From the Guidelines
Transdermal testosterone should be continued up to the day of surgery and resumed as soon as the patient can take medications postoperatively, as the evidence suggests that it does not significantly increase perioperative risks 1. The benefits of continuing transdermal testosterone therapy include maintaining stable serum levels, which can help prevent symptoms of hypogonadism such as fatigue, decreased libido, and mood changes.
Key Considerations
- For patients using testosterone gel, they should apply their normal dose the day before surgery but skip the morning dose on the day of surgery to avoid transfer to healthcare workers.
- Testosterone patches should be removed before entering the operating room.
- Postoperatively, patients can resume their regular testosterone regimen once they are stable, typically within 24-48 hours after surgery.
- If surgery is extensive or recovery is expected to be prolonged, endocrinology consultation may be beneficial to manage hormone replacement appropriately.
Evidence Summary
The evidence from multiple studies, including those published in the Annals of Internal Medicine 1, suggests that transdermal testosterone therapy is safe to continue in the perioperative period. The studies show that testosterone treatment improves vitality and fatigue, and has a less-than-small improvement in depressive symptoms. Additionally, the evidence suggests that there is no increased risk for mortality, cardiovascular events, prostate cancer, or pulmonary embolism or deep venous thrombosis with transdermal testosterone therapy.
Patient Preferences
Patient preferences should also be taken into account when making decisions about testosterone therapy. Some patients may prefer transdermal formulations due to convenience, ease of use, and non-staining of clothes, while others may prefer injectable formulations due to lower cost. However, the evidence suggests that clinical effectiveness and harms are similar between transdermal and intramuscular formulations.
From the Research
Perioperative Management of Transdermal Testosterone
- The management of transdermal testosterone perioperatively is not directly addressed in the provided studies, but some information can be inferred from the discussion of hormone replacement therapy and anticoagulation management 2, 3.
- A systematic review of clinical practice guidelines found that the evidence linking hormone replacement therapy (HRT) to an increased risk of venous thromboembolism (VTE) is equivocal, and some guidelines suggest that non-estrogen-containing transdermal HRT should not be withheld in patients undergoing elective joint arthroplasty 2.
- Another study discussed the use of anticoagulant and antiplatelet agents during surgery, highlighting the importance of evaluating the thromboembolic risk and haemorrhagic risk of individual patients 3.
- A study on testosterone therapy and thrombosis found that testosterone therapy may increase the risk of thrombotic events, but did not provide specific guidance on perioperative management 4.
- The use of transdermal testosterone delivery systems, such as patches and gels, has been discussed in the context of testosterone replacement treatment, but not specifically in relation to perioperative management 5.
Considerations for Perioperative Management
- The decision to continue or discontinue transdermal testosterone perioperatively may depend on the individual patient's risk factors and the type of surgery being performed 2, 3.
- Further research is needed to provide clear guidance on the perioperative management of transdermal testosterone, particularly in relation to the risk of thromboembolic events 4, 2.