Materiały źródłowe

• #1 Non-testosterone management of male hypogonadism: an examination of the existing literature

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7108991/

  Testosterone therapy has historically been offered to men with symptomatic testosterone deficiency in the form of injections, gels, or pellets. […] Human chorionic gonadotropin (hCG) remains the only FDA-approved non-testosterone treatment option for testosterone deficiency in men. […] The authors suggest that the SERM clomiphene citrate (CC) holds the greatest promise as a non-testosterone treatment option for testosterone deficiency. […] The AUA states that selective estrogen receptor modulators (SERMs), AIs, and human chorionic gonadotropin (hCG) may be used alone or in combination to treat testosterone deficiency in this population. […] The SERM most studied in the treatment of testosterone deficiency is clomiphene citrate (CC). […] CC has long been used as a treatment to restore testosterone levels and promote or preserve spermatogenesis in men with testosterone deficiency desiring to preserve fertility, and multiple studies have shown that CC effectively raises testosterone to eugonadal levels.

• #1 Hypogonadism Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/922038-treatment

  Patients with hypogonadism are typically treated with sex steroid replacement. The goals of treatment are: […] In prepubertal patients with hypogonadism, treatment is directed at initiating pubertal development at the appropriate age. […] Therapy with sex steroid replacement ensures development of secondary sexual characteristics and maintenance of normal sexual function. […] An alternative for men with hypogonadotropic hypogonadism has been treatment with pulsatile LHRH or hCG, either of which can stimulate testicular growth and spermatogenesis. […] At a time when fertility is desired, it may be induced with either pulsatile LHRH or (more commonly) with a schedule of injections of hCG and FSH. […] A phase III, multicenter, open-label, single-arm trial by Nieschlag et al indicated that corifollitropin-alfa therapy combined with hCG treatment can significantly increase testicular volume and induce spermatogenesis in adult males with hypogonadotropic hypogonadism whose azoospermia could not be cured by hCG treatment alone.

• #1 Testosterone Replacement Therapy for Male Hypogonadism | AAFP

  https://www.aafp.org/pubs/afp/issues/2024/0600/testosterone-replacement-therapy-male-hypogonadism.html

  Testosterone deficiency, or male hypogonadism, is a clinical syndrome that can be defined as persistently low serum testosterone levels in the setting of symptoms consistent with testosterone deficiency. […] Studies suggest that testosterone replacement therapy may improve sexual function, depressive symptoms, bone density, and lean body mass. […] After a detailed discussion of the potential benefits and risks through shared decision-making, testosterone replacement therapy should be considered for men with testosterone deficiency to correct selected symptoms and induce and maintain secondary sex characteristics. […] Treatment method should take into consideration patient preference, pharmacokinetics, potential for medication interactions, formulation-specific adverse effects, treatment burden, and cost.

• #1 Testosterone Therapy for Hypogonadism Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/testosterone-therapy

  We recommend testosterone therapy in hypogonadal men to induce and maintain secondary sex characteristics and correct symptoms of testosterone deficiency. […] We recommend against testosterone therapy in men planning fertility in the near term or in men with breast or prostate cancer, a palpable prostate nodule or induration, a prostate-specific antigen level 4 ng/mL, a prostate-specific antigen level 3 ng/mL combined with a high risk of prostate cancer (without further urological evaluation), elevated hematocrit, untreated severe obstructive sleep apnea, severe lower urinary tract symptoms, uncontrolled heart failure, myocardial infarction or stroke within the last 6 months, or thrombophilia. […] In hypogonadal men 55 to 69 years old, who are being considered for testosterone therapy and have a life expectancy 10 years, we suggest discussing the potential benefits and risks of evaluating prostate cancer risk and prostate monitoring and engaging the patient in shared decision making regarding prostate cancer monitoring.

• #1 Treatment of Hypogonadism: Current and Future Therapies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5265703/

  There are a variety of testosterone preparations currently on the market in the US and additional formulations available abroad and in development. […] Owing to their ease of use and relatively low cost, injectable and transdermal testosterone preparations are currently the most widely used in the US. […] Transdermal testosterone gels are widely available and popular among both patients and clinicians. […] Benefits of transdermal gels include high efficacy for the management of symptoms of hypogonadism, ease of home administration, and minimizing fluctuations in testosterone concentration from day to day. […] Risks of transdermal gels include mild skin irritation and potential for skin-to-skin transfer to others. […] A subcutaneous testosterone pellet (Testopel) is available for the treatment of hypogonadism. […] Benefits include eliminating risk of skin-to-skin transfer, infrequent dosing, and relatively stable serum testosterone concentrations.

• #1 Prevalence, Diagnosis and Treatment of Hypogonadism in Primary Care Practice » Sexual Medicine » BUMC

  https://www.bumc.bu.edu/sexualmedicine/publications/prevalence-diagnosis-and-treatment-of-hypogonadism-in-primary-care-practice/

  Once testosterone deficiency is confirmed, we then consider testosterone replacement therapy. […] Several treatment options exist for testosterone replacement, including oral preparations of testosterone derivatives; intramuscular injections of long-acting testosterone esters; transdermal patches applied to the scrotum or other areas of the body (eg, upper arms, legs, abdomen, or back); and a recently approved 1% testosterone gel. […] The classic form of androgen replacement is injection therapy using one of the long-acting testosterone preparations such as testosterone enanthate or testosterone cypionate. […] Testosterone replacement therapy can return hormone levels to normal ranges and help alleviate the symptoms associated with hypogonadism.

• #1 Lesson: Novel Therapies Expand Hypogonadism Treatment Options

  https://journalce.powerpak.com/ce/novel-therapies-expand-hypogonadism-treatment

  Optimal medication management for TD treats associated signs and symptoms and maintains eugonadal serum testosterone concentrations. Purported benefits of TRT, historically, have included an increase in libido, sexual function, mood, bone density, erythropoiesis, and body composition in general. However, some evidence exists that patients may not experience all of these benefits. […] Testosterone is available in many formulations and administrative methods. Grouped in a class of TRT, it represents the only FDA-approved treatment for TD resulting from hypogonadism. Transdermal testosterone is available as either patches, gels, or a topical solution. These formulations result in consistent serum testosterone concentrations, which fall quickly upon stopping therapy. […] Esterified formulations of testosterone, given intramuscularly, include cypionate, enanthate, and undecanoate. Hallmarks of this TRT modality include relatively low cost and extended dosing intervals. Testosterone-eluting pellets may be implanted subcutaneously in a prescribers office under local anesthesia.

• #1 Male Hypogonadism: A Review of the Disease and Its Treatment

  https://www.uspharmacist.com/article/male-hypogonadism-a-review-of-the-disease-and-its-treatment

  Androgen therapy in the form of TRT is the most commonly used treatment modality for patients with hypogonadism. There are a variety of delivery forms available for providing testosterone replacement. […] Testosterone gels have anecdotally been reported to emit a musky odor that may be bothersome to some patients. […] Intramuscular (IM) administration of testosterone involves injection of the testosterone esters, testosterone enanthate (Delatestryl) and testosterone cypionate (Depo-Testosterone). These have been recommended due to their lipophilicity, resulting in the storage and gradual release from the oil-based vehicle in which they are administered, and thus limiting the need for frequent injections. […] Recommended dosing regimens include 75 to 100 mg IM weekly or 150 to 200 mg IM every 2 weeks.

