Testosterone Replacement Therapy for Male Hypogonadism: Part III
Testosterone Replacement Therapy for Male Hypogonadism: Part III
Male hypogonadism is associated with potentially distressing adverse effects on diverse organs and tissues. These include sexual dysfunction, particularly diminished libido, as well as mood disturbances, reduced lean body mass, and increased adipose-tissue mass. A wide range of effective and well-tolerated options exists. These include relatively noninvasive therapies, such as testosterone (T) gels and T patches; slightly more invasive treatments, such as the T buccal system; and invasive therapies, such as intramuscular T injections and subcutaneous depot implants (T pellets). Testosterone replacement therapy (TRT) can be individualized to enhance patient health and well-being. Screening and ongoing monitoring are necessary to ensure both the efficacy and safety of TRT, particularly prostate safety. Investigational agents, including selective androgen receptor modulators, may offer new pharmacodynamic and/or pharmacokinetic properties that enhance outcomes of TRT.
Testosterone replacement therapy (TRT) has been administered to men with hypogonadism for decades. The fundamental aim of TRT is to restore serum T to eugonadal levels and minimize signs and symptoms of hypogonadism. Sexual dysfunction, particularly low libido, is among the most readily reversible symptoms of male hypogonadism. The most recent erectile dysfunction (ED) consensus guidelines recommend evaluation of the hypothalamic–pituitary–gonadal axis, including total T, bioavailable T (BT), and free T (FT), 'in patients with sexual dysfunction and at risk of or suspected of hypogonadism.' These guidelines designate testosterone as a second-line therapy. Recent studies have demonstrated significant short-term improvements in erectile function, as well as longer-term improvements in sexual desire and quality of life, in hypogonadal men receiving adjunctive TRT, including sildenafil nonresponders.
Contraindications to the use of exogenous testosterone formulations, which are Schedule III controlled substances, include prostate cancer (PCa), breast cancer, and/or untreated prolactinoma. TRT with any of the modalities described herein should be instituted according to the screening and monitoring guidelines, which are detailed in this review.
Abstract and Introduction
Abstract
Male hypogonadism is associated with potentially distressing adverse effects on diverse organs and tissues. These include sexual dysfunction, particularly diminished libido, as well as mood disturbances, reduced lean body mass, and increased adipose-tissue mass. A wide range of effective and well-tolerated options exists. These include relatively noninvasive therapies, such as testosterone (T) gels and T patches; slightly more invasive treatments, such as the T buccal system; and invasive therapies, such as intramuscular T injections and subcutaneous depot implants (T pellets). Testosterone replacement therapy (TRT) can be individualized to enhance patient health and well-being. Screening and ongoing monitoring are necessary to ensure both the efficacy and safety of TRT, particularly prostate safety. Investigational agents, including selective androgen receptor modulators, may offer new pharmacodynamic and/or pharmacokinetic properties that enhance outcomes of TRT.
Introduction
Testosterone replacement therapy (TRT) has been administered to men with hypogonadism for decades. The fundamental aim of TRT is to restore serum T to eugonadal levels and minimize signs and symptoms of hypogonadism. Sexual dysfunction, particularly low libido, is among the most readily reversible symptoms of male hypogonadism. The most recent erectile dysfunction (ED) consensus guidelines recommend evaluation of the hypothalamic–pituitary–gonadal axis, including total T, bioavailable T (BT), and free T (FT), 'in patients with sexual dysfunction and at risk of or suspected of hypogonadism.' These guidelines designate testosterone as a second-line therapy. Recent studies have demonstrated significant short-term improvements in erectile function, as well as longer-term improvements in sexual desire and quality of life, in hypogonadal men receiving adjunctive TRT, including sildenafil nonresponders.
Contraindications to the use of exogenous testosterone formulations, which are Schedule III controlled substances, include prostate cancer (PCa), breast cancer, and/or untreated prolactinoma. TRT with any of the modalities described herein should be instituted according to the screening and monitoring guidelines, which are detailed in this review.
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