Testosterone Replacement with 1% Testosterone Gel and Priapism: No Definite Risk Relationship

Introduction: Although testosterone replacement therapy (TRT) is the preferred treatment for hypogonadism, information for patients using testosterone includes too frequent or prolonged erections as a potential side effect. Aim: To assess the frequency and risk of priapism or related adverse events (AEs) in hypogonadal men treated with a 1% testosterone gel. Methods: Safety and tolerability data for AndroGel 1% were assessed, including three randomized, controlled clinical trials in varying populations of hypogonadal or near hypogonadal men. Study 1 was a Phase 3 trial of AndroGel 1% 5g, 7.5g, or 10g once daily for 6 months (N=227). Study 2 was a Phase 2 trial of AndroGel 1% 7.5g once daily titrated as needed vs. placebo for 26 weeks in men with type 2 diabetes (N=180). Study 3 was a Phase 4 trial of AndroGel 1% 5g once daily vs. placebo for 12 weeks in men previously unresponsive to sildenafil 100mg monotherapy and receiving concomitant sildenafil 100mg (N=75). Postmarketing AndroGel pharmacovigilance reporting data from 2001 to 2011 was searched for events coded as priapism. Main Outcome Measures: The incidence of priapism and/or related symptoms reported as urogenital or reproductive system AEs. Results: In the 283 men exposed to AndroGel 1% over the three trials, mean exposure ranged from 84 days to 149 days. No AEs described as priapism or related symptoms were reported in the three trials. In the postmarketing data, representing 40 million units sold, eight cases described as priapism were reported. Of the six cases with accompanying data, all were judged as possibly related to AndroGel. Conclusions: Safety data from the clinical trials for AndroGel 1% did not report any cases of priapism, and its incidence in the postmarketing pharmacovigilance data is extremely low, indicating a minimal risk of inducing priapism.