dL and a mean increase in free testosterone level of 0.3 pg/mL.

Hypogonadal symptoms improved in 76% of the men who were switched from one gel to the other.

Commenting on the significant increases in total testosterone levels among men switched from AndroGel to Testim, coinvestigator Larry Lipshultz, MD, professor of urology at Baylor College of Medicine, Houston, Tex, said, "Testim is unique, because it contains an emollient known as pentadecalactone. What we found is that this can increase the absorption of the testosterone into the system."

Dr Lipshultz said these results suggest that switching to another gel may be better than switching to testosterone pills, patches, or injections.

IMWR

"The pill has liver toxicity, and it is often not very effective. The patch has a high incidence of skin reactivity. And there is injectable testosterone, but that causes very high levels of testosterone, pharmacological levels, and that is not really what we are after. We are after normal biologic levels. So they are not the preparations of choice," Dr Lipshultz told .

He added, "Men who have symptoms of depression, fatigue, and erectile dysfunction may very well have low testosterone….There are a lot of men who are on antidepressants who probably have hypogonadism, and they are just not being tested."