Treatment of Hypogonadism in Men

  • Akanksha Mehta
  • Darius A. Paduch
  • Marc Goldstein
Chapter

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.

Keywords

Aromatase inhibitors Androgen deficiency Gonadotropins Hypogonadism Fertility Selective androgen receptor modulators Selective estrogen receptor modulators Testosterone deficiency Testosterone replacement therapy Varicocelectomy 

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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Copyright information

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Authors and Affiliations

  • Akanksha Mehta
    • 1
  • Darius A. Paduch
    • 2
  • Marc Goldstein
    • 2
  1. 1.Department of UrologyWeill Cornell Medical CollegeNew YorkUSA
  2. 2.Department of UrologyCenter for Male Reproductive Medicine, New York Presbyterian Hospital, Weill Cornell Medical CollegeNew YorkUSA

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