Unexpected resolution of chronic gastroesophageal reflux disease with testosterone replacement therapy

A 63-year-old man with a chronic, 30-year, history of gastroesophageal reflux disease (GERD) that required long-term proton pump inhibitor (PPI) use experienced complete symptom resolution after initiation of testosterone replacement therapy (TRT) for symptomatic hypogonadism. After 11 months of TRT, the patient inadvertently discontinued PPI therapy (esomeprazole 20 mg once daily) while away on vacation without any of the expected rebound acid hypersecretion he had previously experienced in the past when trying to stop. Three months post-PPI cessation, he remained asymptomatic with no requirement for antireflux medication. This case presents a novel and unexpected beneficial effect of TRT on the symptoms of GERD and contrasts with current literature that suggest hormone replacement therapy, with estrogen and progesterone, typically exacerbates reflux disease. Mechanisms behind this improvement may involve anti-inflammatory properties of testosterone, a direct effect on lower esophageal sphincter tone and improved gastric motility, or indirect benefits through weight loss and increased physical activity. Or, as is most likely, a combination of several factors. This paper highlights the need for further investigation into the relationship between testosterone and gastrointestinal physiology in men with hypogonadism.