From the Guidelines
Testosterone replacement therapy (TRT) is the primary treatment modality for men with hypogonadism, including those with low normal range testosterone levels.
Treatment Modalities
- Testosterone replacement therapy (TRT): approved by the U.S. Food and Drug Administration (FDA) for replacement therapy in men with primary or secondary hypogonadism caused by disorders of the hypothalamus, pituitary gland, or testes 1.
- Transdermal or intramuscular testosterone therapies: may improve sexual functioning and quality of life in men with low testosterone levels, although effect sizes are small 1.
Considerations for Hyperestrogenism
- Aromatase inhibitors: may be considered to reduce estrogen levels in men with hyperestrogenism, although evidence is limited 1.
- Monitoring: regular monitoring of testosterone and estrogen levels, as well as prostate-specific antigen (PSA) levels, is recommended for men undergoing TRT 1.
Important Considerations
- Long-term efficacy and safety: unknown, and more research is needed to fully understand the benefits and risks of TRT 1.
- Individualized treatment: treatment should be tailored to each patient's specific needs and medical history, and patients should be closely monitored for potential side effects 1.
From the Research
Treatment Modalities for Hypogonadism and Hyperestrogenism
The treatment of hypogonadism and hyperestrogenism in men involves various approaches, including:
- Testosterone replacement therapy (TRT) to address low testosterone levels 2, 3
- Anti-estrogenic medications to manage high estrogen levels 4
- Aromatase inhibitors to reduce estrogen production 4, 5
- Selective estrogen receptor modulators (SERMs) to balance estrogen levels 2
Testosterone Replacement Therapy (TRT)
TRT options include:
- Topical testosterone formulations (gels, creams, patches) 2, 3
- Testosterone injections (cypionate, enanthate) 3
- Testosterone pellets 2
- Nasal testosterone formulations 2
- Oral testosterone formulations 2, 5
Management of Hyperestrogenism
Hyperestrogenism can be managed using:
- Aromatase inhibitors (e.g., anastrozole) to reduce estrogen production 4
- Anti-estrogenic medications (e.g., SERMs) to balance estrogen levels 2, 4
- Monitoring of estrogen levels to adjust treatment as needed 4
Considerations for Treatment
When treating hypogonadism and hyperestrogenism, it is essential to consider: