Evolution of testosterone treatment over 25 years: symptom responses, endocrine profiles and cardiovascular changes

Abstract

Introduction: Testosterone treatment has evolved rapidly over the past 25 years as new, more effective and convenient methods have become available. This study reports experience with seven different methods, introduced on the market in the UK.

Aim: To establish the symptom response when testosterone treatment was initiated on the basis of clinical features and symptoms of androgen deficiency, and the resulting endocrine, biochemical and physiological responses.

Methods: Of 2693 patients attending the 3 Men’s Health Centers – The UK Androgen Study (UKAS), 2247 were treated. Treatments included pellet implants, oral testosterone undecanoate (Testocaps), mesterolone (Proviron), testosterone gel (Testogel), testosterone scrotal cream (Andromen) and scrotal gel (Tostran).

Results: There was no correlation between initial testosterone level, initial symptom score or the success of treatment as defined by adequate resolution of symptoms. Despite the diverse endocrine patterns produced, the testosterone preparations appear equally safe over prolonged periods, with either no change or improvement of cardiovascular risk factors, especially in lowering cholesterol and diastolic blood pressure.

Conclusions: It is suggested that because of excessive reliance on laboratory measures of androgens and undue safety concerns, many men who could benefit from symptom relief, improvement in related clinical conditions and given preventive medical benefits remain untreated.

• Nebido
• symptom scales
• Scrotal Tostran
• Scrotal Androforte
• Testogel
• testosterone replacement therapy
• testosterone resistance
• UK Androgen Study

Acknowledgements

Thanks are due to our late colleague Hugh Welford who created the Practice Management System for collecting the patient data, and the Data Mining Program, which together enabled us to collate and analyze it, making the study possible. Jim McGrew office manager did huge amount of work coordinating the patients and organising their data. We would also like to thank Dr Doug Savage of the Centre for Men's Health for the use of his recent patients' data.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.