Hypogonadism testosterone replacement

Androgens are important for general sexual function and libido, but testosterone supplementation is only effective in patients with documented low serum testosterone levels. In patients with hypogonadism, testosterone replacement is the initial treatment of choice, as it corrects decreased libido, fatigue, muscle loss, sleep disturbances, and depressed mood. Improvements in ED may occur, but they should not be expected to occur in all patients.23 The initial trial should be for 3 months. At that time, re-evaluation and the addition of another ED therapy is warranted. Routes of administration include oral, intramuscular, topical patches or gel, and a buccal tablet. 

Teriparatide can be used if bisphosphonates are not tolerated or contraindicated. Testosterone replacement therapy should be considered in men, and high-dose hormonal oral contraceptives can be considered for premenopausal women with documented hypogonadism. 

Testosterone-replacement regimens restore serum testosterone levels to the normal range (300 to 1,100 ng/dL). These regimens are indicated for symptomatic patients with hypogonadism as confirmed by low testosterone concentrations. 

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

Snyder PJ et al. Effects of testosterone replacement in hypogonadal men. J Clin Endocrinol Metab 2000 85 2670-2677. 

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 hyperplasia, prostatic carcinoma, gynecomastia, fluid retention, polycythemia, exacerbation of hypertension, edema, and an increased risk of cardiovascular disease. 

Parker S, Armitage M. Experience with transdermal testosterone replacement therapy for hypogonadal men. Clin Endocrinol (Oxf) 1999 50(l) 57-62. 

The use of testosterone replacement therapy for the treatment of hypogonadism and ED may assist PDE5 inhibitors if they have failed to be effective (57). Testosterone levels within the normal range have neutral or potentially beneficial effects on the cardiovascular system (58). Androgen replacement therapy should be offered to men with CAD and hypogonadism if symptomatically appropriate. The absence of long-term studies needs to be addressed in terms of possible preventive properties on the vascular wall, reduction in low-density lipoprotein levels, and the reduction of insulin resistance in contrast to the increase in hematocrit and risk of exacerbating prostate cancer. 

Wang C, Eyre DR, Clark R, Kleinberg D, Newman C, Iranmanesh A, Veldhuis J, Dudley RE, Berman N, Davidson T, Barstow TJ, Sinow R, Alexander G, Swerdloff RS. Sublingual testosterone replacement improves muscle mass and strength, decreases bone resorption, and increases bone formation markers in hypogonadal men—a clinical research center study. J Qin Endocrinol Metab 1996 81(10) 3654-62. 

Testosterone replacement regimens can be administered orally, parenterally, and topically (see Table 81-3). Injectable testosterone replacement regimens are preferred for treatment of symptomatic patients with primary or secondary hypogonadism because they are effective, inexpensive, and not associated with the bioavailability problems or hepatotoxic adverse effects of oral androgens. " Although convenient for the patient, testosterone patches and gels are much more expensive than other forms of androgen replacement therefore... 

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. 

For the man with symptomatic hypogonadism (decreased libido, energy loss, and erectile dysfunction), a normal prostate examination, and a normal serum prostate-specific antigen, testosterone can be considered as adjunctive therapy. Testosterone patches (2.5-5 mg daily), intramuscular injections (10 to 400 mg every 2 to 4 weeks), 1% topical gel, pellet implants (150 50 mg every 3-6 months), and a buccal formulation are available (see Table 88-6). Testosterone replacement increases bone density in men. The benefits of therapy need to be... 

Bhasin, S., Storer, T.W, Berman, N. et al.. Testosterone replacement increases fat-free mass and muscle size in hypogonadal men, J Clin Endocrinol Metab, 82, 407, 1997. 

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. 

Finally, sex steroids are also implicated in the pathophysiology of depression. Estrogen deficiency states, which occur in the postpartum and postmenopausal periods, are thought to play a role in the etiology of depression in some women. Likewise, severe testosterone deficiency in men is sometimes associated with depressive symptoms. Hormone replacement therapy in hypogonadal men and women may be associated with an improvement in mood and depressive symptoms. 

Replacement Therapy. Testosterone and other androgens are administered as replacement therapy when the endogenous production of testosterone is impaired. Such conditions include removal of the testes (orchiectomy), various intrinsic forms of testicular failure (cryptorchidism, orchitis), and problems in the endocrine regulation of testosterone production, such as lack of LH production and other forms of hypogonadism.32,144... 

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

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

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