Overview Of Hypogonadism
Current Treatment and Controversies
Testosterone replacement therapy forms the core of treatment for all types of hypogonadism. A number of different androgen preparations and dosage forms are available, including injections, gels, skin patches, and capsules, and treatment can be individualized to achieve the goal of returning testosterone to physiological levels.
Correct diagnosis of hypogonadism is essential before treatment is initiated. However, the diagnosis of hypogonadism has been the subject of controversy, and there is debate about threshold levels for determining hypogonadism, the ideal manner in which to measure testosterone levels, and whether total testosterone, free testosterone, or bioavailable testosterone is the most appropriate hormone fraction to use in determining hypogonadism. In particular, the high prevalence of hypogonadism symptoms in the aging male population and the non-specific nature of these symptoms can make diagnosis difficult, and there is increasing consensus that hypogonadism should be defined by a combination of low testosterone levels and the presence of one or more signs or symptoms of hypogonadism.
The recommendations of recent international consensus documents on the diagnosis, treatment, and monitoring of hypogonadism are outlined in the Diagnosis section. Testosterone replacement therapy is generally associated with a wide margin of safety and good tolerability. However, as with any clinical intervention, the initiation of testosterone replacement therapy should be undertaken on a balance of risk versus benefit. At present, limited data are available about the long-term safety in elderly men, and discussion about if and when to treat late-onset hypogonadism continues. If a diagnosis of hypogonadism is confirmed (symptoms and total testosterone levels between 8–12 nmol/L [231–346 ng/dL]) and the patient is without contraindications, testosterone replacement therapy can be considered.1,2
References:
1. Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2006; 91(6): 1995-2010
2. Wang, C., E. Nieschlag, R. Swerdloff, et al. Investigation, treatment and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA and ASA recommendations. Eur J Endocrinol 2008, 159(5): 507-514.
