Long term testosterone undecanoate replacement therapy: impact of ethnicity

Long term testosterone undecanoate replacement therapy: impact of ethnicity:

Abstract

Background

Testosterone Replacement Therapy (TRT) is indicated for symptomatic male hypogonadism. However, the safety and efficacy profiles across different ethnicities for long term TRT remain unclear.

Objective

To measure the impact of ethnicity on various biochemical parameters following Testosterone Undecanoate (TU) replacement.

Method

A retrospective analysis of 50 male patients treated with TU from 2006 to 2017 in a large secondary care centre was performed. Changes in total testosterone, PSA, haematocrit, haemoglobin, total cholesterol, low density lipoprotein (LDL) over eight years of treatment were analysed. Wilcoxon rank sum test was used to assess differences in these parameters between Caucasians and South Asians.

Results

31 Caucasians (age: median (IQR) 55.0 years (49.0‐68.0); total duration of follow up 6.1 years (2.9‐9.3) and 19 South Asians (age: median (IQR) 52.0 years (38.0‐69.0); duration of follow up 6.5 years (1.3‐8.4) were treated with TU during the study period. There was no significant difference in total testosterone levels between the two ethnicities. We noted a higher free and bioavailable testosterone in South Asians compared to Caucasians, albeit within their reference range. PSA was higher in Caucasians compared to South Asians at two and eight years of TU therapy. After one year of TRT, haematocrit was higher in South Asians compared to Caucasians at one year, whereas LDL and total cholesterol were significantly higher in Caucasians than South Asians.

Conclusions

Caucasians have a tendency towards increased PSA, total cholesterol and LDL compared to South Asians with TU replacement therapy. There is a higher increment of haematocrit in South Asians following one year of TU replacement therapy. All biochemical changes following TRT were within the respective reference ranges suggesting no apparent risk of prostate cancer and venous thromboembolism.