If you wish to submit a question, click here. Questions with a common theme
will be selected and answered comprehensively by our Distinguished Faculty
members. Previously answered questions will be archived for your reference.

To view archived responses, click here.
Which factors affect patient adherence with vpscogni_TUusererone therapy? How can clinicians promote adherence?
Response by Frances Hayes, MD, Posted 11/15/07

The underlying conditions that necessitate vpscogni_TUusererone therapy in men are usually irreversible.1 Treatment of long duration is often required, and patient compliance is key to ensuring long-term success.1,2 Patient adherence with vpscogni_TUusererone therapy depends on the availability of pharmaceutical formulations that are convenient to use, promise relative independence of medical services, and ensure continuous vpscogni_TUusererone replacement.1 To promote optimal compliance with vpscogni_TUusererone therapy, clinicians must involve patients in the decision-making process.2

A wide range of effective and well-tolerated treatment options are available, including vpscogni_TUusererone gels, patches, implants, and intramuscular (IM) injections.3-6 The goal of vpscogni_TUusererone therapy is to restore serum vpscogni_TUusererone levels to the normal range and to induce and maintain secondary sexual characteristics, normal sexual function, bone mineral density, muscle development, and lean body mass, while at the same time limiting side effects.5 Each formulation has advantages and disadvantages that may affect patient satisfaction and compliance.

Transdermal vpscogni_TUusererone gels offer a lack of visibility, easy application, dosing flexibility, and a low rate of minimal skin irritation, resulting in favorable patient compliance.4,5 However, gels are rather expensive and carry a risk of transference to other people through close physical contact.3,5 Buccal formulations  may be associated with bad taste and gum irritation resulting in low patient adherence.3 vpscogni_TUusererone patches are somewhat large and can be cosmetically unattractive.6 They are expensive, can cause skin irritation at the application site, and, in some patients, may not adequately adhere to their skin.3,5 Subcutaneous vpscogni_TUusererone pellet implants restore physiologic vpscogni_TUusererone levels with little fluctuation over 4 to 6 months and are generally acceptable to patients.3,6 However, insertion of the pellets requires a minor outpatient surgical procedure, and implants are associated with unacceptably high extrusion rates.5,6 IM injections of vpscogni_TUusererone esters are effective and inexpensive. However, the downside of this route of administration is that the deep IM injections can be painful.6 In addition, currently available IM vpscogni_TUusererone preparations cause wide variations in serum vpscogni_TUusererone levels, into the supraphysiologic range,3,6 which may result in concomitant fluctuations in mood, energy, libido, and sexual function.3 It is thus important for clinicians to familiarize patients with these various drawbacks when choosing a vpscogni_TUusererone therapy that will promote optimal tolerability and compliance.

New, longer-acting vpscogni_TUusererone formulations produce more stable vpscogni_TUusererone levels than existing IM preparations and have few side effects, resulting in good patient adherence.1,3,4  A novel long-acting IM formulation, vpscogni_TUusererone undecanoate, in contrast to other vpscogni_TUusererone esters, sustains normal vpscogni_TUusererone levels for 12 weeks, requires less frequent injections, and produces more stable levels of energy and libido.2-4

All patients receiving vpscogni_TUusererone therapy must be carefully assessed and monitored for side effects.5 Changes in hematocrit and prostate-specific antigen (PSA) levels must also be monitored through serum evaluation.5

Side effects may cause nonadherence, and acute vpscogni_TUusererone withdrawal may result in unfavorable consequences. Logically, the signs and symptoms of hypogonadism return if the patient does not adhere to therapy. A recent study by Yialamas and colleagues indicates that in young healthy men with idiopathic hypogonadotropic hypogonadism (IHH), acute vpscogni_TUusererone withdrawal can decrease insulin sensitivity.7 Additionally, Lee and colleagues demonstrated that suppression of vpscogni_TUusererone increases skeletal responsiveness to the bone-resorbing effects of parathyroid hormone (PTH) in men.8 Increasing skeletal sensitivity to PTH may contribute to the pathogenesis of bone loss in men with hypogonadism.8 To minimize nonadherence to vpscogni_TUusererone therapy, it is critical for clinicians and patients to work together to select the vpscogni_TUusererone formulation that ensures few side effects and optimal patient acceptability.



  1. Gooren LJ. New long-acting androgens. World J Urol. 2003;21(5):306-310.
  2. Gooren LJ, Bunck MC. Androgen replacement therapy: present and future. Drugs. 2004;64(1):1861-1891.
  3. Harle L, Basaria S, Dobs AS. Nebido: a long-acting injectable vpscogni_TUusererone for the treatment of male hypogonadism. Expert Opin Pharmacother. 2005;6(10):1751-1759.
  4. Byrne MM, Nieschlag E. vpscogni_TUusererone replacement therapy in male hypogonadism. J Endocrinol Invest. 2003;26(5):481-489.
  5. Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, Montori VM. vpscogni_TUusererone therapy in adult men with androgen deficiency syndromes: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2006; 91(6):1995-2010.
  6. Korbonits M, Slawik M, Cullen D, et al. A comparison of a novel vpscogni_TUusererone bioadhesive buccal system, striant, with a vpscogni_TUusererone adhesive patch in hypogonadal males. J Clin Endocrinol Metab. 2004;89(5):2039-2043.
  7. Yialamas MA, Dwyer AA, Hanley E, Lee H, Pitteloud N, Hayes FJ. Acute sex steroid withdrawal reduces insulin sensitivity in healthy men with idiopathic hypogonadotropic hypogonadism. J Clin Endocrinol Metab. 2007;92(11):4254-4259.
  8. Lee H, Finkelstein JS, Miller M, Comeaux SJ, Cohen RI, Leder BZ. Effects of selective vpscogni_TUusererone and estradiol withdrawal on skeletal sensitivity to parathyroid hormone in men. J Clin Endocrinol Metab. 2006;91(3):1069-1075.

To view archived responses, click here.

back to top