Treatment of Estrogen Levels in the Management of Hypogonadism: An Anonymous Survey of ISSM Members

To assess the variability in management of estrogen levels in men treated with testosterone therapy (TTh). With the significant increase in the last 2 decades in the treatment of hypogonadism and the use of TTh, detailed guidelines for the management of estrogen levels are necessary.¹ MATERIALS AND METHODS: An anonymous survey was electronically distributed to the membership of the International Society for Sexual Medicine including questions on demographics, symptoms, and their approach to management of estrogen in patients on TTh. Chi-square test was used to determine associations.

The response rate was 22.5% (489/2168). A total 62.4% of respondents indicated that they check serum estrogen at initial evaluation, but only 54.7% monitor levels in patients on TTh (P = .02). Fellowship-trained and North American respondents were more likely to monitor patients (P < .05). A total of 69.4%, 47.7%, and 14.4% respondents prescribe antiestrogenic medications in symptomatic patients with elevated estrogen levels, for asymptomatic-elevated estrogen levels, and prophylactically, respectively. Academic respondents were more likely to prescribe an antiestrogen medication to symptomatic patients and prophylactically (P < .05). Anastrozole was the most common medication prescribed for symptomatic hyperestrogenemia (62.3%), but starting doses varied significantly, from 1 mg weekly to 1 mg daily.

Approximately 50% of practitioners treating men with TTh monitor estrogen levels. Symptoms play a role in prescribing patterns and significant variability in aromatase inhibitors regimens exists. Increased monitoring of estrogen levels in men on TTh will facilitate an understanding of the symptoms, effects of high and low estrogen levels, and aid in standardization of research and therapy.