Treatment Of Hypogonadism In Men Research Articles

Clinical review 34: Androgen treatment of hypogonadal men

Clinical review 34: Androgen treatment of hypogonadal men

Sex hormone-binding globulin changes with androgen replacement.

Since sex hormone-binding globulin (SHBG) levels are often elevated in sera of patients with testicular insufficiency, it is important to determine whether SHBG declines into the normal range and the extent of change in free testosterone (free T) after androgen administration. Five normal men and five patients with Klinefelter's syndrome were studied before and after the administration of testosterone enanthate (200 mg, im every 2 weeks). An additional five normal men and five patients with hypogonadotropic hypogonadism (HH) were treated with hCG (2000 U, three times a week). Three months after the administration of T or hCG, serum total and free T increased in both normal men and patients. Free T increased significantly in the Klinefelter's and HH patients from 94 +/- 20 and 14 +/- 5 pg/ml, respectively, to 271 +/- 50 and 276 +/- 41 pg/ml (P less than 0.01; P less than 0.001). The increase in the normal men treated with T or hCG was also significant (from 211 +/- 52 and 220 +/- 37 pg/ml to 390 +/- 83 and 330 +/- 90 pg/ml). SHBG fell in both the T-treated normal men (from 6.5 +/- 1.2 ng dihydrotestosterone bound/ml to 4.3 +/- 0.4; P less than 0.02) and the T-treated Klinefelter's patients (from 16.4 +/- 2 to 4.3 +/- 0.5; P less than 0.01). However, it was unchanged in the hCG-treated HH patients and rose in the hCG-treated normal men (from 6.6 +/- 0.7 to 8.6 +/- 1.0; P less than 0.05). This study demonstrates that treatment of hypogonadal men with T and hCG in the doses used increased free T levels above the basal levels for normal men. However, the effects of the increase in free T, as determined by a change in SHBG, were different depending upon the type of treatment.

Effects of Androgen on Sexual Behavior in Hypogonadal Men

Despite the widespread use of androgen in the treatment of hypogonadal men, its efficacy in restoring sexual behavior to hypogonadal patients has not been established in appropriately controlled behavioral studies. Accordingly, testosterone enanthate or vehicle was injected once every 4 weeks im in a double blind experiment. The subjects were six adult males, aged 32-65 yr, two with gonadal failure and four with secondary hypogonadism. Two doses of testosterone (100 and 400 mg) were administered for approximately 5 months, with the treatments varied at random within and among subjects. Details of sexual activity and experience were followed by the use of daily logs. Frequencies of erections, including nocturnal erections and coitus, showed significant dose-related responses to androgen treatment which closely followed the fluctuations in the circulating testosterone level. As indicated by the Profile of Mood States test, behavioral responses did not appear to be mediated by changes in mood. We concluded that the stimulatory effects of testosterone on sexual activity are rapid, reliable, and not due to a placebo effect. To maintain plasma testosterone and adequate sexual function within normal levels, even high doses of testosterone enanthate should be given no less frequency than once every 3 weeks.