Effects of Testosterone and Estradiol Deficiency on Vasomotor Symptoms in Hypogonadal Men

    loading  Checking for direct PDF access through Ovid

Abstract

Context:

The hormonal basis of vasomotor symptoms (VMS) in hypogonadal men is incompletely understood.

Objective:

To determine the contributions of testosterone and estradiol deficiency to VMS in hypogonadal men.

Design:

Two randomized trials were conducted sequentially between September 2004 and April 2011. Controls were recruited separately.

Setting:

A single-site academic medical center.

Participants:

Healthy men ages 20–50, with normal serum testosterone levels.

Intervention:

Cohort 1 (n = 198, 81% completion) received goserelin acetate every 4 weeks to suppress gonadal steroids and were randomized to placebo or 1.25, 2.5, 5, or 10 g of testosterone gel daily for 16 weeks. Cohort 2 (n = 202, 78% completion) received the same regimen as cohort 1 plus anastrozole to block aromatization of testosterone. Controls (n = 37, 89% completion) received placebos for goserelin acetate and testosterone.

Main Outcome Measures:

Incidence of visits with VMS. This was a preplanned secondary analysis.

Results:

VMS were reported at 26% of visits in cohort 1, and 35% of visits in cohort 2 (P = .02), demonstrating an effect of estradiol deficiency. When adjacent estradiol level groups in cohort 1 were compared, the largest difference in VMS incidence was observed between the 5–9.9 and 10–14.9 pg/mL groups (38% vs 16%, P < .001). In cohort 2, the 10-g testosterone group differed significantly from placebo (16% vs 43%, P = .048) after adjustment for small differences in estradiol levels, indicating that high testosterone levels may suppress VMS.

Conclusions:

Estradiol deficiency is the key mediator of VMS in hypogonadal men. At high levels, testosterone may have a suppressive effect.

Related Topics

    loading  Loading Related Articles