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Treatments and drugs
By Mayo Clinic staff
Treatment for adults
Treatment for male hypogonadism depends on the cause and whether you're concerned about fertility.
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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.
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:
- 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.
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Gel. You rub testosterone gel (AndroGel, Testim) into your skin on your lower abdomen, upper arm or shoulder. 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 or a child. The Food and Drug Administration has added a black box warning to these products about this side effect. This is because such transfer has caused inappropriate enlargement of the genitalia, advanced bone age, increased libido and aggressive behavior in young children. Women may develop secondary male sex characteristics such as changes in body hair growth and acne. You can avoid transfer of the medication by taking steps such as washing your hands with soap and water after applying the medication, covering the application area with clothing once it's dried, and thoroughly washing the application area with soap and water before any situation in which you expect skin-to-skin contact.
- Gum and cheek (buccal cavity). Striant, a small putty-like substance, 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 exposed to saliva, softens into a gel-like form, allowing testosterone to be absorbed into your bloodstream.
- 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. Causes of primary of hypogonadism in males. http://www.uptodate.com/home/index.html. Accessed Sept. 19, 2008.
- ?Snyder PJ. Causes of secondary hypogonadism in males. http://www.uptodate.com/home/index.html. Accessed Sept. 19, 2008.
- Snyder PJ. Clinical features and diagnosis of male hypogonadism. http://www.uptodate.com/home/index.html. Accessed Sept. 17, 2008.
- Medical guidelines for clinical practice for the evaluation and treatment of hypogonadism in adult male patients - 2002 update. Endocrine Practice. 2002; 8(6):440-56
- Swerdloff RS, et al. The testis and male sexual function. In: Goldman L. Cecil Medicine. 23rd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/105282103-4/750311888/1492/915.html#4-u1.0-B978-1-4160-2805-5..50258-5--cesec32_11391. Accessed Sept. 21, 2008.
- Snyder PJ. Testosterone treatment of male hypogonadism. http://www.uptodate.com/home/index.html. Accessed Sept. 17, 2008.
- Dietary Reference Intakes: Elements. Institute of Medicine. http://www.iom.edu/Object.File/Master/54/411/DRIs.Vitamins.pdf. Accessed Sept. 21, 2008.
- Dietary Reference Intakes: Vitamins. Institute of Medicine. http://www.iom.edu/Object.File/Master/54/395/DRIs.Elements.pdf. Accessed Sept. 21, 2008.
- Testosterone gel safety concerns prompt FDA to require label changes, medication guide. U.S. Food and Drug Administration. http://www.fda.gov/bbs/topics/NEWS/2009/NEW02011.html. Accessed May 11, 2009.