• #1 Hypogonadism Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/922038-treatment

  A literature review by Taniguchi et al indicated that in late-onset hypogonadism, testosterone therapy significantly improves erectile function. […] The use of oral testosterone preparations, such as 17-alkylated androgens (eg, methyltestosterone), is discouraged because of liver toxicity. […] For older men with testosterone deficiency, a review by the Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency (EMA) found that the evidence concerning the risk of serious cardiovascular side effects from the use of testosterone in men with hypogonadism was inconsistent. […] A literature review by Corona et al indicated that testosterone replacement therapy is safe for age- or comorbidity-related (functional) male hypogonadism, not just for the organic variety. […] A study by Zitzmann et al indicated that the outcomes of testosterone therapy can vary depending on whether the patient has functional or organic (also known as classical) hypogonadism. […] The latest Endocrine Society clinical practice guidelines suggest testosterone therapy for men receiving high doses of glucocorticoids who also have low testosterone levels, to promote bone health.

• #1 Treatment of Hypogonadism: Current and Future Therapies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5265703/

  The treatment of hypogonadism in men is of great interest to both patients and providers. There are a number of testosterone formulations currently available and several additional formulations under development. […] In addition, there are some lesser-used alternative therapies for the management of male hypogonadism, which may have advantages for certain patient groups. The future of hypogonadism therapy may lie in the development of selective androgen receptor modulators that allow the benefits of androgens whilst minimizing unwanted side effects. […] For men with symptomatic hypogonadism, there are a number of potential clinical benefits with testosterone replacement therapy, including improvements in libido, erectile function, muscle strength and body composition (including decreased fat mass, increased lean mass, and improved bone mineral density), mood, and cognition. […] The potential clinical benefits of testosterone therapy must be carefully weighed against potential risks. Potential adverse effects of testosterone replacement include erythrocytosis, increases in prostate-specific antigen (PSA) and worsening of prostate disorders (including benign prostatic hyperplasia [BPH]), dermatologic effects, including acne and skin irritation, and worsening of existing obstructive sleep apnea. […] Thus, testosterone replacement therapy is not appropriate for hypogonadal men desiring fertility.

• #1 Treatment of Hypogonadism: Current and Future Therapies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5265703/

  Given the concerns surrounding the safety and benefits of testosterone therapy in men, other agents have also been used for the treatment of male hypogonadism. […] In particular, in younger men who are interested in fertility, testosterone replacement therapy is not recommended. […] Human chorionic gonadotropin (hCG) therapy (recombinant hCG) is traditionally used in hypogonadal men desiring fertility, since it shares a receptor with LH and produces similar effects. […] Studies have also looked at the role of hCG therapy in the treatment of hypogonadism in men without fertility concerns, and it has been shown to improve hypogonadal symptoms and have favorable effects on body composition. […] Clomiphene is a selective estrogen receptor modulator that has weak anti-estrogen action. […] It works only in individuals with hypogonadotropic hypogonadism with an otherwise intact hypothalamic-pituitary-gonadal axis. […] Though it seems a viable alternative to testosterone, it is not FDA approved for use in the treatment of hypogonadism.

• #1 Male Hypogonadism: A Review of the Disease and Its Treatment

  https://www.uspharmacist.com/article/male-hypogonadism-a-review-of-the-disease-and-its-treatment

  As discussed previously, if induction of spermatogenesis is desired, TRT is often not effective. Consequently, administration of gonadotropins in an attempt to increase secretion of GnRH is recommended. The first agent administered is hCG. FSH is added once a plateau in response to hCG is determined. […] When starting testosterone therapy, the patient should be screened for conditions that could be exacerbated with supplementation. Screening prior to and during use ensures patient safety. Because risk of benign prostatic hyperplasia and prostate cancer is believed to be increased with testosterone therapy, patients must have a baseline PSA test performed with a digital rectal exam. The PSA level should be monitored during treatment, and the patient should be referred to a urologist if abnormalities are detected.

• #1 Non-testosterone management of male hypogonadism: an examination of the existing literature – Krzastek – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/33647/html

  The SERM most studied in the treatment of testosterone deficiency is clomiphene citrate (CC). […] CC has long been used as a treatment to restore testosterone levels and promote or preserve spermatogenesis in men with testosterone deficiency desiring to preserve fertility, and multiple studies have shown that CC effectively raises testosterone to eugonadal levels. […] Of the non-testosterone compounds used to treat testosterone deficiency in men, only hCG is FDA approved. […] hCG is an LH analog and stimulates testosterone production by binding LH receptors. […] While hCG acts directly on the testis and is well-tolerated, this medication is expensive, and with the requirement for multiple injections per week, many patients elect alternative treatments. […] SERMs, including clomiphene citrate, appear to be highly effective at producing physiologic testosterone levels and appear to be well-tolerated and safe when used long-term. […] Consideration may be given to offering clomiphene citrate to men with symptomatic testosterone, regardless of the patients desire to preserve fertility.

• #1 Non-testosterone management of male hypogonadism: an examination of the existing literature – Krzastek – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/33647/html

  Testosterone therapy has historically been offered to men with symptomatic testosterone deficiency in the form of injections, gels, or pellets. […] Human chorionic gonadotropin (hCG) remains the only FDA-approved non-testosterone treatment option for testosterone deficiency in men. […] The authors suggest that the SERM clomiphene citrate (CC) holds the greatest promise as a non-testosterone treatment option for testosterone deficiency. […] Lifestyle modifications and varicocelectomy have been shown to raise endogenous testosterone production. […] Surgical repair of a varicocele, if present, may also be a treatment option for testosterone deficiency, and has been shown to increase testosterone levels in men with testosterone deficiency. […] The AUA states that selective estrogen receptor modulators (SERMs), AIs, and human chorionic gonadotropin (hCG) may be used alone or in combination to treat testosterone deficiency in this population.

• #1 Non-testosterone management of male hypogonadism: an examination of the existing literature

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7108991/

  CC is well-tolerated. […] Preliminary data on men treated for testosterone deficiency on CC for as long as 7 years show that over 80% of men achieve testosterone levels 450 ng/dL, with 78% of men reporting subjective improvement in hypogonadal symptoms, and only 9% reporting side effects from CC treatment with no significant adverse events. […] Enclomiphene citrate (EC) is a trans-isomer of CC and is not currently FDA approved in the United States. […] Like CC, tamoxifen has been shown to increase testosterone and gonadotropin levels, and preserve spermatogenesis, and this SERM is an acknowledged alternative treatment option for testosterone deficiency in men. […] Gonadotropin replacement therapy is an option for treating hypogonadotropic hypogonadism and includes gonadotropin-releasing hormone (GnRH) and the LH analog hCG.

