Hypogonadism medical therapy: Difference between revisions

Jump to navigation Jump to search
 
(8 intermediate revisions by 2 users not shown)
Line 1: Line 1:
__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 of 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 female, estrogen and progesterone replacement is important.<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>  
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 of 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>  
* 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): testicular failure due to conditions such as cryptorchidism, bilateral torsion, orchitis, vanishing testis syndrome, orchiectomy, Klinefelter’s 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.
*** 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): 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.
*** 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"
Line 29: Line 31:
!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.  
* [[Subcutaneous]] [[implantation]] of [[testosterone]] pellets every 3-6 months.  
|
|
* Injection site reactions  
* [[Injection]] site reactions  
|-
|-
|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 (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 patches: one or two doses of 5 mg on non-genital skin as the back, thigh and upper arm.   
* [[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.   
* Testosterone gel: 1% dose of gel on the non-genital skin.   
|Transdermal testosterone may be accompained 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>
|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
* [[Pruritis]]
* Dermatitis  
* [[Dermatitis]]
* Blisters
* [[Blisters]]
* Erythema
* [[Erythema]]
* Vesicles  
* [[Vesicles]]
* Acne  
* [[Acne]]
* Hot flushes
* [[Hot flushes]]
|-
|-
|Testosterone (Buccal)  
|[[Testosterone (buccal)|Testosterone (Buccal)]]
|
|
* 30 mg of bioadhesive tablet every 12 hour.  
* 30 mg of [[Bioadhesives|bioadhesive]] tablet every 12 hour.  
|
|
* Gum irritation  
* Gum irritation  
* Bitter tasting
* Bitter tasting
* Toothache  
* [[Toothache]]
* Stomatitis  
* [[Stomatitis]]
|}
|}


=== Medical therapy for women ===
=== Medical therapy for women ===
* For women, testosterone administration is also indicated as a treatment for the sexual dysfunction in postmenopausal women. Testosterone is important 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>  
* 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.  
* The mainstay medical therapy for the women complaining of hypogonadism will be testosterone and estrogen.  


==== Estrogen replacement therapy ====
==== Estrogen replacement therapy ====
* Indications: treatment of hypoestrogenism due to hypogonadism, castration, or primary ovarian failure.  
* Indications: treatment of [[hypoestrogenism]] due to hypogonadism, [[castration]], or [[primary ovarian failure]].  
* Dosing information: oral tablet, 1 to 2 mg ORALLY daily; titrate and adjust to the lowest dose as necessary to control symptoms
* Dosing information: oral tablet, 1 to 2 mg daily; [[titrate]] and adjust to the lowest dose as necessary to control symptoms.
* Contraindications:  
* Contraindications:  
** Undiagnosed abnormal genital bleeding
** Undiagnosed abnormal genital [[bleeding]]
** Known, suspected, or history of [[breast cancer]]
** Known, suspected, or history of [[breast cancer]]
** Known or suspected estrogen-dependent neoplasia
** Known or suspected estrogen-dependent [[neoplasia]]
** Active [[DVT]], PE, or a history of these conditions
** Active [[DVT]], [[Pulmonary embolism|PE]], or a history of these conditions
** Active [[arterial thromboembolic disease]] (for example, stroke and MI), 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 [[anaphylactic reaction]] or [[angioedema]] with [[Climara]]
** Known liver impairment or disease
** Known liver impairment or disease
** Known [[protein C]], [[protein S]], or [[antithrombin deficiency]], or other known [[thrombophilic disorders]]
** Known [[protein C]], [[protein S]], or [[antithrombin deficiency]], or other known [[thrombophilic disorders]]
** Known or suspected pregnancy
** Known or suspected [[pregnancy]]


==References==
==References==

Latest revision as of 20:38, 3 October 2017

Hypogonadism Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Hypogonadism from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

X ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Hypogonadism medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Hypogonadism medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Hypogonadism medical therapy

CDC on Hypogonadism medical therapy

Hypogonadism medical therapy in the news

Blogs on Hypogonadism medical therapy

Directions to Hospitals Treating Hypogonadism

Risk calculators and risk factors for Hypogonadism medical therapy

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

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

Estrogen replacement therapy

References

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.

Template:WH Template:WS