Nelson Vergel
Founder, ExcelMale.com
A COMPARISON OF ESTRADIOL LEVELS AND GYNECOMASTIA RATES IN HYPOGONADAL MEN USING CLOMIPHENE CITRATE VERSUS TRANSDERMAL TESTOSTERONE
INTRODUCTION AND OBJECTIVES
Clomiphene citrate (CC) is recognized as a management strategy in men with hypogonadism (HG). Some concern exists regarding its ability to raise serum estradiol (E2) levels given its mechanism of action. Serum total testosterone (TT) may be converted to E2 by aromatase irrespective of which T replacement therapy (TRT) modality is used. This analysis was undertaken to compare serum E2 levels in men with HG using CC versus transdermal T (TDT).
METHODS
Study population consisted of men with (i) HG (two early morning serum TT levels <300ng/dl) (ii) who were on either CC or TDT (iii) normal baseline E2 levels (iv) therapy for ≥6 months and (v) follow-up T and E2 levels. CC was commenced at 25 mg every other day and titrated up to 50mg daily to maintain men in the 500-600 ng/dl TT range. Likewise, TDT was titrated to achieve the same effect. All men were examined every 6 months for gynecomastia.
RESULTS
164 men on TDT, mean age = 58±12 years and 142 men on CC, mean age = 44±24 years were studied. Mean duration of treatment: CC 16 months; TDT 22 months. Significant improvements in mean TT levels were seen for both groups during treatment: CC 261 to 498 ng/dl (p<0.05), TDT 246 to 574 ng/dl (p<0.05); no significant difference between CC and TDT for baseline or treatment TT levels. Significant differences existed for LH levels in both groups during treatment: CC 2.4 to 7.8 (p<0.01); TDT 6.2 to 1.4 (p<0.01); significant difference between CC and TDT LH levels at baseline (p<0.01) and on treatment (p<0.01). Baseline E2 levels were similar for both groups (CC 19, TDT 22, p=NS), however, end of treatment E2 levels were significantly increased in both groups (p<0.05) and in particular were significantly different in each group: CC 44pg/ml; TDT 31 pg/ml (p<0.05). Gynecomastia rates were: CC 4/142 (2.8%), TDT 6/164 (3.6%), p=NS.
CONCLUSIONS
While CC increased E2 levels to a significantly greater extent than TDT, the difference is likely not clinically meaningful. Gynecomastia rates were similar between both groups.
Source:
The Journal of Urology
Volume 193, Issue 4, Supplement, April 2015, Pages e9042015 Annual Meeting Program AbstractsAUA Annual Meeting
INTRODUCTION AND OBJECTIVES
Clomiphene citrate (CC) is recognized as a management strategy in men with hypogonadism (HG). Some concern exists regarding its ability to raise serum estradiol (E2) levels given its mechanism of action. Serum total testosterone (TT) may be converted to E2 by aromatase irrespective of which T replacement therapy (TRT) modality is used. This analysis was undertaken to compare serum E2 levels in men with HG using CC versus transdermal T (TDT).
METHODS
Study population consisted of men with (i) HG (two early morning serum TT levels <300ng/dl) (ii) who were on either CC or TDT (iii) normal baseline E2 levels (iv) therapy for ≥6 months and (v) follow-up T and E2 levels. CC was commenced at 25 mg every other day and titrated up to 50mg daily to maintain men in the 500-600 ng/dl TT range. Likewise, TDT was titrated to achieve the same effect. All men were examined every 6 months for gynecomastia.
RESULTS
164 men on TDT, mean age = 58±12 years and 142 men on CC, mean age = 44±24 years were studied. Mean duration of treatment: CC 16 months; TDT 22 months. Significant improvements in mean TT levels were seen for both groups during treatment: CC 261 to 498 ng/dl (p<0.05), TDT 246 to 574 ng/dl (p<0.05); no significant difference between CC and TDT for baseline or treatment TT levels. Significant differences existed for LH levels in both groups during treatment: CC 2.4 to 7.8 (p<0.01); TDT 6.2 to 1.4 (p<0.01); significant difference between CC and TDT LH levels at baseline (p<0.01) and on treatment (p<0.01). Baseline E2 levels were similar for both groups (CC 19, TDT 22, p=NS), however, end of treatment E2 levels were significantly increased in both groups (p<0.05) and in particular were significantly different in each group: CC 44pg/ml; TDT 31 pg/ml (p<0.05). Gynecomastia rates were: CC 4/142 (2.8%), TDT 6/164 (3.6%), p=NS.
CONCLUSIONS
While CC increased E2 levels to a significantly greater extent than TDT, the difference is likely not clinically meaningful. Gynecomastia rates were similar between both groups.
Source:
The Journal of Urology
Volume 193, Issue 4, Supplement, April 2015, Pages e9042015 Annual Meeting Program AbstractsAUA Annual Meeting
