Materiały źródłowe

• #1 Low Testosterone (Low T): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/15603-low-testosterone-male-hypogonadism

  Healthcare providers and medical researchers dont know how to prevent low testosterone from genetic conditions or damage to your testicles, hypothalamus or pituitary gland. […] Lifestyle habits that may help keep testosterone levels normal include: Eating a healthy diet. Exercise. Weight management. Avoiding excessive use of alcohol and drugs.

• #2 Low Testosterone (Male Hypogonadism) | UNC Men’s Health Program

  https://www.med.unc.edu/menshealth/low-testosterone-male-hypogonadism/

  There are no known ways to prevent low testosterone that is caused by genetic conditions or damage to the testes or pituitary gland. […] A healthy lifestyle that includes good nutrition, exercise, weight management, and that avoids excessive use of alcohol and drugs can help keep testosterone levels normal.

• #3 Hypogonadism: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/001195.htm

  Maintaining fitness, normal body weight and healthy eating habits may help in some cases. […] Other causes may not be preventable.

• #4 Improving Low Testosterone Naturally – Whole Health Library

  https://www.va.gov/WHOLEHEALTHLIBRARY/tools/improving-low-testosterone-naturally.asp

  Hormones change as we go through the life cycle. What is normal for a 20-year-old is not the same normal as for a 60-year-old. […] A low testosterone level can be due to many factors. A clinician must also take care not to add testosterone too quickly without exploring other therapies first, because once external testosterone is given, it inhibits the bodys natural production of testosterone. […] Testosterone supplementation is also not without risks, and in terms of long-term use, there is much about safety that we do not yet know. […] This is probably the most important thing a man can do. As belly fat increases, there is an increase in activity of the enzyme aromatase which converts testosterone in the fat cells to estrogen. This reduces testosterone and increases estrogen, which can increase fat deposition in typical female areas (breast, hips, thighs) and increase the risk of enlargement of the prostate and even prostate cancer. With every one-point drop in your body mass index (BMI) your testosterone level will increase by approximately 1 point. In fact, management of obesity may prevent declining total testosterone in the aging male.

• #5 Improving Low Testosterone Naturally – Whole Health Library

  https://www.va.gov/WHOLEHEALTHLIBRARY/tools/improving-low-testosterone-naturally.asp

  Developing diabetes increases the risk of having a total testosterone level of less than what is considered normal. Over a 10-year period, the risk for developing abnormally low testosterone levels more than doubles in diabetic individuals. […] A combination of aerobic (increase in heart rate) and resistance (weightlifting) training has been found to increase the production of testosterone. This also helps prevent the most common diseases that men are most likely to die from, heart disease and cancer. […] Most of the bodys testosterone is made during deep sleep when a person is in Rapid Eye Movement (REM). A disrupted sleep cycle with less time spent in REM has been associated with low testosterone levels. […] Tobacco reduces testosterone. […] Alcohol (more than two drinks a day), increases the conversion of testosterone to estrogen.

• #6

  https://link.springer.com/article/10.1007/s40618-022-01859-7

  We recommend starting TRT in all symptomatic hypogonadal men, after contraindications are excluded, in whom a reversal of the condition cannot be expected in a reasonable time-frame (1 OO). […] We suggest using testosterone gels in older hypogonadal men, in particular in case of potentially reversible conditions (Expert Opinion). […] We suggest using long-acting injectable T preparations to treat younger hypogonadal men, in particular in case of irreversible conditions (Expert Opinion). […] Lifestyle modifications and weight loss should be strongly encouraged in all overweight and obese men with hypogonadism since able to increase T levels per se. […] Data on the role of TRT in patients with compensated hypogonadism are lacking. This condition represents only a preclinical form of an overt hypogonadism, which might deserve an adequate follow-up. TRT should be started only when overt hypogonadism occurs.

• #7 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. […] 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. […] 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. […] Lifestyle intervention and addressing other root causes of NGI should be the first-line treatment for hypogonadal symptoms, over testosterone treatment, as these have the best chance of alleviating symptoms and improving overall health. […] 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.

