Presentation Authors: Carolyn A. Salter*, New York, NY, Alexander Zajichek, Cleveland, OH, Nicole Benfante, New York, NY, Michael Kattan, Cleveland, OH, John P. Mulhall, New York, NY
Introduction: Clomiphene citrate (CC) has established itself as a useful management strategy for men with testosterone deficiency (TD). While CC has been shown to be efficacious in younger men and men with low baseline luteinizing hormone (LH) levels, it is unclear if it is effective in a diverse population of TD patients. We attempted to develop a nomogram to aid clinicians in defining the likelihood of response to CC in men with TD.
Methods: The study population included all men on CC for TD who had available information on age, and baseline and post-treatment T and LH levels. Men with baseline total T â‰¥ 400 ng/dL were excluded. All men started on 25mg clomiphene every other day (QOD) and those with only a partial response were increased to 50mg QOD. Descriptive statistics were used to describe the patient cohort. Logistic regression was used to model the probability of attaining a total T increase of 200 ng/dL within 6 months. Predictors entered into the model were patient age, baseline total T, and baseline LH levels (see figure below).
Results: A total of 143 men in our database had the appropriate data and were included in our study. Median age was 61.7 (IQR 50, 67.5) years. Median baseline T was 287 (IQR 220, 327) ng/dL and LH 3.65 (2.8, 4.9) IU/L. For comorbidities, 42% of men had hypertension, 14.7% diabetes, 45.5% hyperlipidemia, 21.7% sleep apnea, 2.8% coronary artery disease. 32% men were on 25mg QOD and 68% were increased to 50mg QOD. 62% of men had an increase in T of â‰¥200ng/dL within 6 months of starting CC. Predictors of achieving this T increase were younger age, lower baseline LH, and lower baseline total T, though none of these were found statistically significant at a 0.05 level. The concordance index for the nomogram was 0.54. Functional examples of the performance of the nomogram are presented in the table below.
Conclusions: 62% of men experience a T increase of â‰¥ 200ng/dL within 6 months of starting CC. The most potentially influential predictor of this rise is patient age, followed by baseline total T and then baseline LH.