Laird Harrison

May 16, 2013

SAN DIEGO, California — Not everyone with injured testes needs testosterone replacement, according to a study of wounded soldiers.

Ten percent of the 50,000 American soldiers wounded in Afghanistan and Iraq have injuries to the genitourinary tract, which is double the rate of previous conflicts, said Col. Robert Dean, MD, from the Walter Reed National Military Medical Center in Bethesda, Maryland.

"Initially, we thought all these men would need testosterone replacement," Dr. Dean told reporters attending a news conference here at the American Urological Association (AUA) 2013 Annual Scientific Meeting. "But now as we see a rise in endogenous testosterone, we might just follow them."

More soldiers are surviving with genital wounds because body armor saves their lives and because many injuries come from improvised explosive devices, said Molly Williams, MD, a urologist at Walter Reed.

Literature on burns supports the use of exogenous androgens to attenuate protein loss and muscle wasting. But literature on trauma shows that a low testosterone state protects against pulmonary and gastrointestinal injuries by slowing metabolism.

To better understand the need for testosterone replacement in patients with genital injuries, the researchers retrospectively identified 84 patients at Walter Reed for whom testosterone records were available.

All but 3 had scrotal injuries. Collectively, the patients sustained 282 nonscrotal injuries, mostly below the waist.

The researchers identified 27 patients whose testosterone levels returned to normal, defined as 250 ng/dL, after the injuries.

They found that those who recovered did so in a median of 65 days, but the range was from 21 to 714 days. In general, they recovered within 5 months, the researchers report.

The patients who recovered normal testosterone levels on their own started with higher baseline levels than those who did not.

In addition, the speed at which testosterone levels rose was higher in those who recovered than in those who did not. There was also a trend toward a faster recovery in those with less severe injuries, but this was not statistically significant.

Among the men who needed testosterone replacement, those with more severe scrotal injuries needed it more quickly.

Table. Men Who Recovered vs Men Who Needed Replacement Testosterone

Median Values Recovered Testosterone Replacement Testosterone P Value
Baseline testosterone (ng/dL) 35.2 11.9 .0063
Testosterone velocity (ng/dL per day) 1.9 0.1 <.0001
Time to recovery or replacement (days) 65 99 .0614

 

Unfortunately, the researchers don't know how the recovery of testosterone affected the patients' lives. "We don't have long-term data on sexual function," said Dr. Dean. "The patients transfer to the Veteran's Affairs hospitals and we lose our data."

Press conference moderator Mark Edney, MD, who is a member of the AUA Legislative Affairs Committee, said the group is finalizing a proposal to the House Armed Services Committee that would give soldiers the option of donating sperm before being sent to battle.

They could then use the sperm later if they sustain scrotal injuries that prevent them from producing more. "The loss of fertility is absolutely devastating to these young men and women," he said.

Dr. Dean, Dr. Williams, and Dr. Edney have disclosed no relevant financial relationships.

American Urological Association (AUA) 2013 Annual Scientific Meeting: Abstract 15. Presented May 5, 2013.

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