• #1 Treatment of Men with Central Hypogonadism: Alternatives for Testosterone Replacement Therapy

  https://www.mdpi.com/1422-0067/22/1/21

  The advantages of these SERMs over TRT include oral administration, the maintenance of fertility, the avoidance of supraphysiological total testosterone levels and the lower risk of erythrocytosis. […] The SERMs clomiphene citrate and tamoxifen seem to be a safe off-label alternative for TRT for the treatment of functional central hypogonadism in men, especially in younger men who wish to maintain their fertility. However, up until now, data supporting the efficacy of clomiphene citrate and tamoxifen on hypogonadal symptoms are insufficient. Larger RCTs with a clearer definition of the study population and long-time follow-up are necessary to determine the effect of these SERMs on several outcome parameters. Until then, clomiphene citrate and tamoxifen should not be used to treat sexual symptoms in men with central hypogonadism.

• #1 Treatment of Hypogonadism: Current and Future Therapies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5265703/

  Aromatase inhibitors prevent the conversion of testosterone to estrogen and have been investigated for the treatment of male hypogonadism. […] These factors make them a possible alternative to testosterone in obese hypogonadal men with high E2 concentrations, older hypogonadal men with BPH, and younger hypogonadal and subfertile men. […] Selective androgen receptor modulators (SARMs) have stemmed from the concept of achieving beneficial effects on skeletal muscle and bone while minimizing negative effects on erythrocytes, prostate, hair, and skin. […] However, there is not enough evidence to recommend these as an alternative to testosterone for the treatment of hypogonadism as yet. […] Treatment of male hypogonadism remains an area that requires in-depth discussion of the risks and benefits of therapy with the patient before proceeding. […] Additionally, there are a number of non-testosterone alternative therapies too that can be considered, particularly in men desiring fertility or wishing to avoid specific side effects of testosterone therapy.

• #1 Diagnosis and treatment of hypogonadism in men seeking to preserve fertility – what are the options? | International Journal of Impotence Research

  https://www.nature.com/articles/s41443-024-00897-4

  Male hypogonadism is a clinical syndrome that results in low testosterone levels and frequently leads to infertility. […] Testosterone replacement therapy (TRT) is the most common treatment utilised for male hypogonadism. […] For patients who wish to remain fertile, nasal TRT, clomiphene citrate, exogenous gonadotropins, gonadotropin releasing hormone and aromatase inhibitors have been used as alternative treatment options with different degrees of success. […] Gonadotropin releasing hormone can successfully induce spermatogenesis but is impractical to administer. […] Likewise, aromatase inhibitors have limited use due to inducing osteopenia. […] Nasal TRT may be a good treatment option for these patients, but its efficacy has so far only been demonstrated in small sample sizes. […] However, clomiphene citrate and exogenous gonadotropins are safe, offer good symptom control and can successfully induce fertility in hypogonadism patients.

• #1 Male Hypogonadism

  https://www.artfertilityclinics.com/in/en/art-blog/male-hypogonadism-symptoms-causes-treatment

  Male hypogonadism Treatment Options […] The best treatment for male hypogonadism depends on the underlying cause and your individual circumstances. Here are the most common approaches: […] Lifestyle Changes: […] These include: […] Weight loss can significantly increase testosterone levels. […] Regular exercise, especially strength training, helps raise testosterone. […] A balanced diet with fruits, veggies, and whole grains fuels testosterone production. […] Limit processed foods, unhealthy fats, and sugar. […] Practice relaxation techniques to manage stress. […] Aim for 7-8 hours of sleep for optimal hormonal health, including testosterone regulation. […] Testosterone Replacement Therapy: […] Testosterone replacement therapy is the preferred male hypogonadism treatment. The goal of this treatment is to ease signs like loss of libido, tiredness, hair loss on the face and body, and less muscle mass and bone structure. Its effectiveness in men with male hypogonadism due to ageing is unclear.

• #1 Testosterone Replacement Therapy for Male Hypogonadism | AAFP

  https://www.aafp.org/pubs/afp/issues/2024/0600/testosterone-replacement-therapy-male-hypogonadism.html

  Clinicians should monitor men receiving testosterone replacement therapy for symptom improvement, potential adverse effects, and adherence. […] Serum testosterone, hematocrit, and prostate-specific antigen levels should be measured at baseline and at least annually in men 40 years or older receiving testosterone replacement therapy.

• #1 Male hypogonadism – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/male-hypogonadism/diagnosis-treatment/drc-20354886

  Testosterone replacement can raise testosterone levels and help ease the symptoms of male hypogonadism. These include less desire for sex, less energy, less facial and body hair, and loss of muscle mass and bone mass. […] For older adults who have low testosterone and symptoms of hypogonadism due to aging, it’s less clear how well testosterone replacement works. […] Anyone taking testosterone replacement should have a medical checkup and blood tests several times during the first year of treatment and yearly after that. This is to see how well the treatment works and to watch for side effects. […] Testosterone therapy carries risks, including: Making too many red blood cells, Acne, Bigger breasts, Sleep problems, Growth of the prostate, Not making as much sperm. […] Risks from testosterone therapy are most often due to doses that are too high. Many of these side effects go away when the dose is lowered. That’s why it’s so important to have regular follow-up visits with a health care professional, who will monitor the testosterone levels in your blood.

• #1 Hypogonadism – Wikipedia

  https://en.wikipedia.org/wiki/Hypogonadism

  In short- and medium-term testosterone replacement therapy the risk of cardiovascular events (including strokes and heart attacks and other heart diseases) is not increased. The long-term safety of the therapy is not known yet. […] While historically, men with prostate cancer risk were warned against testosterone therapy, that has shown to be a myth. […] Another treatment for hypogonadism is human chorionic gonadotropin (hCG). This stimulates the LH receptor, thereby promoting testosterone synthesis. […] For both men and women, an alternative to testosterone replacement is low-dose clomifene treatment, which can stimulate the body to naturally increase hormone levels while avoiding infertility and other side effects that can result from direct hormone replacement therapy.

• #1 Testosterone Deficiency Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/testosterone-deficiency-guideline

  Clinicians should adjust testosterone therapy dosing to achieve a total testosterone level in the middle tertile of the normal reference range. Exogenous testosterone therapy should not be prescribed to men who are currently trying to conceive. Testosterone therapy should not be commenced for a period of three to six months in patients with a history of cardiovascular events. Clinicians should not prescribe alkylated oral testosterone. Clinicians should discuss the risk of transference with patients using testosterone gels/creams. Clinicians may use aromatase inhibitors, human chorionic gonadotropin, selective estrogen receptor modulators, or a combination thereof in men with testosterone deficiency desiring to maintain fertility. Commercially manufactured testosterone products should be prescribed rather than compounded testosterone, when possible. […] All men with testosterone deficiency should be counseled regarding lifestyle modifications as a treatment strategy.

