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KMID : 1037120230410020390
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The World Journal of Men′s Health
2023 Volume.41 No. 2 p.390 ~ p.395
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Comparison of Intratesticular Testosterone between Men Receiving Nasal, Intramuscular, and Subcutaneous Pellet Testosterone Therapy: Evaluation of Data from Two Single-Center Randomized Clinical Trials
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Parris Diaz
Rohit Reddy
Ruben Blachman-Braun
Isaac Zucker
Alexandra Dullea
Daniel C. Gonzalez
Eliyahu Kresch
Ranjith Ramasamy
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Abstract
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Purpose: Testosterone replacement therapy (TRT) can potentially cause decreased spermatogenesis and subsequent infertility.
Recent studies have suggested that 17-hydroxyprogesterone (17-OHP) is a reliable surrogate for intratesticular testosterone (ITT) that is essential for spermatogenesis. We evaluated data from two ongoing open-label, randomized, two-arm clinical trials amongst different treatment preparations (Trial I) subcutaneous testosterone pellets (TP) and (Trial II) intranasal testosterone (NT) or intramuscular testosterone cypionate (TC).
Materials and Methods: Seventy-five symptomatic hypogonadal men (2 serum testosterone <300 ng/dL) were randomized into open label randomized clinical trials. Eligible subjects received 800 mg TP, 11 mg TID NT or 200 mg ×2 weeks TC.
17-OHP and Serum testosterone were evaluated at baseline and follow-up. The primary outcome was changes in 17-OHP.
Secondary outcome was changes in serum testosterone. Data was analyzed by two-sample and single-sample t-tests, and determination of equal or unequal variances was computed using F-tests.
Results: Median participant age was 45 years old, with overall baseline 17-OHP of 46 and serum testosterone of 223.5 ng/dL.
17-OHP significantly decreased in subjects prescribed long-acting TP or TC. The 4-month change in 17-OHP in the NT group (-33.3% from baseline) was less than the change seen in TC (-65.3% from baseline) or TP (-44% from baseline) (p=0.005). All testosterone formulations increased serum testosterone levels at follow-up, with the largest increase seen in TC (+157.6%), followed by NT (+114.3%) and TP (+79.6%) (p=0.005).
Conclusions: Short-acting nasal testosterone appear to have no impact on serum 17-OHP especially in comparison to longacting testosterone formulations. All modalities saw significant increases in serum testosterone levels at follow-up. NT and other short acting testosterone formulations may better preserve ITT and be beneficial for hypogonadal men seeking to maintain fertility potential while on TRT.
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KEYWORD
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17-alpha-Hydroxyprogesterone, Androgens, Fertility, Hypogonadism, Testosterone
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