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The Effects of Natesto For Treatment Of Hypogonadism

Primary Purpose

Hypogonadism, Male, Infertility, Male, Testosterone Deficiency

Status
Not yet recruiting
Phase
Early Phase 1
Locations
Study Type
Interventional
Intervention
Natesto Nasal Product
Sponsored by
Baylor College of Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hypogonadism, Male focused on measuring Natesto, Male, Hypogonadism, Sexual Medicine

Eligibility Criteria

18 Years - 40 Years (Adult)MaleDoes not accept healthy volunteers

Inclusion Criteria:

  • 1. Voluntarily sign and date the study consent form(s) which have been approved by an Institutional Review Board (IRB). Written consent must be obtained prior to the initiation of any study procedures.

    2. Male between 18 and 64 years of age, inclusive, with documented onset of testosterone induced hypogonadism with impaired semen parameters who are attempting to achieve a successful pregnancy.

    3. Documented diagnosis of primary hypogonadism (congenital or acquired) or hypogonadotropic hypogonadism (congenital or acquired).

    4. Serum total testosterone < 350 ng/dL based on 2 consecutive blood samples obtained 1-4 weeks apart between 6 and 10 AM following an appropriate washout of current androgen replacement therapy; with clinical symptoms of hypogonadism such as diminished energy and sexual function; and/or a decreased sperm count (<20 million sperm/mL semen).

    5. Discontinued current testosterone replacement treatment and completed a washout of 4 weeks following androgen treatment (excluding Testopel TM). Washout must be completed prior to collection of baseline serum testosterone samples to determine study eligibility.

    6. Judged to be in good general health as determined by the principal investigator based upon the results of a medical history, physical examination, vital signs, and laboratory profile.

Exclusion Criteria:

  • 1. History of significant sensitivity or allergy to androgens, castor oil or product excipients.

    2. Clinically significant findings in the pre-study examinations including abnormal breast examination requiring follow-up.

    3. Abnormal prostate digital rectal examination (DRE) with palpable nodule(s) or I-PSS score > 19 points.

    4. Body mass index (BMI) ≥ 35 kg/m2.

    5. History of vasectomy.

    6. Clinically significant abnormal laboratory value, in the opinion of the investigator, in serum chemistry, hematology, or urinalysis including but not limited to:

    1. Baseline hemoglobin > 16 g/dL
    2. Hematocrit < 35% or > 50%
    3. PSA > 4 ng/mL and age >40

      7. History of seizures or convulsions, including febrile, alcohol or drug withdrawal seizures.

      8. History of any clinically significant illness, infection, or surgical procedure within 4 weeks prior to study drug administration.

      9. History of stroke or myocardial infarction within the past 5 years.

      10. History of, or current or suspected, prostate or breast cancer.

      11. History of diagnosed, severe, untreated, obstructive sleep apnea.

      12. History of abuse of alcohol or any drug substance in the opinion of the investigator within the previous 2 years.

      13. History of nasal disorders such as nasal polyps; nasal septal perforation; nasal surgery; nasal trauma resulting in nasal fracture within the previous 6 months or nasal fracture that caused a deviated anterior nasal septum; sinus surgery or sinus disease

      14. Donation or loss of 550 mL or more blood volume (including plasmapheresis) or receipt of a transfusion of any blood product within 12 weeks prior to the start of treatment.

      15. Inadequate venous access for collection of serial blood samples required for pharmacokinetic profiles.

      16. Receipt of any investigational product within 4 weeks or within 5 half-lives prior to the start of treatment.

      17. Inability to understand and provide written informed consent for the study.

      18. Considered by the investigator or the sponsor-designated physician, for any reason, that the subject is an unsuitable candidate to receive Natesto.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm Type

    Experimental

    Arm Label

    Standard Reboot with Natesto

    Arm Description

    Standard Reboot Protocol + Natesto

    Outcomes

    Primary Outcome Measures

    Change in Semen Analysis
    Change in Total Motile Sperm

    Secondary Outcome Measures

    Change in Hypogonadal Panel
    change in blood LH levels
    Change in Hypogonadal Panel
    change in blood FSH levels
    Change Hypogonadal Panel
    change in blood Testosterone levels
    Change in Hypogonadal Panel
    change in blood E2 levels
    Change in Quality of Life Questionnaire
    Change in SF36 score
    Change in Quality of Life Questionnaire
    Change in IPSS score
    Change in Quality of Life Questionnaire
    Change in IIEF score

