Current Urology Reports

, 15:417 | Cite as

Alternative Treatment Modalities for the Hypogonadal Patient

Men’s Health (R Carrion and C Yang, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Men’s Health

Abstract

Testosterone (T) deficiency syndrome (TDS) is a prevalent condition, commonly managed with exogenous T. Despite an abundance of T formulations, alternative treatments are often sought for various reasons. To evaluate outcomes of alternative therapies, a PubMed search was performed of all publications that included men with TDS from 1990 through October 2013, with results summarized. Proposed mechanisms of action were also reviewed to provide a pathophysiologic basis for reported outcomes. Nonpharmacologic therapies that increase endogenous T are weight loss, exercise, and varicocelectomy, while medications used off-label include aromatase inhibitors, human chorionic gonadotropin, and selective estrogen receptor modulators. All reported therapies increase T, while changes in estradiol and adverse events vary by therapeutic class. Although limited data preclude direct comparisons between therapies, exercise and weight loss alone or in combination with medications may be considered first line. The role for surgical therapy in TDS remains undefined and requires further study.

Keywords

Androgen Testosterone Late-onset Aromatase Human chorionic gonadotropin Selective estrogen receptor modulator Anastrozole Clomiphene Enclomiphene Estradiol Luteinizing hormone Varicocele Varicocelectomy Obesity Body mass index Adverse effects Bone mineral density Osteoporosis Osteopenia Letrozole Testolactone 

Abbreviations

AE

Adverse events

AI

Aromatase inhibitors

BMI

Body mass index

DHT

Dihydrotestosterone

E2

Estradiol

ER-α

Estrogen receptor alpha

ER-β

Estrogen receptor beta

FSH

Follicle stimulating hormone

GnRH

Gonadotropin-releasing hormone

HAART

Highly active antiretroviral therapy

HCG

Human chorionic gonadotropin

HPG

Hypothalamic pituitary gonadal axis

IM

Intramuscular

LH

Luteinizing hormone

PC

Placebo controlled

RCT

Randomized controlled trial

SERM

Selective estrogen receptor blockers

T

Testosterone

TDS

Testosterone deficiency syndrome

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Mayo ClinicRochesterUSA
  2. 2.Baylor College of MedicineHoustonUSA
  3. 3.Baylor ClinicHoustonUSA

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