Replacement therapy improved libido and erectile function, and increased muscle mass, study finds.


ANAHEIM, Calif.—Testosterone replacement therapy (TRT) may be an appropriate treatment for hypogonadism in men following radical prostatectomy (RP), according to researchers.

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Although the men in their study were started on TRT on average 54.4 months after RP, clinicians may consider initiating TRT at an earlier time in symptomatic patients, the investigators said.


“Physicians have been very hesitant to put these men on testosterone since we know prostate cancer is related to testosterone,” said study investigator Larry Lipshultz, MD, professor of urology at Baylor College of Medicine in Houston. “But as it turns out, the use of testosterone replacement for hypogonadal men is both safe and effective.” He presented study findings at the American Urological Association annual meeting here.


In the study, only symptomatic men with low testosterone levels were started on TRT.  All men had negative surgical margins and an undetectable PSA level. In a follow-up telephone survey, investigators administered the ADAM (Androgen Deficiency in Aging Males) questionnaire as well as a modified ADAM questionnaire, which quantified each ADAM question on a Likert scale from 1 (terrible) to 5 (excellent).


The study included 21 men with a mean age of 63.1 years (range 51-80 years).  The average PSA level prior to RP was 6.68 ng/dL and the average Gleason score at the time of RP was 6.4. The cohort was followed for an average of 12 months following TRT initiation (range 1-60 months).

On average, testosterone levels following TRT rose from 275 to 440 ng/dL. PSA levels were 0.005 prior to TRT and 0.005 ng/dL after TRT; none of the men had biochemical recurrence.


“We saw that there was not only an improvement in the first questionnaire but also the modified ADAM questionnaire in all the men,” Dr. Lipshultz said. “The men reported improvements in sex drive or libido and erectile function, and an increase in muscle mass. The men also reported a general feeling of better well being.”


In a second study, Dr. Lipshultz and his colleagues found that simply switching brands of testosterone replacement therapy gels may effectively treat otherwise unresponsive hypogonadal men. The study showed testosterone gel substitution among initially unresponsive hypogonadal men is justified prior to abandoning or considering more invasive testosterone replacement therapy.