Brown, Bradley G. Hammill, Laura G. Qualls PURPOSE: Testosterone replacement therapy may ameliorate symptoms of hypogonadism commonly experienced by men with cirrhosis. Anabolic steroids have been reported to be associated with tumor development including hepatic adenomas and hepatocellular carcinoma (HCC). It is unclear if hormone therapy affects HCC risk or progression. Our aim was to identify rates of symptomatic hypogonadism in male
patients listed for liver transplantation (LT), and assess the tumor burden and outcomes associated with testosterone replacement therapy. METHODS: Patients on the current LT list were surveyed to diagnose symptomatic
Topoisomerase inhibitor Selumetinib purchase hypogonadism using the Androgen Deficiency in the Aging Male (ADAM) questionnaire. History of testosterone replacement therapy was noted. We then retrospectively reviewed records of male patients with HCC listed for LT, from 2009 to 2014. The outcomes of those who were currently or previously using testosterone therapy were compared to those never on therapy prior to LT. Measures of outcomes included tumor burden, tumor size and vascular thrombosis. Statistical analysis included Student’s t-test and Chi-square. RESULTS: On survey of the current transplant list, 20 of 32 male individuals (63%) were suspected to have symptomatic hypogonadism using the questionnaire. The primary complaints included sexual dysfunction (75%), fatigue (60%) and loss of muscle mass (60%). Only 4 individuals (20%) had been evaluated for their hypogonadism,
of which 2 were on testosterone therapy. 75% (n=15) of individuals were amenable to being on testosterone therapy. Review of Mirabegron previously listed patients with HCC from 2009 to 2014 showed that 5 of 96 individuals were ever on testosterone therapy. Mean duration of therapy was 11 months, at a mean dose of 50mg testosterone gel daily. Of the patients who had received testosterone therapy, there was no significant difference in tumor burden (p = 0.159 for ≥3 lesions), tumor size (p = 0.44 for size ≥3cm) or vascular thrombosis (p = 0.268) prior to transplantation. CONCLUSION: Symptomatic hypogonadism is under-diagnosed in male individuals with cirrhosis and HCC. It is known that testosterone replacement therapy improves sexual function as well as bone mineral density & muscle mass, and should be offered to those who are evaluated to have symptomatic hypogonadism from low serum testosterone levels. Further studies are ongoing to correlate sex hormone levels and testosterone replacement with HCC. Disclosures: Vinay Sundaram – Advisory Committees or Review Panels: Salix, Gilead, Jansen; Speaking and Teaching: Salix Tram T.