Treatment for Hypogonadism: Approaches for Treating Low Testosterone

Testosterone deficiency (also called TD, or "hypogonadism") affects tens of millions of men in the United States alone. It is characterized by insufficient testosterone levels that are low enough to impact quality of life and well being.

When TD results from a problem within the testicles that leads to low testosterone production, the condition is referred to as "primary hypogonadism." In some cases, TD is caused by problems with the signaling hormones that are secreted from the brain to stimulate testosterone production in the testicles--this is classified as "secondary hypogonadism."

Testosterone Treatment for Hypogonadism

Testosterone replacement therapy is the standard treatment for primary hypogonadism and often for secondary hypogonadism. It consists of administering repeated doses of synthetic testosterone in order to increase the amount present in the blood. Testosterone may be given in one of the following forms:

• Injections: When testosterone is administered in the form of injections, the shots need to be given every two weeks. A patient's low testosterone symptoms may subside and then reappear over the two week interval.
• Oral supplements: Testosterone replacement therapy can be administered in the form of pills taken orally. For long-term use, this method is not recommended because it can eventually cause liver damage.
• Skin patch: Testosterone patches are worn at night and release testosterone into the body over the course of several hours. The sight of placement for the patch needs to be rotated in order to avoid problems with skin irritation.
• Topical gel: In gel form, testosterone is applied to the torso, arms or legs on a daily basis. Although this method is more convenient than regular injections, the patient needs to ensure that the gel is fully absorbed before allowing the treated area to come into contact with water or with other people.

In prepubescent boys with hypogonadism, testosterone replacement therapy helps ensure that these patients undergo many of the normal developmental changes of puberty, including the growth of facial hair, muscle mass accumulation, bone growth and a deepening voice. Testosterone cannot, however, correct infertility caused by hypogonadism at any age.

In men who develop a testosterone deficiency after puberty, testosterone replacement therapy can sometimes help with erectile dysfunction, and often improves the patient's ability to develop muscle tone and stave off osteoporosis due to bone loss. However, older men on testosterone replacement therapy may be at increased risk of prostate cancer, although the evidence is currently unclear.

Pituitary Hormone Treatment

Certain forms of secondary hypogonadism can be treated with pituitary hormones, specifically luteinizing hormone-releasing hormone (LHRH) or a combination of human chorionic gonadotroph (hCG) and follicle-stimulating hormone (FSH). These hormones stimulate testosterone production in the testes. For men with hypogonadotropic hypogonadism (a kind of secondary hypogonadism), therapy with these hormones can restore testicular growth and fertility.

Resources

Faiman, C. (n.d.). Male hypogonadism. Retrieved January 21, 2010 from the Cleveland Clinic Web site: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/endocrinology/male-hypogonadism/#cesec20.

Kemp, S. (2009). Hypogonadism: Treatment and medication. Retrieved January 21, 2010 from the eMedicine Web site: http://emedicine.medscape.com/article/922038-treatment.

Mayo Foundation for Medical Education and Research. (2008). Male hypogonadism. Retrieved January 21, 2010 from the Mayo Clinic Web site: http://www.mayoclinic.com/health/male-hypogonadism/DS00300/DSECTION=complications.

WebMD, LLC staff. (2008). Testosterone. Retrieved January 21, 2010 from the WebMD Web site: http://men.webmd.com/testosterone-15738.

WebMD, LLC staff. (2008). Testosterone. Retrieved January 21, 2010 from the WebMD Web site: http://men.webmd.com/testosterone-15738.

WebMD, LLC staff. (2008). What low testosterone can mean for your health. Retrieved January 21, 2010 from the WebMD Web site: http://www.webmd.com/a-to-z-guides/what-low-testosterone-can-mean-your-health.