MP48-05 COMBINATION THERAPY WITH AN AROMATASE INHIBITOR IS NEEDED IN ONE OUT OF SIX HYPOGONADAL MEN TREATED WITH CLOMIPHENE CITRATE (2014)

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Medical and Non-surgical1 Apr 2014MP48-05 COMBINATION THERAPY WITH AN AROMATASE INHIBITOR IS NEEDED IN ONE OUT OF SIX HYPOGONADAL MEN TREATED WITH CLOMIPHENE CITRATE Tristan Nicholson, Brett Johnson, Andrew Brunk, Tracy Downs, William Ricke, and Daniel Williams Tristan NicholsonTristan Nicholson More articles by this author , Brett JohnsonBrett Johnson More articles by this author , Andrew BrunkAndrew Brunk More articles by this author , Tracy DownsTracy Downs More articles by this author , William RickeWilliam Ricke More articles by this author , and Daniel WilliamsDaniel Williams More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1479AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail 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. Table 1. Demographic information for hypogonadal men treated with CC monotherapy versus CC+AZ. CC (n = 225) CC + AZ (n = 46) Age (years) 36.7 (SD = 8.9, range 19-77) 36.2 (SD = 8.0, range 21 - 62) Race 192 (85%) Caucasian 42 (91%) Caucasian 8 (4%) Hispanic 0 (0%) Hispanic 5 (2%) African American 1 (2%) African American 14 (6%) Asian 3 (7%) Asian 1 (0.4%) Native American 0 (0%) Native American 5 (2%) Other 0 (0%) Other BMI (kg/m2) 29.6 (SD = 6.0, range 18.1 – 31.9)±±± 35.1 (SD = 7.7, range 23.9 – 61.6) © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e528-e529 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Tristan Nicholson More articles by this author Brett Johnson More articles by this author Andrew Brunk More articles by this author Tracy Downs More articles by this author William Ricke More articles by this author Daniel Williams More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...