Introduction: The risk of GERD among males with hypogonadism is relatively unknown. Furthermore, the association between gastroesophageal reflux disease (GERD) and testosterone replacement therapy (TRT) has not been well documented in literature. Precisely, the reported effect of exogenous testosterone on GERD has been conflicting in literature. The aim of our study is to determine the risk of GERD and its complications among males with hypogonadism and the risk of GERD and its complications with TRT versus those who did not receive TRT among males with hypogonadism.
Methods: We used a commercial database (Explorys Inc, Cleveland, OH) which includes electronic health record data from 26 major integrated US healthcare systems. Based on Systematized Nomenclature of Medicine – Clinical Terms (SNOMED-CT), we identified all patients (age >18 years). Inclusion criteria for individuals included: males, age >18 with a diagnosis of “hypogonadism”. The effect of FDA approved testosterone preparations on GERD and Barrett’s esophagus (BE) was assessed. Odds ratios (OR) with 95% confidence intervals (CI) were calculated to compare the risk of GERD and its complications between males on TRT versus those not on TRT.
Results: Of the 70,398,640 individuals in the database from 1999 to May 2022, we identified 408,810 (0.58%) male patients with hypogonadism of whom 135,000 (33%) patients were diagnosed with GERD and 9,430 (2.3%) patients were diagnosed with BE. A total of 183,760 (44.9%) male patients with hypogonadism received TRT. Males with hypogonadism had a significantly higher risk of GERD (5.40, CI 5.36 – 5.43) and BE (5.13, CI 5.02 – 5.24). Furthermore, treatment with TRT was associated with a significantly higher risk of GERD (1.40, CI 1.38 – 1.42) and BE (1.23, CI 1.18 – 1.28) among males with hypogonadism compared to untreated males.
Discussion: In this large retrospective study, we found that males with hypogonadism had a significantly higher risk for GERD and its complications compared to men without hypogonadism. Unfortunately, treatment with TRT may further exacerbate that risk. Accordingly, males with hypogonadism should be closely monitored for GERD and its complications.
