Is discontinuation of hormone replacement therapy possible for patients with late-onset hypogonadism?

The first-line treatment for late-onset hypogonadism (LOH) is hormone replacement therapy (HRT). However, whether lifetime HRT is necessary has not been settled. We evaluated LOH-related symptoms and endocrinologic values after discontinuation of HRT in patients with LOH who had benefited from it.

Twenty-five men (mean age 54.2 years, range 40-73) in whom HRT had been effective and who were available for follow-up 3 months after the discontinuation of HRT were studied. LOH-related symptoms were judged according to the Aging Males' Symptoms (AMS) scale and other questionnaires. Laboratory and endocrinologic values and LOH-related symptoms were assessed before HRT, at the end of HRT, and 3 months after its discontinuation.

Serum testosterone levels increased significantly with HRT. However, they returned to the pretreatment levels after discontinuation of HRT. The total AMS score decreased significantly after HRT, and a significant improvement was maintained 3 months after discontinuation. The somatovegetative and psychological subscores of the AMS also improved, although the sexual subscore did not change significantly. A slight improvement was also observed in the short version of the International Index of Erectile Function (IIEF-5) score and the Self-rating Depression Scale (SDS) score after HRT. However, changes in these scores did not reach statistical significance. No other changes in the endocrinologic profile and no severe adverse effects were seen.

Improvement in symptoms may remain after discontinuation of HRT in patients with LOH even though their endocrinologic status declines. Our findings may encourage physicians to discontinue HRT if LOH-related symptoms have improved after several months of HRT.