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 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:
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.
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.
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