and erectile function) and psychological symptoms (de-
creased enjoyment in life, sad or grumpy mood, lack of
energy, decreased ability to play sports) responded to TST.
Physical symptoms such as recent deterioration in work
performance, falling asleep after dinner, and loss of height
did not appear to improve with TST.
We compared the hormone parameters and symptom
characteristics of men who responded to TST (
= 17;
improvement of three or more symptoms on ADAM) with
men who did not respond to TST (
= 14; improvement of
one or no symptom on ADAM). Men who responded to TST
were younger (aged 48.9 vs 58.3 yr) and had larger increases
in serum total testosterone (368.9 vs 205.3 ng/dl) and free
testosterone (13.1 vs 4.8 pg/ml). On univariate and
multivariate analyses, only age predicted men who
responded to TST (odds ratio: 0.926;
= 0.03). Younger
men appeared to respond better to symptom improvement
following testosterone therapy. Type of TST (injection vs
gel) and changes in posttreatment serum testosterone, free
testosterone, and estradiol levels did not predict symptom
improvement. No particular symptom on the ADAM
questionnaire predicted symptom improvement with TST.
Some strengths of this study include the prospective
design, comparison with an age- and comorbidity-matched
control group, and comparisons of symptoms and hormone
levels before and after commencement of TST. The study is
limited by its relatively small sample size and short follow-
up (approximately 6 mo for men on TST).
In summary, we found that testosterone supplementa-
tion regimens are efficacious for improving both hypogo-
nadal symptoms and serum total testosterone levels.
Carefully designed placebo-controlled trials are required
to assess efficacy and symptom improvement following
testosterone supplementation.
Conflicts of interest:
Larry I. Lipshultz is a clinical trials participant,
consultant, and speaker for Auxilium and Endo. The other authors have
nothing to disclose.
Financial support:
RanjithRamasamyisa K12 scholar supportedbya Male
Reproductive Health Research Career Development Physician-Scientist
Award (grant no. HD073917-01) from the Eunice Kennedy Shriver
National Institute of Child Health and Human Development program.
Mulligan T, Frick MF, Zuraw QC, Stemhagen A, McWhirter C. Prev-
alence of hypogonadism in males aged at least 45 years: the HIM
study. Int J Clin Pract 2006;60:762–9.
Heufelder AE, Saad F, Bunck MC, Gooren L. Fifty-two-week treat-
ment with diet and exercise plus transdermal testosterone reverses
the metabolic syndrome and improves glycemic control in men
with newly diagnosed type 2 diabetes and subnormal plasma
testosterone. J Androl 2009;30:726–33.
Haider A, Gooren LJ, Padungtod P, Saad F. Improvement of the
metabolic syndrome and of non-alcoholic liver steatosis upon
treatment of hypogonadal elderly men with parenteral testoster-
one undecanoate. Exp Clin Endocrinol Diabetes 2010;118:167–71.
Emmelot-Vonk MH, Verhaar HJ, Nakhai-Pour HR, Grobbee DE,
van der Schouw YT. Low testosterone concentrations and the symp-
tomsoftestosterone de±ciencyaccordingtothe AndrogenDe±ciency
in Ageing Males (ADAM) and Ageing Males’ Symptoms rating scale
(AMS) questionnaires. Clin Endocrinol 2011;74:488–94.
Mohamed O, Freundlich RE, Dakik HK, et al. The quantitative ADAM
questionnaire: a new tool in quantifying the severity of hypogo-
nadism. Int J Impot Res 2010;22:20–4.
Ranjith Ramasamy
Nathan Wilken
Jason M. Scovell
Larry I. Lipshultz*
Department of Urology, Baylor College of Medicine, Houston, TX, USA
*Corresponding author. 6624 Fannin Street, #1700, Houston,
TX 77030, USA.
E-mail address:
(L.I. Lipshultz).
August 19, 2014
Which Luteinising Hormone-Releasing Hormone
Agonist Injection Schedule Do Men with Prostate Cancer
Prefer? Results of a European Patient Survey
Luteinising hormone-releasing hormone (LHRH) agonists
are commonly used in the management of high-risk, locally
advanced, and metastatic prostate cancer and should be
continued when castration-resistant disease develops
Several LHRH agonists are available in Europe, with various
injection intervals
, including leuprorelin acetate (1-, 3-,
and 6-mo formulations), goserelin (1- and 3-mo formula-
tions), triptorelin (1-, 3-, and 6-mo formulations), buserelin
(2- and 3-mo formulations), and histrelin (12-mo formula-
tion). Men may require androgen deprivation therapy for
several years, but limited data are available regarding
patient preferences for treatment schedule
We report results of a face-to-face survey of 402
European men receiving LHRH agonists for advanced
prostate cancer (France,
= 50; Germany,
= 56; Italy,
= 100; Poland,
= 121; Spain,
= 75). Physicians (mainly
urologists) were asked to suggest candidates who might be
willing to participate. Interviews were conducted between
April and May 2013 in participants’ native languages and
took approximately 15 min to complete. Participants were
asked to assume that all injection intervals can equally
control prostate cancer. Data were analysed (descriptive
statistics) using Quantum by GfK SE (Nuremberg, Germany)
and interpreted by the authors.
Demographics were comparable across countries; the
mean age of participants was 72 yr (range: 37–92 yr); 58%
had been diagnosed in the previous 4 yr, with the remainder
4 yr ago. Most men (70%) were receiving
injections every 3 mo, 21% were receiving injections every
6 mo, and 9% were receiving monthly injections.
Regardless of current injection frequency, the majority of
men (60%) expressed a preference for 6-mo injection
EUROPEAN UROLOGY 67 (2015) 176–180