• #8

  https://link.springer.com/article/10.1007/s40618-022-01859-7

  We recommend against testosterone replacement therapy in subjects with hypogonadism to specifically improve cognitive function (1 ). […] We recommend against prescribing testosterone replacement therapy to improve muscle strength, with a clinically meaningful aim, in frailty of subjects with hypogonadism (1 0). […] We recommend TRT to improve body composition (reducing fat mass and increasing lean mass) in subjects with hypogonadism with or without metabolic syndrome (MetS) or type 2 diabetes (T2DM) (1 O). […] We suggest TRT to improve fasting and post-load glycemic control in subjects with hypogonadism with MetS or pre-diabetic conditions to reduce the risk of developing T2DM (2 OO). […] We suggest not considering TRT to control dyslipidemia or to improve glycated hemoglobin in patients with or without T2DM (2 OO). […] We suggest TRT to reduce waist circumference in subjects with hypogonadism with MetS (2 OOO).

• #9 Prevention of Male Late-Onset Hypogonadism by Natural Polyphenolic Antioxidants – PubMed

  https://pubmed.ncbi.nlm.nih.gov/38931170/

  Androgen production primarily occurs in Leydig cells located in the interstitial compartment of the testis. […] This review highlights recent findings concerning the use of natural polyphenolics compounds, such as flavonoids, resveratrol, and phenolic acids, to enhance testosterone production, thereby preventing age-related degenerative conditions associated with testosterone insufficiency. […] Thus, many polyphenolic compounds such as luteolin, quercetin, resveratrol, ferulic acid phenethyl ester or gigantol may be promising in delaying the initiation of late-onset hypogonadism accompanying aging in males.

• #10 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

  hCG is an LH analog and stimulates testosterone production by binding LH receptors. […] Gonadotropins, including hCG (the only non-testosterone agent FDA approved for the treatment of male hypogonadism), are effective, but costly and require administration via injection. […] Lifestyle modifications are safe and have been shown to increase endogenous testosterone production and should be offered to all men desiring treatment of testosterone deficiency. […] While numerous compounds exist marketed towards boosting testosterone, data on the safety and efficacy of these are poor, and these are not currently recommended as treatments for testosterone deficiency.

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

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

  Early detection in boys can help prevent problems from delayed puberty. […] Early diagnosis and treatment in men offer better protection against osteoporosis and other related conditions. […] 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: […] 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. […] 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.

• #12 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 deficiency is defined as a total testosterone level 300 ng/dL confirmed on two early morning lab draws. […] Lifestyle modifications and varicocelectomy have been shown to raise endogenous testosterone production. […] The authors suggest that the SERM clomiphene citrate (CC) holds the greatest promise as a non-testosterone treatment option for testosterone deficiency. […] The AUA recommends counseling men with testosterone deficiency to increase physical activity and maintain their weight within the recommended range to reduce the signs and symptoms of testosterone deficiency and increase serum testosterone levels. […] 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.

• #13 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

  Offering varicocelectomy to men with a clinical varicocele and testosterone deficiency may naturally improve endogenous testosterone production and avoid long-term testosterone therapy and associated monitoring and side effects. […] 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 may be a safe and effective treatment option for the long-term management of testosterone deficiency, and consideration should be made to offering this therapy to men as a first-line treatment option for testosterone deficiency, regardless of the patients desire for fertility preservation.

• #14 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. […] 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. […] Although less frequently used in the general population, hCG therapy with or without testosterone supplementation represents an alternative treatment.

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

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

  Discontinuing testosterone therapy alone may be adequate to return spermatogenesis to baseline levels as suggested by the hormonal contraception trials. […] Clomiphene citrate may improve serum testosterone levels. […] 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. […] A randomized, prospective trial of CC for men with hypogonadism with normal semen parameters is vital to confirm the recommendation for the use of SERMs for fertility preservation. […] 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. […] Currently, it is not recommended to repeatedly use aromatase inhibitors due to a paucity of long-standing data.

• #16 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. […] 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. […] However, clomiphene citrate and exogenous gonadotropins are safe, offer good symptom control and can successfully induce fertility in hypogonadism patients.

