Predictive factors for maintenance of efficacy after cessation of testosterone treatment
Park, MG1; Yeo, JK2; Lee, JW 3
1: Inje university, Seoul Paik hospital, Korea, South; 2: Inje university, Seoul Paik hospital; 3: Dongguk university hospital
Objective; For patients with testosterone deficiency (TD), there is no conclusive evidence whether discontinuation of treatment is possible or treatment must continue for the rest of lives. If there is a way to maintain efficacy of TRT after cessation of treatment, the potential risks associated with TRT could be reduced. Therefore, predictive factors for maintenance of efficacy of TRT after stopping treatment were investigated in this study.
Material and Methods; From 2011 to 2016, among 720 hypogonadal patients, 151 men in whom TRT was effective and who were available for follow-up over 6 months after the discontinuation of TRT were included in this study. The type of TRT was consisted of oral testosterone undecanoate (TU), testosterone gel, injection of testosterone enanthate, and injection of TU. Baseline serum total testosterone (TT) levels, the highest TT levels during TRT, and the recent TT levels at 6 months after discontinuation of TRT were investigated with the patients′ medical records including age, body mass index (BMI), waist circumference (WC), comorbidities, life styles, period and type of TRT. Maintenance of response was determined by the recent serum TT levels and the answer of patients to global assessment question about the TD symptoms compared with the baseline
Results; 92 patients (group I) failed to show maintenance of response, and 59 patients (group II) maintained the response over 6 months after the stopping TRT. In comparison between two groups, there was no significant difference in age, comorbidities, WC, and BMI. There was also no significant difference in the type of TRT between the two groups. However, group II showed a longer duration of TRT (10.7 vs 5.2 months, p<0.001) and the peak TT levels during the TRT of group II was significantly higher than the group I (713.7 vs 546.1 ng/dl, p<0.001). The ratio of regular exercise (>3 times a week for 30 minutes) was significantly higher in group II compared to group I (45.8 vs 9.8%, p<0.001). The multivariate analysis by logistic regression model revealed that exercise (B=2.325, Exp(B)=10.231, p<0.001) and the duration of TRT (B=0.153, Exp(B)=1.166, p<0.001) were independent predictive factors for maintenance of response.
Conclusions; In hypogonadal men in whom TRT was effective, the longer period of treatment can improve the durability of response after stopping TRT, regardless of the type of testosterone treatment. Regular exercise can also lead to 10-fold increase of probability of maintaining the response after cessation of TRT.
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