Hypogonadism medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Hypogonadism}} | {{Hypogonadism}} | ||
{{CMG}} | {{CMG}} {{AE}} {{AEL}} | ||
==Overview== | ==Overview== | ||
The mainstay of therapy for hypogonadism is the [[Hormone replacement therapy|hormonal replacement therapy]]. Based on the endocrine society clinical guidelines, [[testosterone]] is important for the treatment of hypogonadism. Different regimens include [[Testosterone (injection)|injected]], [[Testosterone (buccal)|buccal]] and [[Testosterone (transdermal)|transdermal testosterone]]. For women, [[estrogen]] replacement therapy is important besides testosterone.<ref name="pmid15260010">{{cite journal| author=Petak SM, Nankin HR, Spark RF, Swerdloff RS, Rodriguez-Rigau LJ, American Association of Clinical Endocrinologists| title=American Association of Clinical Endocrinologists Medical Guidelines for clinical practice for the evaluation and treatment of hypogonadism in adult male patients--2002 update. | journal=Endocr Pract | year= 2002 | volume= 8 | issue= 6 | pages= 440-56 | pmid=15260010 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15260010 }}</ref> | |||
==Medical Therapy== | ==Medical Therapy== | ||
Patients | Patients with hypogonadism are treated mainly with [[sex hormones]] replacement. [[Sex hormones]] will help in retaining the [[secondary sexual characteristics]] for both genders. They will also help in maintaining normal [[bone density]] and [[muscle mass]]. The main medical therapy in males will be [[testosterone]] replacement. In the females, [[estrogen]] replacement is important besides [[testosterone]].<ref name="pmid15260010">{{cite journal| author=Petak SM, Nankin HR, Spark RF, Swerdloff RS, Rodriguez-Rigau LJ, American Association of Clinical Endocrinologists| title=American Association of Clinical Endocrinologists Medical Guidelines for clinical practice for the evaluation and treatment of hypogonadism in adult male patients--2002 update. | journal=Endocr Pract | year= 2002 | volume= 8 | issue= 6 | pages= 440-56 | pmid=15260010 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15260010 }}</ref> | ||
=== Medical therapy for men === | === Medical therapy for men === | ||
==== Testosterone replacement therapy ==== | ==== Testosterone replacement therapy ==== | ||
* Based on endocrine society clinical practice guidelines, testosterone replacement therapy is the mainstay of treatment in patients | * Based on endocrine society clinical practice guidelines, [[testosterone]] replacement therapy is the mainstay of treatment in patients with hypogonadism.<ref name="pmid20525905">{{cite journal| author=Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS et al.| title=Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. | journal=J Clin Endocrinol Metab | year= 2010 | volume= 95 | issue= 6 | pages= 2536-59 | pmid=20525905 | doi=10.1210/jc.2009-2354 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20525905 }}</ref> | ||
* Indications of testosterone therapy are as the following: | * Indications of testosterone therapy are as the following: | ||
** Testosterone is indicated for replacement therapy in adult males for conditions associated with a deficiency or absence of endogenous [[testosterone]]. | ** [[Testosterone]] is indicated for replacement therapy in adult males for conditions associated with a deficiency or absence of endogenous [[testosterone]]. | ||
*** Primary hypogonadism (congenital or acquired): | *** Primary hypogonadism (congenital or acquired): Testicular failure from conditions such as [[cryptorchidism]], [[Testicular torsion|bilateral torsion]], [[orchitis]], vanishing [[testis]] syndrome, [[orchiectomy]], [[Klinefelter syndrome]], [[chemotherapy]], or [[toxic]] damage from [[alcohol]] or heavy metals. These men usually have low serum [[testosterone]] concentrations and [[gonadotropins]] ([[follicle-stimulating hormone]] [FSH], [[luteinizing hormone]] [LH]) above the normal range. | ||
*** Hypogonadotropic hypogonadism (congenital or acquired): | *** Hypogonadotropic hypogonadism (congenital or acquired): Idiopathic gonadotropin or [[luteinizing hormone-releasing hormone]] (LHRH) deficiency or [[Pituitary gland|pituitary]]-[[hypothalamic]] injury from [[tumors]], [[trauma]], or [[radiation]]. These men have low [[testosterone]] serum concentrations but have [[gonadotropins]] in the normal or low range. | ||
** Limitations of use: | ** Limitations of use: | ||
*** Safety and efficacy of testosterone in males less than 18 years old have not been established. | *** Safety and efficacy of [[testosterone]] in males less than 18 years old have not been established. | ||
* Testosterone therapy is contraindicated in the following cases: | * Testosterone therapy is contraindicated in the following cases: | ||
** Breast carcinoma | ** [[Breast carcinoma]] | ||
** Prostate cancer | ** [[Prostate cancer]] | ||
** Patients with hematocrit value more than 50% | ** Patients with [[hematocrit]] value more than 50% | ||
** Untreated obstructive sleep apnea | ** Untreated [[obstructive sleep apnea]] | ||
** Severe lower urinary tract infections | ** Severe [[Urinary tract infections|lower urinary tract infections]] | ||
** Heart failure | ** [[Heart failure]] | ||
* In this table, the different recommended regimens of testosterone administration are discussed. | * In this table, the different recommended regimens of testosterone administration are discussed. | ||
