From the Guidelines
Testosterone therapy is a viable treatment option for hypogonadism in a 35-year-old male.
Treatment Options
- Intramuscular testosterone is recommended over transdermal formulations due to lower costs and similar clinical effectiveness and harms 1.
- Testosterone treatment may improve sexual functioning and quality of life, although effect sizes are small, and long-term efficacy and safety are unknown 1.
Important Considerations
- Age-related low testosterone is a condition that begins in men in their mid-30s, with a gradual decline in serum total testosterone levels, and is accompanied by clinical symptoms associated with androgen deficiency 1.
- Monitoring is essential for men receiving testosterone treatment, as there are potential risks associated with therapy, including possible stimulation of prostate cancer by testosterone 1.
Treatment Goals
- Improving sexual function is a primary goal of testosterone treatment, as it has been shown to provide small improvements in sexual functioning and quality of life in men with low testosterone levels 1.
- Addressing symptoms of hypogonadism, such as diminished libido, erectile dysfunction, and reduced muscle mass and bone density, is also an important aspect of treatment 1.
From the Research
Treatment Options for Hypogonadism
- Testosterone replacement therapy (TRT) is a common treatment for male hypogonadism, but it may not be suitable for patients who wish to remain fertile 2, 3.
- Alternative treatment options for patients who wish to preserve fertility include:
- Nasal TRT
- Clomiphene citrate
- Exogenous gonadotropins
- Gonadotropin releasing hormone
- Aromatase inhibitors 3
- Gonadotropin therapy, including human chorionic gonadotropin (hCG) and follicle-stimulating hormone (FSH), can stimulate spermatogenesis and induce pregnancy in patients with hypogonadotropic hypogonadism 4.
- The Society for Endocrinology guidelines recommend a multidisciplinary approach to treating patients with male hypogonadism, including consideration of patient preferences and formulation-specific properties of testosterone replacement therapies 5.
Considerations for Treatment
- Contraindications to testosterone-replacement therapy include prostate and breast cancers, uncontrolled congestive heart failure, severe lower-urinary-tract symptoms, and erythrocytosis 2.
- Treatment should be monitored for benefits and adverse effects, including cardiovascular risk 6.
- The choice of treatment should be based on the patient's individual needs and preferences, as well as the potential risks and benefits of each treatment option 2, 3, 5.