Hypogonadism medical therapy: Difference between revisions

	Hypogonadism Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Hypogonadism from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
X ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Hypogonadism medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Hypogonadism medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Hypogonadism medical therapy
CDC on Hypogonadism medical therapy
Hypogonadism medical therapy in the news
Blogs on Hypogonadism medical therapy
Directions to Hospitals Treating Hypogonadism
Risk calculators and risk factors for Hypogonadism medical therapy

VisualWikitext

Latest revision as of 20:38, 3 October 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]

Overview

The mainstay of therapy for hypogonadism is the hormonal replacement therapy. Based on the endocrine society clinical guidelines, testosterone is important for the treatment of hypogonadism. Different regimens include injected, buccal and transdermal testosterone. For women, estrogen replacement therapy is important besides testosterone.^[1]

Medical Therapy

Patients with hypogonadism are treated mainly with sex hormones replacement. Sex hormones will help in retaining the secondary sexual characteristics for both genders. They will also help in maintaining normal bone density and muscle mass. The main medical therapy in males will be testosterone replacement. In the females, estrogen replacement is important besides testosterone.^[1]

Medical therapy for men

Testosterone replacement therapy

Based on endocrine society clinical practice guidelines, testosterone replacement therapy is the mainstay of treatment in patients with hypogonadism.^[2]
Indications of testosterone therapy are as the following:
- Testosterone is indicated for replacement therapy in adult males for conditions associated with a deficiency or absence of endogenous testosterone.
  - Primary hypogonadism (congenital or acquired): Testicular failure from conditions such as cryptorchidism, bilateral torsion, orchitis, vanishing testis syndrome, orchiectomy, Klinefelter syndrome, chemotherapy, or toxic damage from alcohol or heavy metals. These men usually have low serum testosterone concentrations and gonadotropins (follicle-stimulating hormone [FSH], luteinizing hormone [LH]) above the normal range.
  - Hypogonadotropic hypogonadism (congenital or acquired): Idiopathic gonadotropin or luteinizing hormone-releasing hormone (LHRH) deficiency or pituitary-hypothalamic injury from tumors, trauma, or radiation. These men have low testosterone serum concentrations but have gonadotropins in the normal or low range.
- Limitations of use:
  - Safety and efficacy of testosterone in males less than 18 years old have not been established.
Testosterone therapy is contraindicated in the following cases:
- Breast carcinoma
- Prostate cancer
- Patients with hematocrit value more than 50%
- Untreated obstructive sleep apnea
- Severe lower urinary tract infections
- Heart failure
In this table, the different recommended regimens of testosterone administration are discussed.

Type of testosterone drug	Administrative doses	Adverse effects
Testosterone (Injection)	75-100 mg intramuscular injection per week. 150-200 mg intramuscular injection every two weeks. Subcutaneous implantation of testosterone pellets every 3-6 months.	Injection site reactions
Testosterone (Transdermal)^[3]	Testosterone patches: one or two doses of 5 mg on the non-genital skin as the back, thigh and upper arm. Testosterone gel: 1% dose of gel on the non-genital skin.	Transdermal testosterone may be accompanied with the following skin reactions:^[4] Pruritis Dermatitis Blisters Erythema Vesicles Acne Hot flushes
Testosterone (Buccal)	30 mg of bioadhesive tablet every 12 hour.	Gum irritation Bitter tasting Toothache Stomatitis

Medical therapy for women

For women, testosterone administration is also indicated as a treatment for the sexual dysfunction in postmenopausal women. Testosterone is an essential source of estrogen in the postmenopause phase.^[5]
The mainstay medical therapy for the women complaining of hypogonadism will be testosterone and estrogen.

Estrogen replacement therapy

Indications: treatment of hypoestrogenism due to hypogonadism, castration, or primary ovarian failure.
Dosing information: oral tablet, 1 to 2 mg daily; titrate and adjust to the lowest dose as necessary to control symptoms.
Contraindications:
- Undiagnosed abnormal genital bleeding
- Known, suspected, or history of breast cancer
- Known or suspected estrogen-dependent neoplasia
- Active DVT, PE, or a history of these conditions
- Active arterial thromboembolic disease (for example, stroke and MI), or a history of these conditions
- Known anaphylactic reaction or angioedema with Climara
- Known liver impairment or disease
- Known protein C, protein S, or antithrombin deficiency, or other known thrombophilic disorders
- Known or suspected pregnancy