{| class="wikitable" | {| class="wikitable" | ||
!Type of testosterone drug | !Type of testosterone drug | ||
!Administrative doses | !Administrative doses | ||
!Adverse effects | !Adverse effects | ||
|- | |- | ||
|Testosterone (Injection) | |[[Testosterone (injection)|Testosterone (Injection)]] | ||
| | | | ||
* 75-100 mg intramuscular injection per week. | * 75-100 mg [[intramuscular injection]] per week. | ||
* 150-200 mg intramuscular injection every two weeks | * 150-200 mg intramuscular injection every two weeks. | ||
* [[Subcutaneous]] [[implantation]] of [[testosterone]] pellets every 3-6 months. | |||
| | | | ||
* [[Injection]] site reactions | |||
|- | |- | ||
|Testosterone (Transdermal) | |[[Testosterone (transdermal)|Testosterone (Transdermal)]]<ref name="pmid10946892">{{cite journal| author=Wang C, Swerdloff RS, Iranmanesh A, Dobs A, Snyder PJ, Cunningham G et al.| title=Transdermal testosterone gel improves sexual function, mood, muscle strength, and body composition parameters in hypogonadal men. | journal=J Clin Endocrinol Metab | year= 2000 | volume= 85 | issue= 8 | pages= 2839-53 | pmid=10946892 | doi=10.1210/jcem.85.8.6747 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10946892 }}</ref> | ||
| | |||
| | | | ||
* [[Testosterone (transdermal)|Testosterone patches]]: one or two doses of 5 mg on the non-genital [[skin]] as the [[back]], [[thigh]] and [[upper arm]]. | |||
* Testosterone gel: 1% dose of gel on the non-genital skin. | |||
|Transdermal testosterone may be accompanied with the following skin reactions:<ref name="pmid9153333">{{cite journal| author=Jordan WP| title=Allergy and topical irritation associated with transdermal testosterone administration: a comparison of scrotal and nonscrotal transdermal systems. | journal=Am J Contact Dermat | year= 1997 | volume= 8 | issue= 2 | pages= 108-13 | pmid=9153333 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9153333 }}</ref> | |||
* [[Pruritis]] | |||
* [[Dermatitis]] | |||
* [[Blisters]] | |||
* [[Erythema]] | |||
* [[Vesicles]] | |||
* [[Acne]] | |||
* [[Hot flushes]] | |||
|- | |- | ||
|Testosterone (Buccal) | |[[Testosterone (buccal)|Testosterone (Buccal)]] | ||
| | | | ||
* 30 mg of [[Bioadhesives|bioadhesive]] tablet every 12 hour. | |||
| | | | ||
|} | * Gum irritation | ||
* Bitter tasting | |||
* [[Toothache]] | |||
* [[Stomatitis]] | |||
|} | |||
=== Medical therapy for women === | |||
* For women, [[testosterone]] administration is also indicated as a treatment for the [[sexual dysfunction]] in [[postmenopausal]] women. Testosterone is an essential source of [[estrogen]] in the [[postmenopause]] phase.<ref name="pmid16145303">{{cite journal| author=North American Menopause Society| title=The role of testosterone therapy in postmenopausal women: position statement of The North American Menopause Society. | journal=Menopause | year= 2005 | volume= 12 | issue= 5 | pages= 496-511; quiz 649 | pmid=16145303 | doi=10.1097/01.gme.0000177709.65944.b0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16145303 }}</ref> | |||
* The mainstay medical therapy for the women complaining of hypogonadism will be testosterone and estrogen. | |||
==== Estrogen replacement therapy ==== | |||
* Indications: treatment of [[hypoestrogenism]] due to hypogonadism, [[castration]], or [[primary ovarian failure]]. | |||
* Dosing information: oral tablet, 1 to 2 mg daily; [[titrate]] and adjust to the lowest dose as necessary to control symptoms. | |||
* Contraindications: | |||
** Undiagnosed abnormal genital [[bleeding]] | |||
** Known, suspected, or history of [[breast cancer]] | |||
** Known or suspected estrogen-dependent [[neoplasia]] | |||
** Active [[DVT]], [[Pulmonary embolism|PE]], or a history of these conditions | |||
** Active [[arterial thromboembolic disease]] (for example, [[stroke]] and [[ST elevation myocardial infarction|MI]]), or a history of these conditions | |||
** Known [[anaphylactic reaction]] or [[angioedema]] with [[Climara]] | |||
** Known liver impairment or disease | |||
** Known [[protein C]], [[protein S]], or [[antithrombin deficiency]], or other known [[thrombophilic disorders]] | |||
** Known or suspected [[pregnancy]] | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Latest revision as of 20:38, 3 October 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]
Overview
The mainstay of therapy for hypogonadism is the hormonal replacement therapy. Based on the endocrine society clinical guidelines, testosterone is important for the treatment of hypogonadism. Different regimens include injected, buccal and transdermal testosterone. For women, estrogen replacement therapy is important besides testosterone.[1]
Medical Therapy
Patients with hypogonadism are treated mainly with sex hormones replacement. Sex hormones will help in retaining the secondary sexual characteristics for both genders. They will also help in maintaining normal bone density and muscle mass. The main medical therapy in males will be testosterone replacement. In the females, estrogen replacement is important besides testosterone.[1]
Medical therapy for men
Testosterone replacement therapy
- Based on endocrine society clinical practice guidelines, testosterone replacement therapy is the mainstay of treatment in patients with hypogonadism.[2]
- Indications of testosterone therapy are as the following:
- Testosterone is indicated for replacement therapy in adult males for conditions associated with a deficiency or absence of endogenous testosterone.