• #1 Treatment of hypogonadotropic male hypogonadism: Case-based scenarios

  https://www.wjgnet.com/2220-6124/full/v4/i2/245.htm

  The aim of this study is to review four case-based scenarios regarding the treatment of symptomatic hypogonadism in men. […] Our results demonstrated that exogenous testosterone suppresses intratesticular testosterone production, which is an absolute prerequisite for normal spermatogenesis. Cessation of exogenous testosterone should be recommended for men desiring to maintain their fertility. […] Therapies that protect the testis involve human chorionic gonadotropin (hCG) therapy or selective estrogen receptor modulators (SERMs), but may also include low dose hCG with exogenous testosterone. […] At present, routine use of aromatase inhibitors is not recommended based on a lack of long-term data. […] We concluded that exogenous testosterone supplementation decreases sperm production. It was determined that clomiphene citrate is a safe and effective therapy for men who desire to maintain fertility.

• #1 Male hypogonadism – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/male-hypogonadism/diagnosis-treatment/drc-20354886

  If a pituitary problem is the cause, pituitary hormones can be given to help the body make more sperm and restore fertility. […] Treatment of delayed puberty in boys depends on the cause. Three to six months of testosterone shots can help start puberty. The testosterone can help increase muscle mass, beard and pubic hair growth, and growth of the penis. This treatment is given only if the bones have matured enough.

• #1 Testosterone Therapy for Hypogonadism Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/testosterone-therapy

  We suggest against routinely prescribing testosterone therapy to all men 65 years or older with low testosterone concentrations. […] In men 65 years who have symptoms or conditions suggestive of testosterone deficiency (such as low libido or unexplained anemia) and consistently and unequivocally low morning testosterone concentrations, we suggest that clinicians offer testosterone therapy on an individualized basis after explicit discussion of the potential risks and benefits. […] We suggest that clinicians consider short-term testosterone therapy in HIV-infected men with low testosterone concentrations and weight loss (when other causes of weight loss have been excluded) to induce and maintain body weight and lean mass gain. […] In men with type 2 diabetes mellitus who have low testosterone concentrations, we recommend against testosterone therapy as a means of improving glycemic control.

• #1 Hypogonadism: Clinic for Stem Cell Treatment | Swiss Medica

  https://www.startstemcells.com/hypogonadism.html

  In males, primary hypogonadism can be treated with testosterone replacement therapy, e.g., transdermal, using a patch or gel, injection or pellets. This takes up to 2-3 months for optimum levels to be achieved. Blood levels of testosterone should be checked regularly to ensure it increases adequately. […] Using human chorionic gonadotropin (hCG) in men with secondary hypogonadism. hCG stimulates the LH receptor and consequently enhances testosterone synthesis. […] For both male and female hypogonadism, administration of the low dose of clomifene stimulates the body naturally to produce sex hormones. […] Treatment of hypogonadism using hormone replacement therapy has significant side effects both in males and females. In recent research, scientists have used stem cells to bring the levels of testosterone to normal. This was achieved by the transformation of adult skin cells to create Leydig cells of the testicles that are responsible for the production of testosterone. In another experiment conducted by the same team of scientists, testosterone levels were successfully brought to normal levels in rodents. […] It, therefore, suggests that with further experiments, stem cell therapy would be a safer and quicker method of treating hypogonadism in both males and females.

• #1 Male Hypogonadism: A Review of the Disease and Its Treatment

  https://www.uspharmacist.com/article/male-hypogonadism-a-review-of-the-disease-and-its-treatment

  Pharmacologic management of males with hypogonadism can significantly improve their clinical symptoms, resulting in improved quality of life. There are a number of risks involved with therapy; however, the benefits of using TRT for hypogonadism can include increases in sexual function and improved mood, body composition, and bone density.

• #1 Male hypogonadism: Symptoms, causes, and treatment

  https://www.medicalnewstoday.com/articles/307634

  Testosterone replacement therapy (TRT) is the recommended treatment for male hypogonadism. […] TRT can eliminate many, if not all, of the signs and symptoms of male hypogonadism. […] Benefits include: increased libido, mood improvement, increased bone mineral density, overall improved quality of life. […] However, there are a few risks associated with it. […] TRT should not be started without first attending to these conditions. […] All males who are using TRT require ongoing medical evaluation to determine adequate response to treatment. […] The response to TRT is individualized, and testosterone levels are not an indicator of who will respond to TRT and who will not. […] It is also worth noting that while it can relieve symptoms of hypogonadism, TRT does not restore fertility.

• #1 Prevalence, Diagnosis and Treatment of Hypogonadism in Primary Care Practice » Sexual Medicine » BUMC

  https://www.bumc.bu.edu/sexualmedicine/publications/prevalence-diagnosis-and-treatment-of-hypogonadism-in-primary-care-practice/

  Hypogonadism is defined as deficient or absent male gonadal function that results in insufficient testosterone secretion. […] Studies suggest that hypogonadism in adult men is often underdiagnosed and under treated. […] By doing so, many patients who we now consider to be low-normal would probably be considered candidates for androgen replacement. […] Treatments to normalize testosterone can not only improve libido, energy level and the potential to have normal erections, but can also improve the response to sildenafil, if that is deemed appropriate treatment. […] The goal of testosterone replacement therapy is to provide and maintain a normal level of testosterone, thereby restoring libido and improving erectile function; improving mood and providing a sense of well-being; decreasing fatigue; and improving lean body mass, strength and stamina.

• #1 Treatment of hypogonadotropic male hypogonadism: Case-based scenarios

  https://www.wjgnet.com/2220-6124/full/v4/i2/245.htm

  Men wishing for future fertility should refrain from utilizing exogenous testosterone due to the potential for long-term detrimental effects on spermatogenesis. […] Clomiphene citrate, an oral selective estrogen receptor modulator, is an off-label yet innocuous and potent therapy for men who wish to retain future potential fertility. […] hCG therapy, although less used, with or without testosterone supplementation represents an alternative treatment.

• #2 Prevalence, Diagnosis and Treatment of Hypogonadism in Primary Care Practice » Sexual Medicine » BUMC

  https://www.bumc.bu.edu/sexualmedicine/publications/prevalence-diagnosis-and-treatment-of-hypogonadism-in-primary-care-practice/

  Hypogonadism is defined as deficient or absent male gonadal function that results in insufficient testosterone secretion. […] Studies suggest that hypogonadism in adult men is often underdiagnosed and under treated. […] By doing so, many patients who we now consider to be low-normal would probably be considered candidates for androgen replacement. […] Treatments to normalize testosterone can not only improve libido, energy level and the potential to have normal erections, but can also improve the response to sildenafil, if that is deemed appropriate treatment. […] The goal of testosterone replacement therapy is to provide and maintain a normal level of testosterone, thereby restoring libido and improving erectile function; improving mood and providing a sense of well-being; decreasing fatigue; and improving lean body mass, strength and stamina.