References

↑ ^1.0 ^1.1 Petak SM, Nankin HR, Spark RF, Swerdloff RS, Rodriguez-Rigau LJ, American Association of Clinical Endocrinologists (2002). "American Association of Clinical Endocrinologists Medical Guidelines for clinical practice for the evaluation and treatment of hypogonadism in adult male patients--2002 update". Endocr Pract. 8 (6): 440–56. PMID 15260010.
↑ Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS; et al. (2010). "Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline". J Clin Endocrinol Metab. 95 (6): 2536–59. doi:10.1210/jc.2009-2354. PMID 20525905.
↑ Wang C, Swerdloff RS, Iranmanesh A, Dobs A, Snyder PJ, Cunningham G; et al. (2000). "Transdermal testosterone gel improves sexual function, mood, muscle strength, and body composition parameters in hypogonadal men". J Clin Endocrinol Metab. 85 (8): 2839–53. doi:10.1210/jcem.85.8.6747. PMID 10946892.
↑ Jordan WP (1997). "Allergy and topical irritation associated with transdermal testosterone administration: a comparison of scrotal and nonscrotal transdermal systems". Am J Contact Dermat. 8 (2): 108–13. PMID 9153333.
↑ North American Menopause Society (2005). "The role of testosterone therapy in postmenopausal women: position statement of The North American Menopause Society". Menopause. 12 (5): 496–511, quiz 649. doi:10.1097/01.gme.0000177709.65944.b0. PMID 16145303.

Template:WH Template:WS

[pmid15260010-1] 1.0 ^1.1 Petak SM, Nankin HR, Spark RF, Swerdloff RS, Rodriguez-Rigau LJ, American Association of Clinical Endocrinologists (2002). "American Association of Clinical Endocrinologists Medical Guidelines for clinical practice for the evaluation and treatment of hypogonadism in adult male patients--2002 update". Endocr Pract. 8 (6): 440–56. PMID 15260010.

[pmid20525905-2] Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS; et al. (2010). "Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline". J Clin Endocrinol Metab. 95 (6): 2536–59. doi:10.1210/jc.2009-2354. PMID 20525905.

[pmid10946892-3] Wang C, Swerdloff RS, Iranmanesh A, Dobs A, Snyder PJ, Cunningham G; et al. (2000). "Transdermal testosterone gel improves sexual function, mood, muscle strength, and body composition parameters in hypogonadal men". J Clin Endocrinol Metab. 85 (8): 2839–53. doi:10.1210/jcem.85.8.6747. PMID 10946892.

[pmid9153333-4] Jordan WP (1997). "Allergy and topical irritation associated with transdermal testosterone administration: a comparison of scrotal and nonscrotal transdermal systems". Am J Contact Dermat. 8 (2): 108–13. PMID 9153333.

[pmid16145303-5] North American Menopause Society (2005). "The role of testosterone therapy in postmenopausal women: position statement of The North American Menopause Society". Menopause. 12 (5): 496–511, quiz 649. doi:10.1097/01.gme.0000177709.65944.b0. PMID 16145303.

[1]

[2]

[3]

[4]

