Purpose Testosterone replacement therapy (TRT) is recommended for the treatment of most cases of male hypogonadism. Transdermal testosterone (T) gels are commonly used in clinical practice; however, there is little evidence concerning how to monitor dosage to bring and maintain serum T levels in the normal physiologic range. Methods We examined 30 hypogonadal patients undergoing treatment with 40 mg/day transdermal 2% testosterone gel. After a week from treatment onset, all patients underwent a total of four measurements to assess serum total T, bioavailable T and free T at + 2 h (samples A and A ') and + 23 h (samples B and B '). Results No significant difference was found concerning total, free and bioavailable T between the two samples taken at the same time points (A vs A ' and B vs B '). A repeated-measures mixed effects regression model showed significantly lower serum levels of total, free and bioavailable T at + 23 h compared to + 2 h (total T, beta = - 3.050 +/- 0.704, p < 0.001; free T, beta = - 85.187 +/- 22.746, p < 0.001; bioavailable T, beta = - 1.519 +/- 0.497, p = 0.003) without a significant between-sample variability. Serum T > 3.5 ng/ml at + 2 h was reached in 21/30 patients (70%), but only 11 (36.7%) still had adequate serum T at + 23 h. Conclusion Assessment of TRT with transdermal gels at its peak and at its minimum could be useful in providing a finely tailored treatment for hypogonadal men, both preventing supra-physiological levels and maintaining adequate concentrations through the day.
Sansone, A., Sansone, M., Selleri, R., Schiavo, A., Gianfrilli, D., Pozza, C., et al. (2019). Monitoring testosterone replacement therapy with transdermal gel: when and how?. JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION, 42(12), 1491-1496 [10.1007/s40618-019-01082-x].
Monitoring testosterone replacement therapy with transdermal gel: when and how?
Sansone A.;
2019-01-01
Abstract
Purpose Testosterone replacement therapy (TRT) is recommended for the treatment of most cases of male hypogonadism. Transdermal testosterone (T) gels are commonly used in clinical practice; however, there is little evidence concerning how to monitor dosage to bring and maintain serum T levels in the normal physiologic range. Methods We examined 30 hypogonadal patients undergoing treatment with 40 mg/day transdermal 2% testosterone gel. After a week from treatment onset, all patients underwent a total of four measurements to assess serum total T, bioavailable T and free T at + 2 h (samples A and A ') and + 23 h (samples B and B '). Results No significant difference was found concerning total, free and bioavailable T between the two samples taken at the same time points (A vs A ' and B vs B '). A repeated-measures mixed effects regression model showed significantly lower serum levels of total, free and bioavailable T at + 23 h compared to + 2 h (total T, beta = - 3.050 +/- 0.704, p < 0.001; free T, beta = - 85.187 +/- 22.746, p < 0.001; bioavailable T, beta = - 1.519 +/- 0.497, p = 0.003) without a significant between-sample variability. Serum T > 3.5 ng/ml at + 2 h was reached in 21/30 patients (70%), but only 11 (36.7%) still had adequate serum T at + 23 h. Conclusion Assessment of TRT with transdermal gels at its peak and at its minimum could be useful in providing a finely tailored treatment for hypogonadal men, both preventing supra-physiological levels and maintaining adequate concentrations through the day.File | Dimensione | Formato | |
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