Hypogonadism treatment

Hypogonadism treatment of [DRUG DELIVERY SYSTEMS] (Vol 8) from zmc deficiency [MINERAL NUTRIENTS] (Vol 16)... 

Because of its anabolic effects, testosterone has been used to ameliorate catabolic and muscle-wasting states, generally without benefit. One exception is in the treatment of muscle wasting associated with acquired immunodeficiency syndrome (AIDS), which often is accompanied by hypogonadism. Treatment of men with AIDS-related muscle wasting and subnormal serum testosterone concentrations increases their muscle mass and strength. 

Chorionic gonadotropin (HCG) is extracted from human placentas. The actions of HCG are identical to those of the pituitary LH. The hormone is used to induce ovulation in anovulatory women. This drug is also used for the treatment of prepubertal cryptorchism (failure of the testes to descend into the scrotum) and in men to treat selected cases of hypogonadotropic hypogonadism. 

M ale and female hormones play a vital role because they aid in development and maintenance of secondary sex characteristics and are necessary for human reproduction. Although hormones are naturally produced by die body, administration of a male or female hormone may be indicated in the treatment of certain disorders, such as inoperable breast cancer, male hypogonadism, and male or female hormone deficiency. Hormones also are used as contraceptives and for treating the symptoms of menopause... 

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. 

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. 

In support of a role for androgens in sexual behavior is the finding that sexual interest or motivation is low in prepubertal boys and in men with various forms of hypogonadism (Burris, et al., 1992). Androgen treatments are typically associated with increased interest in sexual activities, as measured by self-report, as well as increases in nocturnal erections. However, increases in sexual behavior as a result of androgen treatments are less reliable, probably in part because men with a history of sexual inactivity may lack social skills or opportunities for sexual behavior. Social and historical variables, possibly also experienced as changes in other hormones, are critical determinants of masculine sexuality. 

Hypoestrogenism caused by hypogonadism, castration, or primary ovarian failure-Treatment usually is initiated with a dose of 1 to 2 mg daily, adjusted as necessary to control presenting symptoms determine the minimal effective dose for maintenance therapy by titration. 

In women with an intact uterus for the treatment of moderate to severe vasomotor symptoms associated with menopause treatment of vulval and vaginal atrophy Femhrt and CHmaraPro excluded) osteoporosis prevention CombiPatch and ClimaraPro excluded) treatment of hypoestrogenism caused by hypogonadism, castration, or primary ovarian failure CombiPatch only). 

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. 

Sleep apnea The treatment of hypogonadal men with testosterone esters may potentiate sleep apnea in some patients, especially those with risk factors such as obesity or chronic lung diseases. 

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... 

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... 

Gonadotropins are used to induce spermatogenesis in hypogonadotropic hypogonadal men a lengthy treatment is required to obtain mature sperm. For several weeks hCG is injected to increase testosterone levels, followed by injections of menotropins for several months. Prepubertal cryptorchidism can be treated by injections of hCG for up to several months. 

Androgens come in oral, injectable, implantable, and topical preparations. Because of the toxicity of the oral preparations and the inconvenience of the injectable forms, the transdermal gels have been a major clinical advance for treatment of hypogonadal males. 

B. The only time testosterone is indicated for the treatment of erectile dysfunction is if the cause is clearly related to hypogonadism. In other situations, the adverse effects related to testosterone and its limited effectiveness preclude its use. 

A highly fluorinated androgen agonist, LGD-2941, is in early clinical development for the treatment of several indications related to the beneficial effects of the androgen receptor activation (e.g., hypogonadism). 

S. Bhasin (1993). Androgen treatment of hypogonadal men. J. Clin. Endocrinol. Metab. 81 757. 

Gonadotrophins are used in the treatment of amenorrhoea, infertility, cryptorchidism and hypogonadotrophic hypogonadism in males. It is also useful in in vitro fertilization. 

Primary hypogonadism Estrogens have been used for replacement therapy in estrogen deficient patients (treatment of amenorrhoea). 

Leuprolide Agonist of GnRH receptors Increased LH and FSH secretion with intermittent administration reduced LH and FSH secretion with prolonged continuous administration Ovarian suppression, controlled ovarian hyperstimulation, central precocious puberty advanced prostate cancer Administered IV, SC, IM or intranasally depot formulations are available Toxicity Headache, lightheadedness, nausea, injection site reactions t symptoms of hypogonadism with continuous treatment... 

Androgens and anabolic agents have been used in the treatment of osteoporosis, either alone or in conjunction with estrogens. With the exception of substitution therapy in hypogonadism, bisphosphonates have largely replaced androgen use for this purpose. 

Lunenfeld B, Saad F, Hoesl CE. ISA, ISSAM and EAU recommendations for the investigation, treatment and monitoring of late-onset hypogonadism in males scientific background and rationale. Aging Male 2005 8 59-74. 

Wang C, Cunningham G, Dobs A, Iranmanesh A, Matsumoto AM, Snyder PJ, Weber T, Berman N, Hull L, Swerdloff RS. Long-term testosterone gel (Androgel) treatment maintains beneficial effects on sexual function and mood, lean and fat mass, and bone mineral density in hypogonadal men. J Clin Endocrinol Metab 2004 89 2085-98. 

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