Presentation Authors: David Chernobylsky, Tan Le*, New Orleans, LA, Tony Chen, Seattle, WA, Amit Reddy, Jacob Greenberg, Laith Elzweri, Wayne Hellstrom, Omer Raheem, New Orleans, LA
Introduction: Although Testosterone replacement therapy (TRT) is an effective treatment for hypogonadism, recent concerns regarding its safety have been raised. Fertility preservation is another potential concern especially for men in reproductive age. We aim to assess the effect of Selective Estrogen Receptor Modulator (SERM), Aromatase Inhibitor (AI) and human Chorionic Gonadotrophin (hCG) on Total Testosterone levels (TT), hypogonadism and erectile function via meta-analysis
Methods: We performed a systematic literature review from 1987â€“2018 via PubMed. Subject terms used were infertility, hypogonadism, Selective Estrogen Receptor Modulator, Aromatase Inhibitor and human Chorionic Gonadotrophin. Studies which reported an effect of TT and hypogonadism following treatment of each medication were selected. Hypogonadal symptoms assessed by the androgen deficiency of the aging male (ADAM) questionnaire was included. Aggregated data was analyzed via Chi-Squared Analysis.
Results: From the available literature, 25 studies were selected, of which 12 studies evaluated efficacy of AIs, 8 evaluated SERMs, and 5 evaluated hCG effects. For SERMs, 512 patients with mean age 42.3Â±1.94 years showed mean TT pre-treatment vs post-treatment (167.9Â±202.8 vs 366.2Â±32.3, P < 0.0001 [180.5-216.1 95% CI]). For AIs, 375 patients with mean age 54.1Â±0.67 years showed mean TT pre-treatment vs post-treatment (167.9Â±202.8 vs 366.2Â±32.3, P < 0.0001 [180.5-216.1 95% CI]). SERMs also showed ADAM pre-treatment vs post-treatment (4.95Â±0.28 vs 5.50Â±0.19, P < 0.0001 [0.523-0.581 95% CI]). For hCG, 196 patients with mean age 41.7Â±1.5 years showed mean TT pre-treatment vs post-treatment (284.5Â±13.6 vs 565.6Â±39.7, P < 0.0001 [275.2-287.0 95% CI]). In addition, hCG also showed ADAM pre-treatment vs post-treatment (28.1Â±2.0 vs 30.9Â±2.3, P < 0.0001 [2.313.2 95% CI]).
Conclusions: Non-testosterone therapies are efficacious in men with hypogonadism. Our results show statistically significant improvement in TT and ADAM scores in all three medications following treatment. Future studies are warranted to further elucidate the relationship between improved hypogonadism and erectile function in the setting of non-testosterone based treatment.