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Treatment of Hypogonadism in Men

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Clinical Urologic Endocrinology

Abstract

The goal of testosterone replacement therapy (TRT) is to alleviate the symptoms of hypogonadism while minimizing potential adverse affects associated with testosterone replacement. There are several approved options available for the treatment of androgen deficiency, including oral, transdermal, injectable, and implantable formulations of testosterone, as well as emerging therapies such as selective androgen receptor modulators (SARMs), each associated with specific advantages, disadvantages, and side effects. In men with an identifiable etiology of hypogonadism, the underlying pathology should be addressed first. For men interested in fertility, androgen deficiency may be treated with pulsatile gonadotropin-releasing hormone (GnRH) or gonadotropin therapy using human chorionic gonadotropin (hCG), purified or recombinant luteinizing hormone (LH) and follicle-stimulating hormone (FSH) preparations. The empiric use of selective estrogen receptor modulators (SERMs) and aromatase inhibitors for the treatment of men with primary hypogonadism is associated with variable outcomes, depending on the severity of the underlying defect. The choice of therapy should be guided by consideration of the formulation-specific pharmacokinetics and adverse effects, cost, and patient preference. All patients on any form of TRT should be evaluated on a regular basis.

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Abbreviations

ASA:

American Society of Andrology

CC:

Clomiphene citrate

CHF:

Congestive heart failure

DHT:

Dihydrotestosterone

EAA:

European Association of Andrology

EAU:

European Association of Urology

FDA:

Food and Drug Administration

FSH:

Follicle-stimulating hormone

GnRH:

Gonadotropin-releasing hormone

hCG:

Human chorionic gonadotropin

HH:

Hypogonadotropic hypogonadism

hMG:

Human menopausal gonadotropin

ISA:

International Society of Andrology

ISSAM:

International Society for Study of the Aging Male

LH:

Luteinizing hormone

PSA:

Prostate-specific antigen

SARM:

Selective androgen receptor modulator

SERM:

Selective estrogen receptor modulator

SHBG:

Sex hormone binding globuin

T:

Testosterone

TRT:

Testosterone replacement therapy

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Authors and Affiliations

  1. Department of Urology, Weill Cornell Medical College, 525 East 68th Street, Starr 900, New York, NY, USA

    Akanksha Mehta M.D.

  2. Department of Urology, Center for Male Reproductive Medicine, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA

    Darius A. Paduch M.D., Ph.D. & Marc Goldstein M.D., D.Sc. (Hon)

Authors
  1. Akanksha Mehta M.D.
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  2. Darius A. Paduch M.D., Ph.D.
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  3. Marc Goldstein M.D., D.Sc. (Hon)
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Correspondence to Akanksha Mehta M.D. .

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Editors and Affiliations

  1. , Department of Urology, Austin Fertility & Reproductive Medicine, JAMES CASEY SUITE B 4303, AUSTIN, 78745, Texas, USA

    Parviz K. Kavoussi

  2. University of Virginia School of Medicin, University Of Virginia Hospital, 1300 Jefferson Parks Avenue, Charlottesville, 22903, Virginia, USA

    Raymond A. Costabile

  3. Department of Urology, University Vita-Salute San Raffaele, Via Olgettina 60, Milan, 20132, Italy

    Andrea Salonia

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Mehta, A., Paduch, D.A., Goldstein, M. (2013). Treatment of Hypogonadism in Men. In: Kavoussi, P., Costabile, R., Salonia, A. (eds) Clinical Urologic Endocrinology. Springer, London. https://doi.org/10.1007/978-1-4471-4405-2_5

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  • DOI: https://doi.org/10.1007/978-1-4471-4405-2_5

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