Hypogonadism medical therapy: Difference between revisions

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==Overview==
==Overview==
The mainstay of therapy for hypogonadism is the hormonal replacement therapy. Bases on the endocrine society clinical guidelines, testosterone is importan in the treatment of hypogonadism. Different regimens include injected, buccal and transdermal testosterone. For women, estrogen replacement therapy is important besides testosterone.<ref name="pmid15260010" />  
The mainstay of therapy for hypogonadism is the hormonal replacement therapy. Bases on the endocrine society clinical guidelines, testosterone is importan in the treatment of hypogonadism. Different regimens include injected, buccal and 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==

Revision as of 23:05, 23 July 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The mainstay of therapy for hypogonadism is the hormonal replacement therapy. Bases on the endocrine society clinical guidelines, testosterone is importan in 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 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 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 of 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 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 serumtestosterone 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 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)
  • 75-100 mg intramuscular injection per week.
  • 150-200 mg intramuscular injection every two weeks.
  • Subcutaneous implantation of testosterone pellets every 3-6 months.
  • Injection site reactions
Testosterone (Transdermal)[3]
  • Testosterone patches: one or two doses of 5 mg on 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 accompained with the following skin reactions:[4]
  • Pruritis
  • Dermatitis
  • Blisters
  • Erythema
  • Vesicles
  • Acne
  • Hot flushes
Testosterone (Buccal)
  • 30 mg of 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 important 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 ORALLY daily; titrate and adjust to the lowest dose as necessary to control symptoms
  • Contraindications:

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.

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