The importance of achieving threshold levels in TRT, EAU stockholm 2014


Importance of achieving threshold levels in testosterone replacement therapy.

Dr. Hackett presents data on the importance of achieving and sustaining testosterone thresholds during testosterone replacement therapy, in order to maximize benefits. He supports this by the BLAST global efficacy data showing that giving patients testosterone treatment for longer almost doubled patient satisfaction. In men with type 2 diabetes, a sustained trough level of >15 nmol/L is necessary in order to realize maximal benefits, and this may take 12-18 month to achieve. He makes the point that 4-6 months in not long enough for a therapeutic testosterone trial to prove benefit. For example, the TIMES2 study showed that improvements in HbA1c did not appear until after 9-12 months of testosterone treatment. He also points out the flaws of the notorious studies by Vigen and Finkle as they relate to testosterone levels and treatment duration.


Professor Geoffrey Hackett has been a Primary Care Physician for the past 29 years, and a Consultant in Urology and Sexual Medicine at Good Hope Hospital, Birmingham, UK, since 1994. He qualified in medicine in 1974 at King’s College Hospital, London, UK, and gained his MD from Keele University, UK, in 2000 on the links between erectile dysfunction (ED) and cardiovascular disease.

Prof. Hackett’s major research interest is in the role of testosterone in metabolic syndrome and type 2 diabetes. He is the author of over 80 publications in sexual medicine, and 2 original books on male sexual health and andrology, as well as contributing chapters to several medical textbooks. He is lead author of the British Society for Sexual Medicine (BSSM) guidelines on ED management, and the use of testosterone therapy to manage sexual problems in both men and women, co-author of the consensus guidelines on ED and coronary artery disease prediction, and a panel member for the International Society for Sexual Medicine (ISSM) guidelines on premature ejaculation.



Prof Geoffrey Hackett

Professor Geoff Hackett
Aston University &
University Hospitals Birmingham NHS Foundation Trust.

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