Compliance with Testosterone Replacement Therapy

Take-home points:

• The benefits of TRT are not always immediate.
• Benefits range from improved sex drive, erectile function, as well as improved quality of life for patients with hypogonadism.
• Discontinuation rates can be high, and this is often down to side effects and a poor understanding of how to use TRT.
• Speak to your doctor if you are experiencing any side effects or lack of benefit with TRT, and your doctor will run through what alternative treatments are available.

What is medication compliance?

Medication compliance is staying on your medication as prescribed and recommended by your doctor. Although the idea of not taking prescribed medication may seem strange, it happens repeatedly and can impact health outcomes such as not getting better or worsening of the underlying condition.¹

Men with hypogonadism (also known as low testosterone), experience an array of symptoms that can significantly impact quality of life.^2,3 Testosterone replacement therapy (TRT) has been shown to alleviate these symptoms and confer a wide range of health benefits.⁴ To maximise the benefits of TRT, staying on treatment is key.  

The benefits of staying on TRT

Despite the proven health benefits of TRT, there’s a large proportion of patients who discontinue treatment early.

• In one study evaluating adherence rates to TRT in over 15,000 hypogonadal men, only 34.7% were still taking their TRT at 6 months, and only 15.4% at 12 months.⁵

To put these findings into context, the British Society of Sexual Medicine (BSSM) recommends hypogonadal patients receive testosterone therapy for a minimum of 6 months.⁶  

What benefits may I observe with my Testosterone treatment, and when?

In men with hypogonadism (low testosterone), TRT has been shown to be associated with:

Increased sex drive (libido) and erectile function^7,8

When?

• 1 month^7,8

‍Improved quality of life^9,10

When?

• 6 months^9,10

Alleviation of depressed moods¹¹ ‍

When?

• Between 6 weeks to 7 months¹¹

‍Improved bone health in men with low bone density^12–14

When?

• From 6 months

Improved haemoglobin levels in patients with anaemia^15,16

When?

• Up to 12 months^15,16

Improvements in waist circumference and body fat in overweight patients¹⁷

When?

• From 12 months¹⁷

Reasons for discontinuation and improving adherence to TRT

There are several reasons why patients tend not to take medications. Some of the common reasons include worrying about a particular side effect, or misinterpreting how their medication should be taken.

• One study found that over 60% of patients who were interviewed right after leaving their doctors had misunderstood the directions they had been given for taking their medications.¹

If you have any concerns on how to take TRT, it's important to speak to your doctor as they will be happy to run through the demonstration again.

Side effects are a common concern that can lead to avoiding your prescribed TRT. If you are experiencing a side effect from treatment, it's important to speak to your doctor.

Join the conversation on the TRTed Community!

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References

1. Jimmy. Oman Med J. 2011 May; 26(3): 155–159.
2. Goodale, et al. Methodist Debakey Cardiovasc J. 2017;13(2):68–72.
3. Barbonetti, et al. Andrology. 2020; 8(6):1551–1566.
4. Saad F, et al. Eur J Endocrinol. 2011;165(5):675–85.
5. Schoenfeld M.J, et al. J Sex Med 2013. 10(5): 1401–9.  
6. Hackett G, et al. J Sex Med 2017;14:1504–1523.
7. Mulhall JP, et al. Urol. 2004;63(2):348–353.
8. Wang C, et al. Clin Endocrinol Metab. 2000;85(8):2839–2853.
9. Rosen RC, et al. J Seks Med 2017;14(9):1104–1115.
10. Elliot J, et al. BMJ Open 2016 ;16 :e015284.
11. Walther A, et al. JAMA Psychiatry 2019;76(1):31–49.
12. Isidori AM, et al. Clin Endocrinol 2005;63(3):280–93.
13. Watts BW, et al. J Clin Endo & Metab 2012;97(6):1802–1822.
14. Wang C, et al. J Clin Endo & Meab 2004;89(5):2085–2098.
15. Roy N, et al. JAMA Intern Med 2017;177(4):480–490.
16. Zhang LT, et al. J Urology 2016;195(4):1057–1064.
17. Wang C, et al. J Clin Endo 2004;89(5):2085–2098.
18. Kang, et al. World J Mens Health. 2022;40(4):686–692.

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