Treatment for adults
Treatment for male hypogonadism depends on the cause and whether you're concerned about fertility.
Hormone replacement. For hypogonadism caused by testicular failure, doctors use male hormone replacement (testosterone replacement therapy, or TRT). TRT can restore sexual function and muscle strength and prevent bone loss. In addition, men receiving TRT often experience an increase in energy, sex drive and sense of well-being.
If a pituitary problem is the cause, pituitary hormones may stimulate sperm production and restore fertility. Testosterone replacement therapy can be used if fertility isn't an issue. A pituitary tumor may require surgical removal, medication, radiation or the replacement of other hormones.
- Assisted reproduction. Although there's often no effective treatment to restore fertility in a man with primary hypogonadism, assisted reproductive technology may be helpful. This technology covers a variety of techniques designed to help couples who have been unsuccessful in achieving conception.
Treatment for boys
In boys, testosterone replacement therapy (TRT) can stimulate puberty and the development of secondary sex characteristics, such as increased muscle mass, beard and pubic hair growth, and growth of the penis. Pituitary hormones may be used to stimulate testicle growth. An initial low dose of testosterone with gradual increases may help to avoid adverse effects and more closely mimic the slow increase in testosterone that occurs during puberty.
Types of testosterone replacement therapy
Several testosterone delivery methods exist. Choosing a specific therapy depends on your preference of a particular delivery system, the side effects and the cost. Methods include:
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Injection. Testosterone injections are safe and effective. Injections are given in a muscle about every two weeks. Your symptoms may come and go between doses.
You or a family member can learn to give TRT injections at home. If you're uncomfortable giving yourself injections, a nurse or doctor can give the injections.
- Patch. A patch containing testosterone (Androderm) is applied each night to your back, abdomen, upper arm or thigh. The site of the application is rotated to maintain seven-day intervals between applications to the same site, to lessen skin reactions.
Gel. There are several gel preparations available with different ways of applying them. Depending on the brand, you either rub testosterone gel into your skin on your upper arm or shoulder (AndroGel, Testim), apply with an applicator under each armpit (Axiron) or spray on your inner thigh (Foresta).
As the gel dries, your body absorbs testosterone through your skin. Gel application of testosterone replacement therapy appears to cause fewer skin reactions than patches do. Don't shower or bathe for several hours after a gel application, to be sure it gets absorbed.
A potential side effect of the gel is the possibility of transferring the medication to your partner. You can avoid this by avoiding skin-to-skin contact until the gel is completely dry or by covering the area after an application. All preparations contain testosterone, the same hormone your body normally makes.
- Gum and cheek (buccal cavity). A small putty-like substance, gum and cheek testosterone replacement (Striant) delivers testosterone through the natural depression above your top teeth where your gum meets your upper lip (buccal cavity). This product quickly sticks to your gumline and, as it is exposed to saliva, softens into a gel-like form, allowing testosterone to be absorbed into your bloodstream.
- Implantable pellets. Testosterone containing pellets (Testopel) are surgically implanted under the skin and need to be placed every three to six months.
- Oral. Taking testosterone orally isn't recommended for long-term hormone replacement because it may cause liver problems, raise your cholesterol and increase your risk of heart disease.
- Snyder PJ. Clinical features and diagnosis of male hypogonadism. http://www.uptodate.com/home. Accessed July 29, 2013.
- Anawalt BD, et al. Performance of total testosterone measurement to predict free testosterone for the biochemical evaluation of male hypogonadism. The Journal of Urology. 2012;187:1369.
- Papadakis MA, et al. Current Medical Diagnosis & Treatment 2013. 52nd ed. New York, N.Y.: The McGraw-Hill Companies; 2013. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=1. Accessed July 29, 2013.
- Snyder PJ. Causes of primary of hypogonadism in males. http://www.uptodate.com/home. Accessed July 29, 2013.
- Snyder PJ. Causes of secondary hypogonadism in males. http://www.uptodate.com/home. Accessed July 29, 2013.
- Grinspon RP, et al. New perspectives in the diagnosis of pediatric male hypogonadism: The importance of AMH as a sertoli cell marker. Arquivos Brasileiros de Endocrinologia & Metabologia. 2011;55:512.
- Pantalone KM, et al. Male hypogonadism: More than just a low testosterone. Cleveland Clinic Journal of Medicine. 2012;79:717.
- Snyder PJ. Testosterone treatment of male hypogonadism. http://www.uptodate.com/home. Accessed July 29, 2013.
- Dietary Reference Intakes for calcium and vitamin D. Institute of Medicine. http://www.iom.edu/vitamind. Accessed July 31, 2013.
- Testosterone therapy in adult men with androgen deficiency syndromes. Chevy Chase, Md.: The Endocrine Society. http://www.endo-society.org/guidelines/Current-Clinical-Practice-Guidelines.cfm. Accessed July 31, 2013.