Special Considerations for Care
According to Dr. Sullivan, treatment modalities and treatment goals are the same for men with hypogonadism with or without SCI. The one exception is hope for improved sexual function in men with motor-complete SCI.
It remains unclear whether recovery from injury will also lead to recovery of gonadal function because no studies have been conducted so far, and recovery is uncommon.
“Special considerations include setting realistic expectations for improvement in sexual function in men with deficits due to direct neurological insult to sexual function and assessing the role of chronic pain medications as contributing factors to testosterone deficiency in this population,” said Dr. Sullivan.
“Considerations in which testosterone formulation to use include [choosing] formulations that will not affect skin quality in men already at risk for chronic skin ulcers due to immobility, for example. Considerations should be made with respect to testosterone patch placement or testosterone gel application site.”
Because cardiovascular disease (CVD) is a leading cause of death among men with SCI who achieve long-term post-injury survival, Dr. Sullivan recommends that clinicians implement preventive strategies to minimize CVD-related morbidity and mortality among SCI individuals. In addition, routine screening for hypogonadism is warranted in all men with SCI.
Going forward, Sullivan and colleagues aim to conduct a randomized, controlled trial of testosterone replacement therapy in young men with chronic SCI. This could determine whether it benefits such men in terms of CVD risk, health-related quality of life and bone mineral density.
- National Spinal Cord Injury (SCI) Statistical Center at the University of Alabama at Birmingham. Spinal Cord Injury Facts and Figures at a Glance. Available at: https://www.nscisc.uab.edu/PublicDocuments/fact_figures_docs/Facts%202014.pdf. Accessed October 27, 2014.
- Sullivan SD et al. SAT-555: Prevalence and Etiology of Hypogonadism Among Men with Chronic Spinal Cord Injury. The Endocrine Society’s 95th Annual Meeting and Expo; June 15-18, 2013; San Francisco.
- Sullivan SD et al. SAT-557: Hypogonadism is Associated with Increased Cardiometabolic Risk in Young Men with Chronic Spinal Cord Injury. The Endocrine Society’s 95th Annual Meeting and Expo; June 15-18, 2013; San Francisco.