Measurement of salivary testosterone in adolescents and young men with Duchenne muscular dystrophy

Abstract BackgroundMany young adults with Duchenne Muscular Dystrophy (DMD) receive long-term glucocorticoids (GC). GC can cause hypogonadotrophic hypogonadism and adolescents may therefore be candidates for pubertal induction. It is unclear whether men with DMD on or off GC have age-appropriate endogenous testosterone production.MethodsWe undertook a quality improvement project to assess the feasibility of measuring salivary testosterone (SalT) levels in men with DMD at home. A Sal-T sampling kit was sent by post to all patients with DMD, aged 17 and older, registered at the John Walton Muscular Centre in Newcastle (n=75). Submitted Sal-T samples were collected and submitted for analysis. Results28 out of 75 patients returned samples (age range: 17-34 years). 6/28 samples were unsuitable for analysis. Overall Sal-T levels (n=22) were significantly lower than in the healthy population (178 ±107 v 287 ±109 pmol/l, p=0.0001). Sal-T was lower in those on GC compared to those off GC (144± 81 versus 218 ±125 pmol/l, p=0.05). 3 patients were unable to collect a sample due to ventilator dependence.ConclusionSal T can provide information about androgen status in DMD patients at home, overcoming barriers such as mobility difficulties and challenging venepuncture. However we only obtained samples in a minority of patients suggesting that Sal-T measurement may not be appropriate or acceptable to everyone. There needs to be a more detailed exploration of the barriers to sample submission.