[5]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Hypogonadism}}
-{{CMG}}
+{{CMG}} {{AE}} {{AEL}}
 ==Overview==
+The mainstay of therapy for hypogonadism is the [[Hormone replacement therapy|hormonal replacement therapy]]. Based on the endocrine society clinical guidelines, [[testosterone]] is important for the treatment of hypogonadism. Different regimens include [[Testosterone (injection)|injected]], [[Testosterone (buccal)|buccal]] and [[Testosterone (transdermal)|transdermal testosterone]]. For women, [[estrogen]] replacement therapy is important besides testosterone.<ref name="pmid15260010">{{cite journal| author=Petak SM, Nankin HR, Spark RF, Swerdloff RS, Rodriguez-Rigau LJ, American Association of Clinical Endocrinologists| title=American Association of Clinical Endocrinologists Medical Guidelines for clinical practice for the evaluation and treatment of hypogonadism in adult male patients--2002 update. | journal=Endocr Pract | year= 2002 | volume= 8 | issue= 6 | pages= 440-56 | pmid=15260010 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15260010  }}</ref>
 ==Medical Therapy==
-Treatments of hypogonadism depend on the cause.
+Patients with hypogonadism are treated mainly with [[sex hormones]] replacement. [[Sex hormones]] will help in retaining the [[secondary sexual characteristics]] for both genders. They will also help in maintaining normal [[bone density]] and [[muscle mass]]. The main medical therapy in males will be [[testosterone]] replacement. In the females, [[estrogen]] replacement is important besides [[testosterone]].<ref name="pmid15260010">{{cite journal| author=Petak SM, Nankin HR, Spark RF, Swerdloff RS, Rodriguez-Rigau LJ, American Association of Clinical Endocrinologists| title=American Association of Clinical Endocrinologists Medical Guidelines for clinical practice for the evaluation and treatment of hypogonadism in adult male patients--2002 update. | journal=Endocr Pract | year= 2002 | volume= 8 | issue= 6 | pages= 440-56 | pmid=15260010 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15260010  }}</ref>
+=== Medical therapy for men ===
+==== Testosterone replacement therapy ====
+* Based on endocrine society clinical practice guidelines, [[testosterone]] replacement therapy is the mainstay of treatment in patients with hypogonadism.<ref name="pmid20525905">{{cite journal| author=Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS et al.| title=Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. | journal=J Clin Endocrinol Metab | year= 2010 | volume= 95 | issue= 6 | pages= 2536-59 | pmid=20525905 | doi=10.1210/jc.2009-2354 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20525905  }}</ref>
+* Indications of testosterone therapy are as the following:
+** [[Testosterone]] is indicated for replacement therapy in adult males for conditions associated with a deficiency or absence of endogenous [[testosterone]].
+*** Primary hypogonadism (congenital or acquired): Testicular failure from conditions such as [[cryptorchidism]], [[Testicular torsion|bilateral torsion]], [[orchitis]], vanishing [[testis]] syndrome, [[orchiectomy]], [[Klinefelter syndrome]], [[chemotherapy]], or [[toxic]] damage from [[alcohol]] or heavy metals. These men usually have low serum [[testosterone]] concentrations and [[gonadotropins]] ([[follicle-stimulating hormone]] [FSH], [[luteinizing hormone]] [LH]) above the normal range.
+*** Hypogonadotropic hypogonadism (congenital or acquired): Idiopathic gonadotropin or [[luteinizing hormone-releasing hormone]] (LHRH) deficiency or [[Pituitary gland|pituitary]]-[[hypothalamic]] injury from [[tumors]], [[trauma]], or [[radiation]]. These men have low [[testosterone]] serum concentrations but have [[gonadotropins]] in the normal or low range.
+** Limitations of use:
+*** Safety and efficacy of [[testosterone]] in males less than 18 years old have not been established.
+* Testosterone therapy is contraindicated in the following cases:
+** [[Breast carcinoma]]
+** [[Prostate cancer]]
+** Patients with [[hematocrit]] value more than 50%
+** Untreated [[obstructive sleep apnea]]
+** Severe [[Urinary tract infections|lower urinary tract infections]]
+** [[Heart failure]]
+* In this table, the different recommended regimens of testosterone administration are discussed.
+{| class="wikitable"
+!Type of testosterone drug
+!Administrative doses
+!Adverse effects
+|-
+|[[Testosterone (injection)|Testosterone (Injection)]]
+|
+* 75-100 mg [[intramuscular injection]] per week.
+* 150-200 mg intramuscular injection every two weeks.
+* [[Subcutaneous]] [[implantation]] of [[testosterone]] pellets every 3-6 months.
+|
+* [[Injection]] site reactions
+|-
