A Study of the Effect of Testosterone Replacement Therapy on Blood Pressure in Adult Male Participants With Hypogonadism

Phase 4

Completed

• Conditions: Hypogonadism, Male; Hypogonadotropic Hypogonadism; Hypogonadism
• Interventions: Drug: Aveed Injectable Product; Drug: Testim; Drug: Fortesta

• Registration Number: NCT04456296
• Lead Sponsor: Endo Pharmaceuticals

Brief Summary

Testosterone is the principal androgen produced by the male testes. Male Hypogonadism is the result of inadequate production of testosterone by the Leydig cells of the testes and is reflected by total serum concentrations of testosterone of \< 300 nanograms (ng)/deciliters (dL), with no discernible diurnal pattern. The etiology of hypogonadism may be primary or secondary. The treatment of males with primary, and in some cases, secondary hypogonadism includes administration of testosterone.

Testim® and Fortesta® are topical gels that when applied daily help to increase the total testosterone levels in the blood through skin absorption. Aveed® is an injectable form of testosterone treatment and participants randomized to this treatment arm will receive 3 injections over the course of 16 weeks.

This study is designed to evaluate the effect on blood pressure of approved testosterone products (Testim®, Fortesta®, and Aveed®) after 16 weeks of therapy using 24-hour ambulatory blood pressure to reveal shifts in blood pressure levels.

Detailed Description

Not available

Study Timeline

• Study Start: 2020-06-30
• Study First Submitted: 2020-06-30
• Study First Submitted QC: 2020-06-30
• Study First Posted: 2020-07-02
• Primary Completion: 2023-07-12
• Study Completion: 2023-07-12
• Results First Submitted: 2024-07-11
• Status Verified: 2025-03
• Results First Submitted QC: 2025-03-04
• Last Update Submitted: 2025-03-04
• Results First Posted: 2025-03-14
• Last Update Posted: 2025-03-14

Recruitment & Eligibility

• Status: COMPLETED
• Sex: Male
• Target Recruitment: 673

Inclusion Criteria

1. Have a diagnosis of primary hypogonadism or hypogonadotropic hypogonadism.
2. Have a total serum testosterone at screening < 300 ng/dL based on 2 blood samples obtained at 10 am (+/-2 hours) on 2 separate occasions at least 48 hours apart
3. Be naïve to androgen replacement or washout of 12 weeks following intramuscular androgen injections; 4 weeks following topical or buccal, nasal, or oral androgens.
4. Have a screening blood pressure at rest of less than 140 millimeters of mercury (mm Hg) for systolic blood pressure and less than 90 mm Hg for diastolic blood pressure.
5. Be judged to be in good health.
6. Participants enrolled in the Testim or Fortesta treatment arms: participants agree to take necessary precautions to avoid skin-to-skin contact and potential transfer and if male use effective contraception.
7. Be willing and able to cooperate with the requirements of the study.

Exclusion Criteria

1. Is from a vulnerable population, as defined by the US Code of Federal Regulations (CFR) Title 45, Part 46, Section 46.111(b) and other local and national regulations, including but not limited to, employees (temporary, part-time, full time, etc) or a family member of the research staff conducting the study, or of the sponsor, or of the contract research organization, or of the Institutional Review Board/Independent Ethics Committee (IRB/IEC).

2. Has a history of significant sensitivity or allergy to the study drugs, including androgens, or product excipients.

3. Has a history of or medical examination findings renal, hepatic, neurologic, hematologic, endocrine, oncologic, pulmonary, immunologic, psychiatric conditions, cardiovascular disease/dysrhythmia) or any other condition(s) that restricts study participation.

4. Has clinically significant changes in any medications (including dosages) or medical conditions in the 28 days prior to screening

5. Is not on a stable medication regimen for at least 3 months for the treatment of a chronic condition.

6. Has had a cardiovascular and/or cerebrovascular event within the last 6 months.

7. Needs blood pressure cuff size larger than 50 centimeters.

8. Works a night shift or performs heavy manual labor.

9. Has any known contraindication(s) to active study treatment including, but not limited to: known or suspected carcinoma of the prostate or breast, previous history of cancer (except basal cell carcinoma of the skin) liver disease, active deep vein thrombosis, atrial fibrillation, untreated sleep apnea, or is immune compromised.

10. Uses known inhibitors (for example, ketoconazole) or inducers of cytochrome P450 3A (for example, dexamethasone, phenytoin, rifampin, carbamazepine) of cytochrome P450 3A (CYP3A) within 30 days prior to study drug administration and through the end of the study.

    1. Uses any of the above listed drugs within 5 half lives of the last dose in the past 6 months prior to study drug administration.
    2. Has received any of the above listed drugs by injection within 30 days or 10 half lives (whichever is longer) prior to study drug administration.
    3. Uses nutraceuticals or homeopathic compounds which have a known effect on blood pressure.

11. Has a history of drug or alcohol abuse within 6 months prior to study drug administration.

12. Has untreated moderate to severe depression.

13. Has any skin lesions/cuts/injury at the application site that prohibits topical application and/or intramuscular injection of study drug.

14. Has suspected reversible hypogonadism.

15. Donated blood or blood products or experienced significant blood loss within 90 days prior to study drug administration.

16. Intends to conceive at any time during the study.

17. Donated bone marrow within 6 months prior to study drug administration.

18. Has participated in a previous investigational study or received treatment with an investigational product within 30 days of screening.

19. Has a diagnosis of, is undergoing therapy for, or has received therapy for a hematologic malignancy in the 5 years prior to screening.

20. Has a history of substance abuse or is taking any substance of abuse (Note: participants on a stable dose of any medications that have been prescribed by a healthcare practitioner for a properly documented medical condition are exempt).

21. Abnormal electrocardiogram (ECG) (QT prolongation with QTc ≥450 milliseconds).

22. Has evidence of abnormalities on physical examination, vital signs, ECG, or clinical lab values, unless judged to be clinically insignificant by the investigator

23. Has any other condition that, in the investigator's opinion, might indicate the participant to be unsuitable for the study.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
AVEED (Testosterone Undecanoate Injection)	Aveed Injectable Product	Fixed dosage level of 750 milligrams (mg)/3 milliliters (mL) administered by intramuscular injections.
TESTIM (Testosterone Gel)	Testim	50 mg once daily topical gel administration.
FORTESTA (Testosterone Gel)	Fortesta	40 mg once daily topical gel administration.

Primary Outcome Measures

Name	Time	Method
Change From Baseline in 24-Hour Average Systolic Ambulatory Blood Pressure to End of Study (EOS)	Baseline (Day 1), EOS Visit: up to Day 107 for the Aveed Arm, and up to Day 114 for Fortesta and Testim Arms	The mean change from Baseline to EOS in 24-hour average systolic ambulatory blood pressure, for each treatment group was analyzed using an analysis of covariance (ANCOVA) model with treatment and study center (pooled centers) as fixed effects, Baseline 24-hour average systolic ambulatory blood pressure as covariate. EOS for the Aveed arm was Day 107 and EOS for Fortesta and Testim, was Day 114.

Secondary Outcome Measures

Name	Time	Method
Change From Baseline in 24-Hour Average Mean Arterial Pressure (MAP) to EOS	Baseline (Day 1), EOS Visit: up to Day 107 for the Aveed Arm, and up to Day 114 for Fortesta and Testim Arms	The mean change from Baseline to EOS in 24-hour MAP, for each treatment group was analyzed using an ANCOVA model with treatment and study center (pooled centers) as fixed effects, Baseline 24-hour MAP as covariate.EOS for the Aveed arm was Day 107 and EOS for Fortesta and Testim, was Day 114.
Change From Baseline in 24-Hour Average Diastolic Ambulatory Blood Pressure to EOS	Baseline (Day 1), EOS Visit: up to Day 107 for the Aveed Arm, and up to Day 114 for Fortesta and Testim Arms	The mean change from Baseline to EOS in 24-hour average diastolic ambulatory blood pressure, for each treatment group was analyzed using an ANCOVA model with treatment and study center (pooled centers) as fixed effects, Baseline 24-hour average diastolic ambulatory blood pressure as covariate. EOS for the Aveed arm was Day 107 and EOS for Fortesta and Testim, was Day 114.
Change From Baseline in 24-Hour Average Heart Rate to EOS	Baseline (Day 1), EOS Visit: up to Day 107 for the Aveed Arm, and up to Day 114 for Fortesta and Testim Arms	The mean change from Baseline to EOS in 24-hour average heart rate, for each treatment group was analyzed using an ANCOVA model with treatment and study center (pooled centers) as fixed effects, Baseline 24-hour average heart rate as covariate. EOS for the Aveed arm was Day 107 and EOS for Fortesta and Testim, was Day 114.
Change From Baseline in 24-Hour Average Pulse Pressure (PP) to EOS	Baseline (Day 1), EOS Visit: up to Day 107 for the Aveed Arm, and up to Day 114 for Fortesta and Testim Arms	The mean change from Baseline to EOS in 24-hour average PP for each treatment group was analyzed using an ANCOVA model with treatment and study center (pooled centers) as fixed effects, Baseline 24-hour average PP as covariate. EOS for the Aveed arm was Day 107 and EOS for Fortesta and Testim, was Day 114.
Percentage of Participants Taking New Antihypertensive Medications	EOS Visit: up to Day 107 for the Aveed Arm, and up to Day 114 for Fortesta and Testim Arms	A new antihypertensive medication was any antihypertensive medication taken on or after the screening Visit through the EOS visit and not taken prior to the screening visit.
Percentage of Participants With Dose Increase From Baseline in Antihypertensive Medications	EOS Visit: up to Day 107 for the Aveed Arm, and up to Day 114 for Fortesta and Testim Arms	A new antihypertensive medication was any antihypertensive medication taken on or after the screening Visit through the EOS visit and not taken prior to the screening visit.