- Primary hypogonadism (congenital or acquired): Testicular failure from conditions such as cryptorchidism, bilateral torsion, orchitis, vanishing testis syndrome, orchiectomy, Klinefelter syndrome, chemotherapy, or toxic damage from alcohol or heavy metals. These men usually have low serum testosterone concentrations and gonadotropins (follicle-stimulating hormone [FSH], luteinizing hormone [LH]) above the normal range.
- Hypogonadotropic hypogonadism (congenital or acquired): Idiopathic gonadotropin or luteinizing hormone-releasing hormone (LHRH) deficiency or pituitary-hypothalamic injury from tumors, trauma, or radiation. These men have low testosterone serum concentrations but have gonadotropins in the normal or low range.
- Limitations of use:
- Safety and efficacy of testosterone in males less than 18 years old have not been established.
- Testosterone is indicated for replacement therapy in adult males for conditions associated with a deficiency or absence of endogenous testosterone.
- Testosterone therapy is contraindicated in the following cases:
- Breast carcinoma
- Prostate cancer
- Patients with hematocrit value more than 50%
- Untreated obstructive sleep apnea
- Severe lower urinary tract infections
- Heart failure
- In this table, the different recommended regimens of testosterone administration are discussed.
| Type of testosterone drug | Administrative doses | Adverse effects |
|---|---|---|
| Testosterone (Injection) |
|
|
| Testosterone (Transdermal)[3] |
|
Transdermal testosterone may be accompanied with the following skin reactions:[4] |
| Testosterone (Buccal) |
|
|
Medical therapy for women
- For women, testosterone administration is also indicated as a treatment for the sexual dysfunction in postmenopausal women. Testosterone is an essential source of estrogen in the postmenopause phase.[5]
- The mainstay medical therapy for the women complaining of hypogonadism will be testosterone and estrogen.
Estrogen replacement therapy
- Indications: treatment of hypoestrogenism due to hypogonadism, castration, or primary ovarian failure.
- Dosing information: oral tablet, 1 to 2 mg daily; titrate and adjust to the lowest dose as necessary to control symptoms.
- Contraindications:
- Undiagnosed abnormal genital bleeding
- Known, suspected, or history of breast cancer
- Known or suspected estrogen-dependent neoplasia
- Active DVT, PE, or a history of these conditions
- Active arterial thromboembolic disease (for example, stroke and MI), or a history of these conditions
- Known anaphylactic reaction or angioedema with Climara
- Known liver impairment or disease
- Known protein C, protein S, or antithrombin deficiency, or other known thrombophilic disorders
- Known or suspected pregnancy
References
- ↑ 1.0 1.1 Petak SM, Nankin HR, Spark RF, Swerdloff RS, Rodriguez-Rigau LJ, American Association of Clinical Endocrinologists (2002). "American Association of Clinical Endocrinologists Medical Guidelines for clinical practice for the evaluation and treatment of hypogonadism in adult male patients--2002 update". Endocr Pract. 8 (6): 440–56. PMID 15260010.
- ↑ Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS; et al. (2010). "Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline". J Clin Endocrinol Metab. 95 (6): 2536–59. doi:10.1210/jc.2009-2354. PMID 20525905.
- ↑ Wang C, Swerdloff RS, Iranmanesh A, Dobs A, Snyder PJ, Cunningham G; et al. (2000). "Transdermal testosterone gel improves sexual function, mood, muscle strength, and body composition parameters in hypogonadal men". J Clin Endocrinol Metab. 85 (8): 2839–53. doi:10.1210/jcem.85.8.6747. PMID 10946892.
- ↑ Jordan WP (1997). "Allergy and topical irritation associated with transdermal testosterone administration: a comparison of scrotal and nonscrotal transdermal systems". Am J Contact Dermat. 8 (2): 108–13. PMID 9153333.
- ↑ North American Menopause Society (2005). "The role of testosterone therapy in postmenopausal women: position statement of The North American Menopause Society". Menopause. 12 (5): 496–511, quiz 649. doi:10.1097/01.gme.0000177709.65944.b0. PMID 16145303.