Testosterone Substitution Therapy

Abstract

Klinefelter’s syndrome is characterized by decreased testosterone production which may become apparent at various stages of life. It is the clinician’s task to initiate substitution therapy as soon as clinical or biochemical signs of this deficiency are diagnosed. Clinical signs and symptoms include potency problems, lower backache, muscle weakness, anemia, and psychosocial maladjustment. The biochemical signs are a lower than normal level of serum or saliva testosterone, increased serum luteinizing hormone (LH) levels, and low erythropoietic parameters (red blood cells, hemoglobin, hematocrit). The most important of these parameters is the serum or saliva testosterone concentration. If it falls below the normal levels, substitution therapy has to be commenced; on the other hand if testosterone production is still normal when the syndrome is diagnosed, the patient must be closely monitored to detect any decrease in testosterone at its onset. This is important because some symptoms, such as those due to osteoporosis, cannot be completely reversed and even sufficient testosterone therapy may merely prevent further deterioration.