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Testosterone replacement therapy does not promote priapism in hypogonadal men with sickle cell disease: 12-month
B F Morrison1, M Reid, W Madden
1Department of Surgery, University of the West Indies, Mona, Jamaica. bfmorrison11@hotmail.com
Insights
Testosterone replacement therapy (TRT) is safe for hypogonadal men with sickle cell disease (SCD). This treatment did not increase priapism and improved sexual function, suggesting it
Area of Science:
- Endocrinology
- Hematology
- Urology
Background:
- Hypogonadism is common in sickle cell disease (SCD), impacting quality of life and increasing morbidity.
- The safety of testosterone replacement therapy (TRT) in SCD patients, particularly concerning priapism, is not well-established.
Purpose of the Study:
- To assess the safety and efficacy of TRT using testosterone undecanoate in hypogonadal men with SCD.
- To monitor for adverse events, specifically priapism, and evaluate effects on sexual function and quality of life.
Main Methods:
- Seven adult men with homozygous SCD (Hb SS) and hypogonadism received 1g of intramuscular testosterone undecanoate for 12 months.
- Regular monitoring of testosterone levels, blood counts, organ function, and priapism events.
- Assessment of sexual function (IIEF), hypogonadism symptoms (ADAM), and quality of life (WHOQOL) via questionnaires.
Main Results:
- Testosterone undecanoate treatment led to a decrease in lactate dehydrogenase levels (p < 0.05) with stable other lab indices.
- No significant increase in priapism frequency was observed; injection site pain was the most common adverse event.
- Significant improvements in erectile function (IIEF, p=0.018) and reduction in hypogonadism symptoms (ADAM, p=0.016) were noted.
Conclusions:
- TRT with testosterone undecanoate appears safe for hypogonadal men with SCD, with no increased risk of priapism.
- This therapy may improve sexual function in men with SCD and hypogonadism.
- Further research in larger cohorts is needed to confirm these findings.
Abstract:
Hypogonadism, which is highly prevalent in men with sickle cell disease (SCD), affects quality of life and causes great morbidity. The safety of testosterone replacement therapy (TRT) in SCD in relation to priapism episodes is relatively unknown. Our aim was to monitor the safety of TRT in a cohort of seven hypogonadal men with SCD. Testosterone undecanoate (Nebido) 1 g was administered intramuscularly to adult men with homozygous SCD (Hb SS) having hypogonadism [serum total testosterone ≤12.0 nmol/L (346 ng/dL), reference range 12.5-38.1 nmol/L (360-1098 ng/dL)] for 12 months. Serum total testosterone, haemoglobin, haematocrit, renal and liver function tests, glucose and PSA measurements were done at baseline and 12-month follow-up. Trough serum total testosterone, haemoglobin and haematocrit were measured three monthly. Priapism events and adverse drug events were assessed every 3 months. International Index of Erectile Function (IIEF), Androgen Deficiency in the Ageing Male (ADAM) and World Health Organization Quality of Life (WHOQOL) questionnaires were administered at baseline, 6 and 12 months. Seven men with a mean age of 34.4 years were treated. Median total testosterone increased from 10.6 to 11.2 nmol/L (p = 0.46). Median serum lactate dehydrogenase levels decreased from 1445 to 1143.5 IU/L (p < 0.05), while all other laboratory indices remained stable. Injection site pain was the most frequently reported adverse event, with no increases in painful crises, hypersensitivity or oedema. After TRT, there was no significant increase in priapism frequency. Median questionnaire scores were increased for the IIEF (46-68, p = 0.018), reduced for ADAM (5.0-2.0, p = 0.016) and unchanged for WHOQOL (98-103, p = 0.086). TRT using testosterone undecanoate with eugonadal intent for hypogonadism appears to be safe in men with SCD. This treatment does not appear to promote priapism occurrences and rather it possibly improves sexual function. Future prospective evaluations in larger groups of hypogonadal men with SCD are necessary to confirm these findings.
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