• #17 Testosterone Therapy: Review of Clinical Applications | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1001/p441.html

  Patients receiving testosterone therapy should be monitored to ensure testosterone levels rise appropriately, clinical improvement occurs, and no complications develop. […] Testosterone therapy is contraindicated in patients with known or suspected prostate cancer. […] Use of testosterone therapy in men with hypogonadism and previously treated (and presumed cured) prostate cancer is controversial, with little data to guide treatment decisions in this group. […] Testosterone measurement should be considered in older men with unexplained anemia. […] An increase in hematocrit to greater than 54% should lead to cessation of treatment, lowering of the dose, or change to a lower-risk formulation. […] The effects of testosterone therapy on cardiovascular health remain unclear. […] The FDA has mandated that testosterone product manufacturers conduct a large-scale randomized controlled trial specifically to determine cardiovascular risk.

• #18

  https://link.springer.com/article/10.1007/s40618-022-01859-7

  We recommend against starting TRT in patients with active breast and prostate cancers (Good clinical practice). […] We suggest not considering a treated low-risk prostate cancer as an absolute contraindication to TRT (2, OOO). […] We suggest not considering a mild-to-moderate lower urinary tract symptoms (LUTS) as absolute contraindication to TRT (2, O). […] We suggest not considering mild-to-moderate heart failure as an absolute contraindication for TRT (2, OO). […] We suggest not prescribing TRT to patients with a recent major adverse cardiovascular event (2, O). […] We suggest considering the global cardiovascular risk and associated morbidities, including hematocrit level, before prescribing TRT (2, OO). […] We recommend against TRT as monotherapy for improving major depressive symptoms in subjects with hypogonadism (1 OO).

• #19 Male hypogonadism and ageing: rejuvenating the guidance | Society for Endocrinology

  https://www.endocrinology.org/endocrinologist/131-spring19/society-news/male-hypogonadism-and-ageing-rejuvenating-the-guidance/

  The Society for Endocrinologys position statement on male hypogonadism and ageing has recently been updated. […] The absence of a ubiquitous male andropause indicates that men with a well-founded diagnosis of hypogonadism should generally receive testosterone therapy. […] We therefore emphasise the primacy of lifestyle interventions over testosterone treatment in men with borderline-low serum testosterone levels and low-normal LH, unless there are other compelling reasons, such as osteoporosis, anaemia, small testes or sexual dysfunction refractory to first line treatment. […] Testosterone treatment of men with a well-founded diagnosis of hypogonadism is effective and safe, and should not be withheld on the basis of age or disability. […] The long term effects of testosterone treatment on cardiovascular disease susceptibility are currently unknown and it should therefore be used cautiously in men with symptomatic cardiovascular disease.

• #20 Testosterone Therapy: Review of Clinical Applications | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1001/p441.html

  Testosterone therapy should be considered for men with low testosterone levels and clinical symptoms of hypogonadism, particularly sexual dysfunction. […] Men considering testosterone therapy should be counseled about the uncertainty of the long-term safety of testosterone, including possible cardiovascular harms, and patients and physicians should engage in shared decision making, weighing the risks and benefits of therapy. […] Do not prescribe testosterone therapy unless there is laboratory evidence of testosterone deficiency. […] The U.S. Food and Drug Administration clarified in 2015 that prescribing testosterone for low testosterone levels due to aging constitutes off-label use. […] Testosterone therapy may also be used to treat hypoactive sexual desire disorder in postmenopausal women and to produce physical male sex characteristics in female-to-male transgender patients.

• #21 Male Hypogonadism Program — School of Medicine University of Louisville

  https://louisville.edu/medicine/departments/medicine/divisions/endocrinology/patient-care/male-hypogonadism

  Most men with hypogonadism can be treated with testosterone, and specialized treatments are available for some men who are infertile. […] Also available is referral to colleagues in the University of Louisville Division of Reproductive and Infertility in the UofL Department of Obstetrics, Gynecology and Women’s Health for assisted reproduction (IVF).

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