Hypogonadism, male, testosterone

To replace androgenic effects in hypogonadal males, testosterone and its esters and methyltestosterone are still the most widely used agents. This use... 

In the eugonadal male with normal sperm analysis, no endocrine investigations are required. In the hypogonadal male, testosterone and the gonadotrophins should be measured First (Fig. 2). Causes of. subfertility in the male include ... 

Korbonits M, Slawik M, Cullen D, Ross RJ, Stalla G, Schneider H, Reincke M, Bouloux P.M, Grossman AB. A comparison of a novel testosterone bioadhesive buccal system, Striant, with a testosterone adhesive patch in hypogonadal males. J Clin Endocrinol Metab 2004 89 2039-43. 

Testosterone Dihydro testosterone Hormone-replacement therapy in hypogonadal males... 

Hajjar RR, Kaiser FE, Morley JE. Outcomes of long-term testosterone replacement in older hypogonadal males A retrospective analysis. J Chn Endocrinol Metab 1997 82 3793-3796. 

FSH and hCG also find application in the treatment of male subfertility or related conditions. Both are administered to males exhibiting hypogonadotrophic hypogonadism to stimulate sperm synthesis and normal sexual function. hCG has found limited application in the treatment of prepubertal cryptorchidism (a condition characterized by failure of the testes to descend fully into the scrotum from the abdomen). The ability of this hormone to stimulate testosterone production also caught the attention of some athletes, and, as a result, the International Olympic Committee has banned its use. 

Replacement therapy - Replacement therapy in hypogonadism associated with a deficiency or absence of endogenous testosterone. Prior to puberty, androgen replacement therapy is needed for development of secondary sexual characteristics. Prolonged treatment is required to maintain sexual characteristics in these and other males who develop testosterone deficiency after puberty. Appropriate adrenal cortical and thyroid hormone replacement therapy are still necessary, however, and are of primary importance. 

Methyltestosterone Synthetic androgen, longer circulatory half-life than testosterone Replacement therapy for male hypogonadal disorders. Breast cancer in females... 

Testosterone Main androgen produced by testes. Esterified forms display longer circulatory half lives Treatment of male hypogonadism. Also sometimes used in treatment of post-menopausal breast carcinoma and osteoporosis... 

Mechanism of Action A synthetic testosterone derivative with androgen activity that promotes growth and development of male sex organs and maintains secondary sex characteristics in androgen-deficient males, TIicrapcuticE/fcct Treats hypogonadism in males. 

Male hormone replacement therapy has been reviewed (11). Hypogonadism can be accompanied by hot flushes, similar to those seen in postmenopausal women, and gynecomastia. The potential risks of testosterone replacement in adult men are precipitation or worsening of sleep apnea, hastened onset of clinical significant prostate disease, benign prostatic hjrperplasia, prostatic carcinoma, gynecomastia, fluid retention, polycythemia, exacerbation of hypertension, edema, and an increased risk of cardiovascular disease. 

Many of the endocrine disorders that result in male infertility have been discussed earher in this chapter in the section on male reproductive abnormalities. Testosterone is essential for normal sperm development. Therefore, any disorder that results in hypogonadism (and hence low testosterone concentrations) results in infertility. Among the causes are both hypogonadotropic and hypergonadotropic hypogo-... 

Testosterone stimulates libido or sexual drive in males. Within the normal physiologic serum concentration range (normal, 300 to 1100 ng/ dL), sexual drive is normal. Approximately one-third of men older than 50 years of age have hypogonadism, which is characterized by subphysiologic serum testosterone levels. Such patients complain of loss of energy, loss of muscle strength, depressive mood, and decreased libido. 

Some men with osteoporosis possess clearly identifiable risk factors. In others, further investigation for secondary canses is warranted (see above patient assessment section). Men 70 years and older should have DXA tests to screen for osteoporosis. DXA standards state T-scores shonld be compared with a white male normative reference database, regardless of ethnicity. BMD determination shonld also be considered for men with a low-tranma fracture, prevalent vertebral deformity, glucocorticoid use, hypogonadism, alcoholism, or poor overall health. Measmement of serum free or total testosterone can also determine if hypogonadism is contributing to bone loss. 

Hypogonadism in the male may be primary (where the cause is a failure of testosterone synthesis or of spermatogenesis in the testes) or secondary where the problem is in the hypothalamus or pituitary. Gonadal dysfunction in women may present as primary or secondary amenorrhoea, infertility, hirsutism or virilism. 

Testosterone, an androgen, is nsed in male hypogonadism, delayed pnberty in males, postpartnm breast pain and engorgement, and in inoperable breast cancer (see also Table 8 and Figure 95). 

MALE HYPOGONADISM The best-established indication for androgen administration is to treat male hypogonadism (testosterone deficiency in men). Any of the transdermal testosterone preparations or testosterone esters described above can be used with good efficacy. 

Testosterone along with other androgens are invariably employed in the male for replacement therapy in hypogonadism, eunuchoidism, and the male climacteric. 

Menotropins are a natural product that is obtained from the urine of postmenopausal women and then biologically standardized (International units [lU]) for FSH and LH activities in an approximate ratio of 1 1. Menotropins are used in males with primary (hypothalamic) or secondary (pituitary) hypogonadism to stimulate spermatogenesis, providing they have been treated previously with human chorionic gonadotropin (hCG a peptide hormone of placental origin that has activity very similar to LH discussed below) to effect masculinization (increased testosterone... 

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