Hypogonadism medical therapy: Difference between revisions

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** Severe lower urinary tract infections
** Severe lower urinary tract infections
** Heart failure  
** Heart failure  
* Adverse effects of testosterone:
** [[PSA]] increased
** [[Headache]]
** [[Rhinorrhea]]
** [[Epistaxis]]
** Nasal discomfort
** [[Nasopharyngitis]] 
** [[Bronchitis]]
** Upper respiratory tract infection
** [[Sinusitis]]
** Nasal scab
* In this table, the different recommended regimens of testosterone administration are discussed.   
* In this table, the different recommended regimens of testosterone administration are discussed.   
{| class="wikitable"
{| class="wikitable"
!Type of testosterone drug
!Type of testosterone drug
!Administrative doses
!Administrative doses
!Adverse effects
|-
|-
|Testosterone (Injection)  
|Testosterone (Injection)  
|
|
* 75-100 mg intramuscular injection per week.  
* 75-100 mg intramuscular injection per week.  
* 150-200 mg intramuscular injection every two weeks
* 150-200 mg intramuscular injection every two weeks.
|
* Subcutaneous implantation of testosterone pellets every 3-6 months.
|-
|-
|Testosterone (Transdermal)  
|Testosterone (Transdermal)  
|
|
* Patches: one or two doses of 5 mg on non-genital skin as the back, thigh and upper arm.   
* Testosterone patches: one or two doses of 5 mg on non-genital skin as the back, thigh and upper arm.   
|
* Testosterone gel: 1% dose of gel on the non-genital skin. 
|-
|-
|Testosterone (Buccal)  
|Testosterone (Buccal)  
|
|
|
* 30 mg of bioadhesive tablet every 12 hour.  
|}
|}
 
Treatments of hypogonadism depend on the cause.
 
:*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]].
 
=== Medical therapy for women ===
=== Medical therapy for women ===
For women [[estradiol]] and [[progesterone]] are replaced. Some types of fertility defects can be treated; some cannot.
For women [[estradiol]] and [[progesterone]] are replaced. Some types of fertility defects can be treated; some cannot.

Revision as of 14:33, 21 July 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Medical Therapy

Patients of 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 female, estrogen and progesterone replacement is important.

Medical therapy for men

Testosterone replacement therapy

  • Based on endocrine society clinical practice guidelines, testosterone replacement therapy is the mainstay of treatment in patients of hypogonadism.
  • 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 due to conditions such as cryptorchidism, bilateral torsion, orchitis, vanishing testis syndrome, orchiectomy, Klinefelter’s syndrome, chemotherapy, or toxic damage from alcohol or heavy metals. These men usually have low serumtestosterone 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
  • Adverse effects of testosterone:
  • In this table, the different recommended regimens of testosterone administration are discussed.
Type of testosterone drug Administrative doses
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.
Testosterone (Transdermal)
  • Testosterone patches: one or two doses of 5 mg on non-genital skin as the back, thigh and upper arm.
  • Testosterone gel: 1% dose of gel on the non-genital skin.
Testosterone (Buccal)
  • 30 mg of bioadhesive tablet every 12 hour.

Medical therapy for women

For women estradiol and progesterone are replaced. Some types of fertility defects can be treated; some cannot.

References

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