Treatment of Hypogonadism in Men

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.