    Full Information

    First Posted
    December 7, 2020
    Last Updated
    May 9, 2023
    Sponsor
    Baylor College of Medicine
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    1. Study Identification

    Unique Protocol Identification Number
    NCT04717362
    Brief Title
    The Effects of Natesto For Treatment Of Hypogonadism
    Official Title
    The Effects of Natesto For Treatment Of Hypogonadism On Maintenance Of Spermatogensis.
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    May 2023
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    March 1, 2024 (Anticipated)
    Primary Completion Date
    December 31, 2024 (Anticipated)
    Study Completion Date
    December 31, 2024 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    Baylor College of Medicine

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    No
    Product Manufactured in and Exported from the U.S.
    No
    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    In this prospective study, the investigators plan is to confirm the role of Natesto (intranasal testosterone) to combat hypogonadal symptoms in men trying to recover spermatogenesis following the withdrawal of conventional Testosterone replacement therapy.
    Detailed Description
    Testosterone replacement therapy (TTh) is becoming increasingly common among men of reproductive age in the United States. An estimated 3 million men are on TTh; however exogenous testosterone use can disrupt the hypothalamus-pituitary-gonadal (HPG) axis, leading to reduced spermatogenesis and possible infertility. In normal physiology, the hypothalamus releases Gonadotropin-releasing hormone (GnRH), which stimulates the anterior pituitary to release Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH). FSH then stimulates the Sertoli cells in the testis to support spermatogonial differentiation and maturation. LH stimulates the Leydig cells in the testes to produce endogenous testosterone. Regulation of this HPG axis occurs via negative feedback where testosterone directly inhibits the release of GnRH and LH from the hypothalamus and pituitary, respectively. The use of exogenous testosterone thus leads to reduced Sertoli function causing diminished spermatogenesis. The spontaneous recovery of spermatogenesis after cessation of TTh is possible but may take months to years and cause the patient to experience new onset of severe hypothalamic hypogonadal symptoms. Human chorionic gonadotropin (HCG) is a naturally occurring protein that mimics LH and may be used as a therapy to support the return of spermatogenesis quickly with minimal side effects and resolve hypogonadal symptoms. Studies have shown that testosterone-induced infertile patients can recover sperm in the ejaculate in 4.6 months when treated with HCG supplemented with clomiphene citrate, tamoxifen, anastrozole, or recombinant FSH. With the cessation of TTh, despite the use of LH stimulatory protocols, these patients still experience hypogonadal symptoms. Recent preliminary results show the potential to offset hypogonadism symptoms that accompany exogenous testosterone cessation through administration of 4.5% intranasal testosterone gel. Natesto is a nasally administered exogenous 4.5% testosterone gel, administered from a non-pressurized, manual pump dispenser equipped with a specialized nasal applicator which administers 125uL (5.5mg of testosterone). Previous studies have shown that a single nasal dose has a rapid absorption with a Tmax at 60 mins and a half-life that ranged between 10-100 minutes. Three to four daily doses achieve eugonadal levels of circulating testosterone comparable to normal pulsatile-regulated release of testosterone. It has also been shown that men on Natesto maintain FSH and LH levels as well as total motile sperm count within the normal range. In this prospective study, the investigators seek to confirm the role of Natesto to combat hypogonadal symptoms in men trying to recover spermatogenesis following the withdrawal of conventional TTh.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Hypogonadism, Male, Infertility, Male, Testosterone Deficiency
    Keywords
    Natesto, Male, Hypogonadism, Sexual Medicine