• #2 Prevalence, Diagnosis and Treatment of Hypogonadism in Primary Care Practice » Sexual Medicine » BUMC

  https://www.bumc.bu.edu/sexualmedicine/publications/prevalence-diagnosis-and-treatment-of-hypogonadism-in-primary-care-practice/

  Once testosterone deficiency is confirmed, we then consider testosterone replacement therapy. […] Several treatment options exist for testosterone replacement, including oral preparations of testosterone derivatives; intramuscular injections of long-acting testosterone esters; transdermal patches applied to the scrotum or other areas of the body (eg, upper arms, legs, abdomen, or back); and a recently approved 1% testosterone gel. […] The classic form of androgen replacement is injection therapy using one of the long-acting testosterone preparations such as testosterone enanthate or testosterone cypionate. […] Testosterone replacement therapy can return hormone levels to normal ranges and help alleviate the symptoms associated with hypogonadism.

• #2 A Review of Testosterone Therapy Options for Men

  https://www.uspharmacist.com/article/a-review-of-testosterone-therapy-options-for-men

  Testosterone is the treatment of choice for testosterone deficiency and hypogonadism. Since its chemical synthesis in 1935, scientists have explored various dosage formulations of testosterone. Testosterone therapy is available in multiple forms, including topical gel, topical solution, transdermal patch, intranasal gel, injectable, and implantable pellets. The target range for total testosterone in men is 450 ng/dL to 600 ng/dL. Initial testosterone monitoring following therapy initiation is determined based on the testosterone formulation. Routine monitoring of testosterone should occur every 6 to 12 months to ensure maintenance of target levels. […] Multiple topical testosterone products are available in both branded and generic form. All topical products carry the risk of accidental exposure, which could potentially cause virilization in women and children. Testosterone nasal gel requires multiple applications per day and has nasal side effects. Oral testosterone is easy to administer, but it must be taken with food. Although injectable therapy has flexible dosing, there is a risk of symptom fluctuations. Testosterone pellets have a long duration of action; however, they require an in-office procedure.

• #2 Lesson: Novel Therapies Expand Hypogonadism Treatment Options

  https://journalce.powerpak.com/ce/novel-therapies-expand-hypogonadism-treatment

  Optimal medication management for TD treats associated signs and symptoms and maintains eugonadal serum testosterone concentrations. Purported benefits of TRT, historically, have included an increase in libido, sexual function, mood, bone density, erythropoiesis, and body composition in general. However, some evidence exists that patients may not experience all of these benefits. […] Testosterone is available in many formulations and administrative methods. Grouped in a class of TRT, it represents the only FDA-approved treatment for TD resulting from hypogonadism. Transdermal testosterone is available as either patches, gels, or a topical solution. These formulations result in consistent serum testosterone concentrations, which fall quickly upon stopping therapy. […] Esterified formulations of testosterone, given intramuscularly, include cypionate, enanthate, and undecanoate. Hallmarks of this TRT modality include relatively low cost and extended dosing intervals. Testosterone-eluting pellets may be implanted subcutaneously in a prescribers office under local anesthesia.

• #2 Male Hypogonadism

  https://www.artfertilityclinics.com/in/en/art-blog/male-hypogonadism-symptoms-causes-treatment

  During testosterone replacement therapy, it is best to have regular check-ups with a doctor to see how well the treatment is working and to handle any side effects that might happen. There are different kinds of testosterone replacement, such as: […] Gels and Solutions: These can be put on the skin of the upper arm, shoulder, thigh, or chest. Brands like AndroGel, Testim, Vogelxo, and Fortesta are some examples. […] Patches: Androderm patches are put on the legs or chest every night. […] Gum and Cheek (Buccal Cavity): A putty-like material is put on top of the upper teeth and along the gumline. This releases testosterone into the bloodstream. […] Nasal Gel: This gel is pumped into the nose, and it needs to be used several times a day. […] Implantable Pellets: Every couple of months, testosterone-filled pellets called Testopel are medically put under the skin.

• #2 Treatment of Men with Central Hypogonadism: Alternatives for Testosterone Replacement Therapy

  https://www.mdpi.com/1422-0067/22/1/21

  Central hypogonadism is a clinical condition, characterized by sexual symptoms and low serum testosterone levels, due to an impaired function of the hypothalamus or pituitary gland. Testosterone replacement therapy (TRT) is the standard treatment for hypogonadism, but it has some disadvantages. TRT is not a good option in men wishing to preserve fertility, nor in men with (a high risk of) prostate cancer, polycythemia, thrombophilia and severe cardiovascular disease. […] In this review, we discuss alternative treatments for central hypogonadism. If reversible causes are present, non-pharmacological interventions can be therapeutic. Gonadotropins are a good alternative to TRT when fertility is desired in the near future though they require frequent injections. Clomiphene citrate and tamoxifen seem to be a safe alternative for the treatment of functional central hypogonadism in men, as several studies reported a significant increase in testosterone levels with these drugs. However, their use is off-label and data supporting the efficacy of clomiphene citrate and tamoxifen on hypogonadal symptoms are insufficient. For this reason, clomiphene citrate and tamoxifen should not be used in routine clinical practice to treat sexual symptoms in men with central hypogonadism.

• #2 Non-testosterone management of male hypogonadism: an examination of the existing literature – Krzastek – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/33647/html

  The SERM most studied in the treatment of testosterone deficiency is clomiphene citrate (CC). […] CC has long been used as a treatment to restore testosterone levels and promote or preserve spermatogenesis in men with testosterone deficiency desiring to preserve fertility, and multiple studies have shown that CC effectively raises testosterone to eugonadal levels. […] Of the non-testosterone compounds used to treat testosterone deficiency in men, only hCG is FDA approved. […] hCG is an LH analog and stimulates testosterone production by binding LH receptors. […] While hCG acts directly on the testis and is well-tolerated, this medication is expensive, and with the requirement for multiple injections per week, many patients elect alternative treatments. […] SERMs, including clomiphene citrate, appear to be highly effective at producing physiologic testosterone levels and appear to be well-tolerated and safe when used long-term. […] Consideration may be given to offering clomiphene citrate to men with symptomatic testosterone, regardless of the patients desire to preserve fertility.

• #2 Non-testosterone management of male hypogonadism: an examination of the existing literature

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7108991/

  Of the non-testosterone compounds used to treat testosterone deficiency in men, only hCG is FDA approved. […] hCG has also been used with concurrent exogenous testosterone to maintain intratesticular testosterone levels and preserve spermatogenesis. […] While studies exist suggesting that many of these treatment options are well tolerated and efficacious, further prospective studies must be conducted to support their use as first line treatment options in the management of testosterone deficiency.

