Hypogonadism medical therapy
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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 is indicated for replacement therapy in adult males for conditions associated with a deficiency or absence of endogenous testosterone.
- 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 |
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| Testosterone (Injection) |
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| Testosterone (Transdermal) |
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| Testosterone (Buccal) |
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 antibiotics may be helpful. When tumors 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 effects.
- 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
For women estradiol and progesterone are replaced. Some types of fertility defects can be treated; some cannot.