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Early Phase 1
    Interventional Study Model
    Single Group Assignment
    Model Description
    Prospective non-blinded study
    Masking
    None (Open Label)
    Allocation
    N/A
    Enrollment
    40 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    Standard Reboot with Natesto
    Arm Type
    Experimental
    Arm Description
    Standard Reboot Protocol + Natesto
    Intervention Type
    Drug
    Intervention Name(s)
    Natesto Nasal Product
    Intervention Description
    Nasally administered exogenous 4.5% testosterone gel, administered from a non-pressurized, manual pump dispenser equipped with a specialized nasal applicator which administers 125uL (5.5mg of testosterone).
    Primary Outcome Measure Information:
    Title
    Change in Semen Analysis
    Description
    Change in Total Motile Sperm
    Time Frame
    Baseline, 14 weeks, 26 weeks.
    Secondary Outcome Measure Information:
    Title
    Change in Hypogonadal Panel
    Description
    change in blood LH levels
    Time Frame
    Baseline, 14 weeks, 26 weeks.
    Title
    Change in Hypogonadal Panel
    Description
    change in blood FSH levels
    Time Frame
    Baseline, 14 weeks, 26 weeks.
    Title
    Change Hypogonadal Panel
    Description
    change in blood Testosterone levels
    Time Frame
    Baseline, 14 weeks, 26 weeks.
    Title
    Change in Hypogonadal Panel
    Description
    change in blood E2 levels
    Time Frame
    Baseline, 14 weeks, 26 weeks.
    Title
    Change in Quality of Life Questionnaire
    Description
    Change in SF36 score
    Time Frame
    Baseline, 14 weeks, 26 weeks.
    Title
    Change in Quality of Life Questionnaire
    Description
    Change in IPSS score
    Time Frame
    Baseline, 14 weeks, 26 weeks.
    Title
    Change in Quality of Life Questionnaire
    Description
    Change in IIEF score
    Time Frame
    Baseline, 14 weeks, 26 weeks.

    10. Eligibility

    Sex
    Male
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    40 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: 1. Voluntarily sign and date the study consent form(s) which have been approved by an Institutional Review Board (IRB). Written consent must be obtained prior to the initiation of any study procedures. 2. Male between 18 and 64 years of age, inclusive, with documented onset of testosterone induced hypogonadism with impaired semen parameters who are attempting to achieve a successful pregnancy. 3. Documented diagnosis of primary hypogonadism (congenital or acquired) or hypogonadotropic hypogonadism (congenital or acquired). 4. Serum total testosterone < 350 ng/dL based on 2 consecutive blood samples obtained 1-4 weeks apart between 6 and 10 AM following an appropriate washout of current androgen replacement therapy; with clinical symptoms of hypogonadism such as diminished energy and sexual function; and/or a decreased sperm count (<20 million sperm/mL semen). 5. Discontinued current testosterone replacement treatment and completed a washout of 4 weeks following androgen treatment (excluding Testopel TM). Washout must be completed prior to collection of baseline serum testosterone samples to determine study eligibility. 6. Judged to be in good general health as determined by the principal investigator based upon the results of a medical history, physical examination, vital signs, and laboratory profile. Exclusion Criteria: 1. History of significant sensitivity or allergy to androgens, castor oil or product excipients. 2. Clinically significant findings in the pre-study examinations including abnormal breast examination requiring follow-up. 3. Abnormal prostate digital rectal examination (DRE) with palpable nodule(s) or I-PSS score > 19 points. 4. Body mass index (BMI) ≥ 35 kg/m2. 5. History of vasectomy. 6. Clinically significant abnormal laboratory value, in the opinion of the investigator, in serum chemistry, hematology, or urinalysis including but not limited to: Baseline hemoglobin > 16 g/dL Hematocrit < 35% or > 50% PSA > 4 ng/mL and age >40 7. History of seizures or convulsions, including febrile, alcohol or drug withdrawal seizures. 8. History of any clinically significant illness, infection, or surgical procedure within 4 weeks prior to study drug administration. 9. History of stroke or myocardial infarction within the past 5 years. 10. History of, or current or suspected, prostate or breast cancer. 11. History of diagnosed, severe, untreated, obstructive sleep apnea. 12. History of abuse of alcohol or any drug substance in the opinion of the investigator within the previous 2 years. 13. History of nasal disorders such as nasal polyps; nasal septal perforation; nasal surgery; nasal trauma resulting in nasal fracture within the previous 6 months or nasal fracture that caused a deviated anterior nasal septum; sinus surgery or sinus disease 14. Donation or loss of 550 mL or more blood volume (including plasmapheresis) or receipt of a transfusion of any blood product within 12 weeks prior to the start of treatment. 15. Inadequate venous access for collection of serial blood samples required for pharmacokinetic profiles. 16. Receipt of any investigational product within 4 weeks or within 5 half-lives prior to the start of treatment. 17. Inability to understand and provide written informed consent for the study. 18. Considered by the investigator or the sponsor-designated physician, for any reason, that the subject is an unsuitable candidate to receive Natesto.
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Larry Lipshultz, MD
    Phone
    713-798-6270
    Email
    Larryl@bcm.edu

    12. IPD Sharing Statement

    Plan to Share IPD
    No

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