• #2 Clomiphene Citrate Treatment as an Alternative Therapeutic Approach for Male Hypogonadism: Mechanisms and Clinical Implications

  https://www.mdpi.com/1424-8247/17/9/1233

  Clomiphene citrate, a drug originally developed for female infertility, has recently gained attention as an off-label treatment for male hypogonadism. By blocking the negative feedback of estrogen on the hypothalamus and pituitary glands, clomiphene stimulates gonadotropin secretion, leading to increased endogenous testosterone production, which, in turn, improves sperm parameters and fertility and alleviates the symptoms of hypogonadism. […] Clomiphene citrate may offer a promising alternative to TRT for men with hypogonadism, particularly those desiring fertility preservations. However, its long-term efficacy and safety remain inadequately understood. […] Non-hormonal treatment strategies for male hypogonadism have emerged as viable therapeutic options, including AIs and SERMs. […] Clomiphene is considered a cost-effective medication compared with TRT; however, extensive direct comparison research related to male hypogonadism is still lacking.

• #2 Secondary Hypogonadism: Causes and Potential Treatment – Endocrinology Advisor

  https://www.endocrinologyadvisor.com/features/secondary-hypogonadism-causes-and-potential-treatment/

  Selective estrogen receptor modulators may offer a viable treatment option for men with secondary hypogonadism. […] Most cases of secondary hypogonadism appear to respond to selective estrogen receptor modulator (SERM) therapy. […] This class of agents is truly bioidentical for testosterone replacement, as they augment native or endogenous testosterone levels rather than replacing them with exogenous testosterone. […] SERMs can also help preserve fertility and testicular size, he noted. […] Clinicians now often empirically treat idiopathic oligospermia with clomiphene citrate to increase luteinizing hormone (LH) and subsequently intratesticular testosterone. […] The biggest thing is a new pure version of clomiphene citrate (enclomiphene) for secondary hypogonadism in men, said Dr Turek, noting that the drug was up for review by the US Food and Drug Administration (FDA) in 2015.

• #2 Current National and International Guidelines for the Management of Male Hypogonadism: Helping Clinicians to Navigate Variation in Diagnostic Criteria and Treatment Recommendations

  https://www.e-enm.org/journal/view.php?number=2071

  The ISSM recommends that MH in men with CV disease be assessed and monitored in the same way as in other men, whereas the BSSM recommends assessing CV risk factors and optimising secondary prevention in men with established disease before commencing testosterone. […] The AUA recommended the need to counsel patients prior to starting testosterone, explaining that the evidence is patchy and that it is unknown whether testosterone can increase or decrease the risk of any major adverse CV event. […] The ES and AUS concur that functional HH/NGI due to obesity can be reversed by addressing the excess weight through diet and exercise. […] Testosterone treatment is not generally recommended by ES or AUS for the other category of men having intrinsically intact HPT axis, but suppressed function due to other causes (e.g., obesity or other comorbidity).

• #2 Testosterone Replacement Therapy for Male Hypogonadism | AAFP

  https://www.aafp.org/pubs/afp/issues/2024/0600/testosterone-replacement-therapy-male-hypogonadism.html

  Clinicians should monitor men receiving testosterone replacement therapy for symptom improvement, potential adverse effects, and adherence. […] Serum testosterone, hematocrit, and prostate-specific antigen levels should be measured at baseline and at least annually in men 40 years or older receiving testosterone replacement therapy.

• #2 Male Hypogonadism | Choose the Right Test

  https://arupconsult.com/content/hypogonadism-male

  Testosterone concentration should be assessed 3-6 months after the initiation of therapy, then again at 12 months after the initiation of therapy, and then annually thereafter with the goal of achieving a concentration in the middle of the reference interval. […] Because testosterone therapy may increase the risk of polycythemia, hemoglobin and hematocrit should be assessed before initiating therapy. […] Individuals 55-69 years of age (or 40-69 years of age in high-risk groups) who are pursuing testosterone therapy should participate in shared decision-making to determine if monitoring for prostate cancer is appropriate. […] Serum estradiol should be measured in individuals with gynecomastia before beginning testosterone therapy.

• #2 Treatment of Hypogonadism: Current and Future Therapies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5265703/

  The treatment of hypogonadism in men is of great interest to both patients and providers. There are a number of testosterone formulations currently available and several additional formulations under development. […] In addition, there are some lesser-used alternative therapies for the management of male hypogonadism, which may have advantages for certain patient groups. The future of hypogonadism therapy may lie in the development of selective androgen receptor modulators that allow the benefits of androgens whilst minimizing unwanted side effects. […] For men with symptomatic hypogonadism, there are a number of potential clinical benefits with testosterone replacement therapy, including improvements in libido, erectile function, muscle strength and body composition (including decreased fat mass, increased lean mass, and improved bone mineral density), mood, and cognition. […] The potential clinical benefits of testosterone therapy must be carefully weighed against potential risks. Potential adverse effects of testosterone replacement include erythrocytosis, increases in prostate-specific antigen (PSA) and worsening of prostate disorders (including benign prostatic hyperplasia [BPH]), dermatologic effects, including acne and skin irritation, and worsening of existing obstructive sleep apnea. […] Thus, testosterone replacement therapy is not appropriate for hypogonadal men desiring fertility.

• #2 Male Hypogonadism: A Review of the Disease and Its Treatment

  https://www.uspharmacist.com/article/male-hypogonadism-a-review-of-the-disease-and-its-treatment

  Treatment strategies for both primary and secondary forms of male hypogonadism are similar and involve supplementation of testosterone or induction of endogenous testosterone production. Of the candidates appropriate to receive therapy, only 5% actually are prescribed testosterone replacement therapy (TRT). TRT is recommended for men with clinical symptoms of androgen deficiency combined with laboratory evidence of abnormally low levels of serum testosterone. However, testosterone therapy in patients with diagnoses of breast or prostate cancer is not recommended. This is also true in patients with an elevated prostate-specific antigen (PSA) 3 ng/mL, without further urologic workup. […] Goals of treating hypogonadal patients are focused around improvement of those symptoms, many of which can be achieved with exogenous testosterone replacement. For patients with primary hypogonadism with decreased sperm counts, virility is commonly not achieved despite supplementation with testosterone products. Thus, GnRH production must be stimulated through use of pulsatile GnRH or treatment with exogenous gonadotropins. Choice of agent is dependent on the cause of the disorder. If the problem stems from the hypothalamus, GnRH administration is appropriate, whereas exogenous gonadotropins should be utilized for patients with a combination of pituitary and hypothalamic disorders.

• #2 MALE HYPOGONADISM AND TESTOSTERONE REPLACEMENT | Society for Endocrinology

  https://www.endocrinology.org/endocrinologist/143-spring-22/features/male-hypogonadism-and-testosterone-replacement/

  However, there are hardly any data demonstrating that testosterone treatment improves features of MH in men when the serum total testosterone is 12nmol/l. […] It seems a paradox that MH is associated with increased cardiovascular risk, yet testosterone treatment has been mired in controversy regarding the risk of provoking cardiovascular events cited by the US Food and Drug Administration, although not by the European Medicines Agency or the UK Medicines and Healthcare Products Regulatory Agency. […] In men with high cardiovascular risk, we recommend counselling them that the cardiovascular safety of testosterone therapy remains uncertain. […] We strongly advise that you ask men with MH about new urinary symptoms within the first few months following testosterone treatment initiation and refer for urological assessment appropriately.

