An update on male hypogonadism therapy

Abstract

Introduction Men who have symptoms associated with persistently low serum total testosterone level should be assessed for testosterone replacement therapy. Areas covered Acute and chronic illnesses are associated with low serum testosterone and these should be recognized and treated. Once the diagnosis of male hypogonadism is made, the benefits of testosterone treatment usually outweigh the risks. Without contraindications, the patient should be offered testosterone replacement therapy. The options of testosterone delivery systems (injections, transdermal patches/gels, buccal tablets, capsules and implants) have increased in the last decade. Testosterone improves symptoms and signs of hypogonadism such as sexual function and energy, increases bone density and lean mass and decreases visceral adiposity. In men who desire fertility and who have secondary hypogonadism, testosterone can be withdrawn and the patients can be placed on gonadotropins. New modified designer androgens and selective androgen receptor modulators have been in preclinical and clinical trials for some time. None of these have been assessed for the treatment of male hypogonadism. Expert opinion Despite the lack of prospective long-term data from randomized, controlled clinical trials of testosterone treatment on prostate health and cardiovascular disease risk, the available evidence suggests that testosterone therapy should be offered to symptomatic hypogonadal men.

Obesity’s role in secondary male hypogonadism: a review of pathophysiology and management issues

“…Males with HIV and obesity also seem to prone to hypogonadism [5][6][7][8]. Testosterone is a vital steroid for males as it plays roles in vast physiological functions such as testicular function, hair growth, nitrogen retention, development of bone density, development and distributing muscle mass, metabolism of fat, development of secondary sexual characteristics, and psychological factors dictating personality such as aggression, self-esteem, and motivation [1,[5][6][7][8][9][10]. A significant decrease in testosterone, such as one due to hypogonadism, significantly decreases the quality of life since multiple physiological mechanisms will not be operating at normal levels.…”

“…The development of increased oiliness of skin and acne are common adverse events of testosterone replacement therapy because of the androgenic effects on the sebaceous gland [5]. Several major harmful effects are an increase in hemoglobin, hematocrit, and red cell indices [87].…”

Thromboembolism Peaking 3 Months after Starting Testosterone Therapy: Testosterone–Thrombophilia Interactions

“…Testosterone has been approved in the USA since the 1950s as hormone replacement therapy (HRT) for male hypogonadism,1 and its use has been carefully evaluated 2 3. Ultimately the risk/benefit ratio of testosterone therapy (TT) can optimally be better defined by a placebo-controlled clinical trial, comparable to the Women’s Health Initiative trials,4 which were required to resolve conflicting epidemiological and clinical data.…”

Solidification of Nanostructured Lipid Carriers Loaded Testosterone Undecanoate: In Vivo and In Vitro Study

“…With the development of the society, aging population is becoming more and more, which is significantly associated with a decrease in serum testosterone levels, and causing a series of clinical signs and symptoms of hypogonadism like sexual function, infertility, fatigue, anemia, muscle strength, etc. [1][2][3][4][5]. Testosterone replacement therapy is required for patients with low testosterone levels associated with ages.…”