Nelson Vergel
Founder, ExcelMale.com
Abstracts printed from AUA2014.org
COMBINATION THERAPY WITH AN AROMATASE INHIBITOR IS NEEDED IN ONE OUT OF SIX HYPOGONADAL MEN TREATED WITH CLOMIPHENE CITRATE
Authors: Tristan Nicholson*, Brett Johnson, Andrew Brunk, Tracy Downs, William Ricke, Daniel Williams, Madison, WI
Abstract: MP48-05
Introduction and Objectives
Clomiphene citrate (CC) is a selective estrogen receptor modulator used off label to stimulate endogenous testosterone production in hypogonadal men. In some patients, CC leads to elevated estradiol levels, necessitating combination therapy with an aromatase inhibitor, such as anastrozole (AZ). The objectives of this project were to (1) determine the previously unreported rate of conversion from CC monotherapy to combination therapy with CC+AZ in hypogonadal men, and (2) test the hypothesis that men needing combination therapy with CC+AZ would have higher body mass index (BMI) compared to men maintained on CC monotherapy.
Methods
We obtained institutional review board approval and performed a retrospective chart review of hypogonadal men treated with CC by a single urologist at our institution between 2006 and 2013. Response to CC therapy was monitored with serum hormones; when estradiol became elevated above the reference range, AZ therapy was added.
Results
We identified 271 hypogonadal men treated with CC and followed for an average of 28 months (SD = 19). Following initiation of CC therapy, 46 (17%) patients required combination therapy with CC+AZ due to elevated estradiol levels. While age and race were similar between groups, the average BMI of patients who converted to CC+AZ combination therapy was significantly higher than those patients who remained on CC monotherapy (Table 1, p < 0.001).
Conclusions
Following initiation of therapy with CC, 17% of hypogonadal men developed elevated estradiol levels, necessitating combination therapy with an aromatase inhibitor. Men requiring the addition of AZ were obese (BMI > 30 kg/m2), implicating increased peripheral aromatization of androgens to estrogens as a contributor to elevated estradiol levels in these men during CC therapy.
COMBINATION THERAPY WITH AN AROMATASE INHIBITOR IS NEEDED IN ONE OUT OF SIX HYPOGONADAL MEN TREATED WITH CLOMIPHENE CITRATE
Authors: Tristan Nicholson*, Brett Johnson, Andrew Brunk, Tracy Downs, William Ricke, Daniel Williams, Madison, WI
Abstract: MP48-05
Introduction and Objectives
Clomiphene citrate (CC) is a selective estrogen receptor modulator used off label to stimulate endogenous testosterone production in hypogonadal men. In some patients, CC leads to elevated estradiol levels, necessitating combination therapy with an aromatase inhibitor, such as anastrozole (AZ). The objectives of this project were to (1) determine the previously unreported rate of conversion from CC monotherapy to combination therapy with CC+AZ in hypogonadal men, and (2) test the hypothesis that men needing combination therapy with CC+AZ would have higher body mass index (BMI) compared to men maintained on CC monotherapy.
Methods
We obtained institutional review board approval and performed a retrospective chart review of hypogonadal men treated with CC by a single urologist at our institution between 2006 and 2013. Response to CC therapy was monitored with serum hormones; when estradiol became elevated above the reference range, AZ therapy was added.
Results
We identified 271 hypogonadal men treated with CC and followed for an average of 28 months (SD = 19). Following initiation of CC therapy, 46 (17%) patients required combination therapy with CC+AZ due to elevated estradiol levels. While age and race were similar between groups, the average BMI of patients who converted to CC+AZ combination therapy was significantly higher than those patients who remained on CC monotherapy (Table 1, p < 0.001).
Conclusions
Following initiation of therapy with CC, 17% of hypogonadal men developed elevated estradiol levels, necessitating combination therapy with an aromatase inhibitor. Men requiring the addition of AZ were obese (BMI > 30 kg/m2), implicating increased peripheral aromatization of androgens to estrogens as a contributor to elevated estradiol levels in these men during CC therapy.
