Ramachandran, S, Hackett, GI and Strange, RC (2020) Testosterone replacement therapy: Pre-treatment sex hormone binding globulin levels and age may identify clinical subgroups. Andrology.

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Abstract

BACKGROUND: Testosterone replacement therapy (TRT) improves health in some but not all men with type 2 diabetes (T2DM) and adult onset testosterone deficiency (TD). Such heterogeneity is compatible with the concept of patient subgroups that respond differently to therapy. OBJECTIVES: Use baseline SHBG and age to identify putative subgroups that demonstrate different responses in variables such as waist circumference and HbA1c following TRT. MATERIALS AND METHODS: A randomised double-blind trial approach was used to recruit and randomise men with T2DM and adult onset TD into placebo and TRT treated groups. Multiple regression was used to study differences between groups. RESULTS: Baseline SHBG and change in SHBG (∆SHBG) were inversely related in the TRT group. Both median values of SHBG and age mediated the effect of TRT on ∆SHBG depending on whether baseline values were ≤ or >median (28.1nmol/l, 63 years respectively). In men with both SHBG≤28.1 nmol/l and age≤63 years (subgroup 1), TRT was positively associated with ∆SHBG (c = 4.67, 95%CI 1.17 - 8.16, p=0.010) while in those with SHBG>28.1 nmol/l and age>63.1 years (subgroup 4) the association was inverse (c = -7.07, 95%CI -11.64 - -2.49, p=0.003). The association between TRT and change (∆) in waist circumference, HbA1c and International Index of Erectile Function (IIEF) score differed between subgroups; in subgroup 4 but not subgroup 1, the therapy was significantly, associated with ∆waist circumference, ∆HbA1c and ∆IIEF. DISCUSSION: Though the mechanism remains unclear, our finding of different responses to TRT in terms of change in waist circumference, HbA1c and IIEF score supports the concept of subgroups in men with T2DM and adult onset TD. CONCLUSION: Our approach may provide a basis for identifying men who will or will not derive benefit from TRT though a larger study is required.

Item Type: Article
Additional Information: The final accepted manuscript and all relevant information regarding this paper can be found at; https://onlinelibrary.wiley.com/doi/abs/10.1111/andr.12813
Uncontrolled Keywords: testosterone therapy; sex hormone binding globulin; testosterone; type 2 diabetes
Subjects: R Medicine > R Medicine (General)
R Medicine > R Medicine (General) > R735 Medical education. Medical schools. Research
R Medicine > RA Public aspects of medicine
Divisions: Faculty of Medicine and Health Sciences > School of Pharmacy and Bioengineering
Related URLs:
Depositing User: Symplectic
Date Deposited: 21 May 2020 14:31
Last Modified: 11 Jun 2020 09:59
URI: https://eprints.keele.ac.uk/id/eprint/7995

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