• #2 Treatment of hypogonadotropic male hypogonadism: Case-based scenarios

  https://www.wjgnet.com/2220-6124/full/v4/i2/245.htm

  Although less frequently used in the general population, hCG therapy with or without testosterone supplementation represents an alternative treatment. […] Testosterone therapy does not improve spermatogenesis and should not be used by men of reproductive age. […] Clomiphene citrate (CC) can be a fairly effective treatment option in increasing serum testosterone levels. […] Clomiphene citrate should be considered as a therapy for male patients with hypogonadism. […] Clomiphene citrate is an effective and less expensive treatment option. […] Long-term use of Clomiphene citrate is a safe way to improve serum testosterone levels. […] Cessation of T therapy should be the first treatment concern for nearly all men who are interested in preserving their fertility. […] hCG may be considered, but it requires frequent injections and can produce side effects.

• #2 Male hypogonadism | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/male-hypogonadism

  Testosterone replacement can raise testosterone levels and help ease the symptoms of male hypogonadism. These include less desire for sex, less energy, less facial and body hair, and loss of muscle mass and bone mass. […] For older adults who have low testosterone and symptoms of hypogonadism due to aging, it’s less clear how well testosterone replacement works. […] Anyone taking testosterone replacement should have a medical checkup and blood tests several times during the first year of treatment and yearly after that. This is to see how well the treatment works and to watch for side effects. […] Testosterone therapy carries risks, including: making too many red blood cells, acne, bigger breasts, sleep problems, growth of the prostate, and not making as much sperm. […] If a pituitary problem is the cause, pituitary hormones can be given to help the body make more sperm and restore fertility. […] Treatment of delayed puberty in boys depends on the cause. Three to six months of testosterone shots can help start puberty. The testosterone can help increase muscle mass, beard and pubic hair growth, and growth of the penis. This treatment is given only if the bones have matured enough.

• #2 MALE HYPOGONADISM AND TESTOSTERONE REPLACEMENT | Society for Endocrinology

  https://www.endocrinology.org/endocrinologist/143-spring-22/features/male-hypogonadism-and-testosterone-replacement/

  With the overwhelming majority of males retaining Leydig cell sensitivity to luteinising hormone stimulation into old age, we can envisage no compelling circumstances wherein testosterone treatment should be withheld from patients with MH on the basis of chronological age per se. […] We hope this guidance provides a sensible and rational framework for diagnosing and managing MH, which chimes with the views of members of the Society for Endocrinology and helps us all to treat men effectively.

• #2 Hypogonadism Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/922038-treatment

  A literature review by Taniguchi et al indicated that in late-onset hypogonadism, testosterone therapy significantly improves erectile function. […] The use of oral testosterone preparations, such as 17-alkylated androgens (eg, methyltestosterone), is discouraged because of liver toxicity. […] For older men with testosterone deficiency, a review by the Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency (EMA) found that the evidence concerning the risk of serious cardiovascular side effects from the use of testosterone in men with hypogonadism was inconsistent. […] A literature review by Corona et al indicated that testosterone replacement therapy is safe for age- or comorbidity-related (functional) male hypogonadism, not just for the organic variety. […] A study by Zitzmann et al indicated that the outcomes of testosterone therapy can vary depending on whether the patient has functional or organic (also known as classical) hypogonadism. […] The latest Endocrine Society clinical practice guidelines suggest testosterone therapy for men receiving high doses of glucocorticoids who also have low testosterone levels, to promote bone health.

• #2 Hypogonadism Treatment: Testosterone Replacement Therapy, TRT Therapy | University of Utah Health | University of Utah Health

  https://healthcare.utah.edu/mens-health/conditions/hypogonadism

  Many men have lowered testosterone levels as they age, and these low levels can start to cause a variety of symptoms. Male hormone replacement therapy, or TRT therapy, is a safe and effective treatment option if you have symptoms or difficulty with low testosterone levels. […] Individualized, long-term testosterone therapy has been shown to improve bone density, stabilize mood, normalize body fat and body muscle, increase energy, and increase libido. […] Many treatments are available to get testosterone back to normal levels. It is important to monitor your levels as well as some related blood tests, as it can be dangerous to have testosterone levels that are too high. […] Treatment options can include these: Intramuscular injections, Patches, Absorbable tablets, Creams, Gels, Long-acting depots.

• #2 Male hypogonadism: Symptoms, causes, and treatment

  https://www.medicalnewstoday.com/articles/307634

  Testosterone replacement therapy (TRT) is the recommended treatment for male hypogonadism. […] TRT can eliminate many, if not all, of the signs and symptoms of male hypogonadism. […] Benefits include: increased libido, mood improvement, increased bone mineral density, overall improved quality of life. […] However, there are a few risks associated with it. […] TRT should not be started without first attending to these conditions. […] All males who are using TRT require ongoing medical evaluation to determine adequate response to treatment. […] The response to TRT is individualized, and testosterone levels are not an indicator of who will respond to TRT and who will not. […] It is also worth noting that while it can relieve symptoms of hypogonadism, TRT does not restore fertility.

• #2 EAU Guidelines on Sexual and Reproductive Health – Uroweb

  https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/male-hypogonadism

  Patients with symptomatic hypogonadism (total testosterone 12 nmol/L) without specific contraindications are suitable candidates to receive testosterone therapy. […] Testosterone therapy in hypogonadal men (total testosterone 12 nmol/L) may have a beneficial effect on several aspects of sexual life; in contrast, there is no evidence of benefits in using testosterone therapy for treating sexual dysfunction in eugonadal men. […] Testosterone therapy has also been found to decrease waist circumference, body weight and BMI, with these effects more predominant after twelve months of treatment. […] Testosterone therapy is contraindicated in men with secondary hypogonadism who desire fertility. […] Testosterone therapy is contraindicated in men with active prostate cancer or breast cancer, as these patients are usually excluded from RCTs. […] There is no substantive evidence that testosterone therapy, when replaced to normal levels, results in the development of major adverse cardiovascular events.

• #2 Hypogonadism in males

  https://dermnetnz.org/topics/hypogonadism-in-males

  Effective testosterone replacement in men with hypogonadism has been showed to maintain secondary sexual characteristics, increase libido, muscle strength, fat-free mass, and bone density. […] Adverse effects of testosterone replacement include: Acne, Prostate enlargement, Stimulation of the growth of breast cancer or prostate cancer, Sleep apnoea, Heart failure, Erythrocytosis. […] Testosterone should not be started in individuals with breast cancer, prostate cancer or an increased risk of prostate cancer, haematocrit above 50%, untreated obstructive sleep apnoea, severe lower urinary tract symptoms, or uncontrolled heart failure.