+|[[Testosterone (transdermal)|Testosterone (Transdermal)]]<ref name="pmid10946892">{{cite journal| author=Wang C, Swerdloff RS, Iranmanesh A, Dobs A, Snyder PJ, Cunningham G et al.| title=Transdermal testosterone gel improves sexual function, mood, muscle strength, and body composition parameters in hypogonadal men. | journal=J Clin Endocrinol Metab | year= 2000 | volume= 85 | issue= 8 | pages= 2839-53 | pmid=10946892 | doi=10.1210/jcem.85.8.6747 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10946892  }}</ref>
+|
+* [[Testosterone (transdermal)|Testosterone patches]]: one or two doses of 5 mg on the non-genital [[skin]] as the [[back]], [[thigh]] and [[upper arm]].
+* Testosterone gel: 1% dose of gel on the non-genital skin.
+|Transdermal testosterone may be accompanied with the following skin reactions:<ref name="pmid9153333">{{cite journal| author=Jordan WP| title=Allergy and topical irritation associated with transdermal testosterone administration: a comparison of scrotal and nonscrotal transdermal systems. | journal=Am J Contact Dermat | year= 1997 | volume= 8 | issue= 2 | pages= 108-13 | pmid=9153333 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9153333  }}</ref>
+* [[Pruritis]]
+* [[Dermatitis]]
+* [[Blisters]]
+* [[Erythema]]
+* [[Vesicles]]
+* [[Acne]]
+* [[Hot flushes]]
+|-
+|[[Testosterone (buccal)|Testosterone (Buccal)]]
+|
+* 30 mg of [[Bioadhesives|bioadhesive]] tablet every 12 hour.
+|
+* Gum irritation
+* Bitter tasting
+* [[Toothache]]
+* [[Stomatitis]]
+|}
+=== Medical therapy for women ===
+* For women, [[testosterone]] administration is also indicated as a treatment for the [[sexual dysfunction]] in [[postmenopausal]] women. Testosterone is an essential source of [[estrogen]] in the [[postmenopause]] phase.<ref name="pmid16145303">{{cite journal| author=North American Menopause Society| title=The role of testosterone therapy in postmenopausal women: position statement of The North American Menopause Society. | journal=Menopause | year= 2005 | volume= 12 | issue= 5 | pages= 496-511; quiz 649 | pmid=16145303 | doi=10.1097/01.gme.0000177709.65944.b0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16145303  }}</ref>
+* The mainstay medical therapy for the women complaining of hypogonadism will be testosterone and estrogen.
+==== Estrogen replacement therapy ====
+* Indications: treatment of [[hypoestrogenism]] due to hypogonadism, [[castration]], or [[primary ovarian failure]].
+* Dosing information: oral tablet, 1 to 2 mg daily; [[titrate]] and adjust to the lowest dose as necessary to control symptoms.
+* Contraindications:
+** Undiagnosed abnormal genital [[bleeding]]
+** Known, suspected, or history of [[breast cancer]]
+** Known or suspected estrogen-dependent [[neoplasia]]
+** Active [[DVT]], [[Pulmonary embolism|PE]], or a history of these conditions
+** Active [[arterial thromboembolic disease]] (for example, [[stroke]] and [[ST elevation myocardial infarction|MI]]), or a history of these conditions
+** Known [[anaphylactic reaction]] or [[angioedema]] with [[Climara]]
+** Known liver impairment or disease
+** Known [[protein C]], [[protein S]], or [[antithrombin deficiency]], or other known [[thrombophilic disorders]]
+** Known or suspected [[pregnancy]]
-:*For hypogonadism resulted from certain autoimmune disorders or [[infection]] in sex glands, treatment protocol may focus on these causes and [[corticosteroids]] or [[antibiotic]]s may be helpful. When [[tumor]]s in [[central nervous system]] are the main causes of hypogonadism, treatment opinion may be [[surgery]], [[radiation therapy]] and [[chemotherapy]]. If liver and kidney diseases result in hypogonadism, recovery of liver and renal function may be the first.
-:*Hormone replacement: Hormone replacement for patients with hypogonadism during childhood can stimulate puberty and the development of secondary sex characteristics. Hormones often used include [[estrogen]] or [[testosterone]], and pituitary hormones. Doctors will begin with an initial low dose of such hormones and gradual increases to avoid [[side effect]]s.
-:*Hypogonadism is most often treated by replacement of the appropriate hormones. For men this is [[testosterone]]. Commonly used testosterone formulations include  transdermal testosterone, injectable testosterone, and buccal testosterone. Oral testosterone is no longer used in the U.S. because it is broken down in the liver and rendered inactive.
-Another feasible alternative is [[hCG]].
-For women [[estradiol]] and [[progesterone]] are replaced. Some types of fertility defects can be treated; some cannot.
 ==References==
 {{reflist|2}}
@@ Line 16: / Line 85: @@
 {{WS}}
 [[Category:Endocrinology]]
-[[Category:Signs and symptoms]]
 [[Category:Disease]]
 [[Category:Urologic Surgery]]
 [[Category:Gynecology]]