Trial Locations

Locations (35)

Endo Clinical Trial Site #22; 🇺🇸 Tucson, Arizona, United States

Endo Clinical Trial Site #3; 🇺🇸 Oviedo, Florida, United States

Endo Clinical Trial Site #27; 🇺🇸 Glen Burnie, Maryland, United States

Endo Clinical Trial Site #35; 🇺🇸 East Orange, New Jersey, United States

Endo Clinical Trial Site #5; 🇺🇸 Dayton, Ohio, United States

Endo Clinical Trial Site #11; 🇺🇸 Pompano Beach, Florida, United States

Endo Clinical Trial Site #32; 🇺🇸 Bell Gardens, California, United States

Endo Clinical Trial Site #17; 🇺🇸 Towson, Maryland, United States

Endo Clinical Trial Site #9; 🇺🇸 Garden City, New York, United States

Endo Clinical Trial Site #13; 🇺🇸 Bala-Cynwyd, Pennsylvania, United States

Endo Clinical Trial Site #7; 🇺🇸 New York, New York, United States

Endo Clinical Trial Site #12; 🇺🇸 Boynton Beach, Florida, United States

Endo Clinical Trial Site #21; 🇺🇸 Missouri City, Texas, United States

Endo Clinical Trial Site #25; 🇺🇸 Winston-Salem, North Carolina, United States

Endo Clinical Trial Site #2; 🇺🇸 Miami, Florida, United States

Endo Clinical Trial Site #28; 🇺🇸 Miami, Florida, United States

Endo Clinical Trial Site #4; 🇺🇸 Pembroke Pines, Florida, United States

Endo Clinical Trial Site #23; 🇺🇸 West Palm Beach, Florida, United States

Endo Clinical Trial Site #16; 🇺🇸 Chicago, Illinois, United States

Endo Clinical Trial Site #19; 🇺🇸 Houston, Texas, United States

Endo Clinical Trial Site #24; 🇺🇸 Virginia Beach, Virginia, United States

Endo Clinical Trial Site #31; 🇺🇸 Houston, Texas, United States

Endo Clinical Trial Site #1; 🇺🇸 San Antonio, Texas, United States

Endo Clinical Trial Site #20; 🇺🇸 Houston, Texas, United States

Endo Clinical Trial Site #8; 🇺🇸 Birmingham, Alabama, United States

Endo Clinical Trial Site #15; 🇺🇸 North Little Rock, Arkansas, United States

Endo Clinical Trial Site #33; 🇺🇸 Canoga Park, California, United States

Endo Clinical Trial Site #30; 🇺🇸 Beverly Hills, Florida, United States

Endo Clinical Trial Site #34; 🇺🇸 Boynton Beach, Florida, United States

Endo Clinical Trial Site #29; 🇺🇸 Fleming Island, Florida, United States

Endo Clinical Trial Site #26; 🇺🇸 Miami, Florida, United States

Endo Clinical Trial Site #10; 🇺🇸 Miami Beach, Florida, United States

Endo Clinical Trial Site #18; 🇺🇸 Miami Gardens, Florida, United States

Endo Clinical Trial Site #14; 🇺🇸 Rutland, Vermont, United States

Endo Clinical Trial Site #6; 🇺🇸 Charlottesville, Virginia, United States