• #2 Endocrine Society of Australia position statement on male hypogonadism (part 2): treatment and therapeutic considerations | The Medical Journal of Australia

  https://www.mja.com.au/journal/2016/205/5/endocrine-society-australia-position-statement-male-hypogonadism-part-2

  Part 1 of this position statement dealt with the assessment of male hypogonadism, including the indications for testosterone therapy. This article, Part 2, focuses on treatment and therapeutic considerations for male hypogonadism and identifies key questions for future research. […] Testosterone is the native hormone that should be replaced in men being treated for pathological hypogonadism. Convenient and cost-effective treatment modalities include depot intramuscular injection and transdermal administration (gel, cream or liquid formulations). […] Treatment aims to relieve an individuals symptoms and signs of androgen deficiency by administering standard doses and maintaining circulating testosterone levels within the reference interval for eugonadal men. […] Treatment aims to relieve symptoms and signs of androgen deficiency, using convenient and effective formulations of testosterone. Therapy should be monitored for efficacy and safety.

• #3 Testosterone Therapy for Hypogonadism Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/testosterone-therapy

  In hypogonadal men who have started testosterone therapy, we recommend evaluating the patient after treatment initiation to assess whether the patient has responded to treatment, is suffering any adverse effects, and is complying with the treatment regimen. […] We recommend a urological consultation for hypogonadal men receiving testosterone treatment if during the first 12 months of testosterone treatment there is a confirmed increase in prostate specific antigen concentration 1.4 ng/mL above baseline, a confirmed prostate-specific antigen 4.0 ng/mL, or a prostatic abnormality detected on digital rectal examination.

• #3 Testosterone Replacement Therapy: Injections, Patches, and Gels

  https://www.webmd.com/men/testosterone-replacement-therapy-is-it-right-for-you

  There are a few health conditions that experts believe testosterone therapy can worsen: […] As with any medicine, the decision on whether the possible benefits outweigh any risks is up to you and your doctor. […] TRT side effects often include: […] Many clinics and doctors offer testosterone replacement therapy, but you may not need it. Before prescribing testosterone, your doctor should check your testosterone levels and make sure your low T is not due to something else, like an illness. If your levels are low because of aging, you don’t need TRT. If you start on TRT, you’ll likely continue for life. Many men who take it find a lot of benefits.

• #3 Low Testosterone (Testosterone Deficiency): Symptoms and Treatment

  https://patient.info/mens-health/erectile-dysfunction-impotence/testosterone-deficiency

  Low testosterone can be treated with testosterone replacement therapy. Any underlying cause for the testosterone deficiency will also need treatment. The outlook will depend on the underlying cause. […] The treatment for low testosterone also depends on the underlying cause. […] Testosterone treatment is usually given in the form of a gel. Other forms of testosterone treatment include long-acting injections or using a patch applied to your skin. […] If low testosterone is caused by a pituitary gland problem, treatment with pituitary hormones may stimulate sperm production and improve fertility. Testosterone replacement therapy can be used. […] Although there’s often no effective treatment to restore fertility in a man with primary testosterone deficiency, infertility treatments may be helpful. […] Testosterone replacement is contra-indicated (not allowed) in patients with male breast cancer, prostate cancer, men with severe heart failure, men with a very raised haematocrit (a marker of red blood cell production) and men actively wanting to conceive a child in the future.

• #3 Burden of Male Hypogonadism and Major Comorbidities, and the Clinical, | CEOR

  https://www.dovepress.com/burden-of-male-hypogonadism-and-major-comorbidities-and-the-clinical-e-peer-reviewed-fulltext-article-CEOR

  Male hypogonadism can be managed with testosterone therapy, which is intended to normalize testosterone concentrations and thereby reduce both hypogonadism symptoms and risk of comorbidities. […] Evidence from the published literature suggests that the impacts of male hypogonadism and its related comorbidities can be alleviated through this treatment, which can improve both clinical parameters and patient-reported outcomes, while reducing overall costs. […] Multiple clinical benefits have been seen in clinical and observational studies of testosterone therapy. These include improvements in parameters of T2DM. […] Improvements in glycemic control have also been demonstrated in longer-term observational data from a registry study of hypogonadal men with prediabetes, where HbA1c was shown to be significantly improved at eight years with testosterone undecanoate treatment.

• #3 Hypogonadism and Health Implications in Men and Women

  https://www.verywellhealth.com/hypogonadism-8784748

  Hypogonadism treatment in both males and females involves hormone replacement therapy. These therapies can help minimize or eliminate the symptoms. While certain causes of hypogonadism can be cured, many others cannot and require long-term treatment. […] Testosterone replacement therapy (TRT) treats male hypogonadism. TRT is available in the following forms: Intramuscular (into the muscle) injection, Long-lasting testosterone implants, Oral tablets, Rectal suppositories, Subcutaneous (under the skin) injection, Sublingual (under the tongue) pills or drops, Topical (on the skin) gels, Transdermal patches (applied to the skin). […] In male hypogonadism, TRT can: Improve erectile dysfunction, Improve overall quality of life, Increase libido and sexual satisfaction, Significantly increase lean body mass.

• #3 Male hypogonadism – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/male-hypogonadism/diagnosis-treatment/drc-20354886

  Testosterone replacement can raise testosterone levels and help ease the symptoms of male hypogonadism. These include less desire for sex, less energy, less facial and body hair, and loss of muscle mass and bone mass. […] For older adults who have low testosterone and symptoms of hypogonadism due to aging, it’s less clear how well testosterone replacement works. […] Anyone taking testosterone replacement should have a medical checkup and blood tests several times during the first year of treatment and yearly after that. This is to see how well the treatment works and to watch for side effects. […] Testosterone therapy carries risks, including: Making too many red blood cells, Acne, Bigger breasts, Sleep problems, Growth of the prostate, Not making as much sperm. […] Risks from testosterone therapy are most often due to doses that are too high. Many of these side effects go away when the dose is lowered. That’s why it’s so important to have regular follow-up visits with a health care professional, who will monitor the testosterone levels in your blood.

• #3 MALE HYPOGONADISM AND TESTOSTERONE REPLACEMENT | Society for Endocrinology

  https://www.endocrinology.org/endocrinologist/143-spring-22/features/male-hypogonadism-and-testosterone-replacement/

  Society for Endocrinology guidelines for testosterone replacement therapy in male hypogonadism have recently been published in Clinical Endocrinology. Here, guideline working group members Channa N Jayasena and Richard Quinton discuss some of the topical issues that they addressed in developing the guidelines. […] Many of us find male hypogonadism (MH) a difficult condition to diagnose and manage. Unfortunate trends in over-diagnosis and over-prescribing, which originated in North America, but which resonate worldwide, have put clinicians on guard about the safety of testosterone treatment. […] For this reason, the Clinical Committee of the Society for Endocrinology commissioned us to develop new guidance for the UK, which we felt was best achieved through a multidisciplinary approach, comprising expertise from endocrinology (medical and nursing), primary care, clinical biochemistry, urology and reproductive medicine practices, and a patient expert.

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