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Serum testosterone profiles in men on testosterone therapy after bilateral orchiectomy

Torremade , J1; Kagacan, C1; Ortega, Y1; Mulhall, JP1

1: Memorial Sloan Kettering Cancer Center, USA

Objectives: A low but well recognized incidence of bilateral testis cancer occurs. Such men, requiring bilateral orchiectomy, rely entirely on adrenal androgens, sustaining a testosterone (T) level not compatible with a healthy life and thus testosterone therapy (TT) is mandatory. The objective of this study was to define the outcomes of transdermal therapy in such men.

Material and Methods: Men who had undergone bilateral orchiectomy and presented for testosterone therapy were studied. All such patients received 200mg of intramuscular testosterone injection in the recovery room at the completion of their second orchiectomy prior to discharge. 2-4 weeks later they were commenced on transdermal TT at maximum dose. 2 weeks later they had a serum total testosterone (T) level checked. If less than 300 ng/dl switching to intramuscular (IM) TT was discussed with the patient. For those who opted to switch, 100mg IM testosterone cypionate was administered and was to be injected by the patient every 7 days. An attempt was made using multivariable analysis to find predictors of achievement of a total T level >300ng/dl on transdermal TT.

Results: 47 patients were studied with a mean age of 26±11 (22-41) years. 4 had had synchronous, 43 metachronous bilateral orchiectomy. 19 of these men had been on transdermal TT between the 2 orchiectomies, all with good levels achieved. On transdermal TT, mean total T level was 246±196 (184-480 ng/dl), 20 men (42%) having levels above 300ng/dl. All 27 of the men failing to achieve a physiological T level opted to pursue IM T, as did 11/20 men who did achieve total T levels above 300. All 38 of these men achieved total T levels above 300 while injecting. On IM TT, mean total T was 711±140 (548-902) ng/dl. No predictors were found of achievement of physiological total T level on transdermal TT.

Conclusions: Many men who have undergone bilateral orchiectomy struggle to achieve physiological total T levels using transdermal testosterone administration. This information should be helpful to clinicians in their discussion with such patients.


Work supported by industry: no.

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