Hypogonadism medical therapy

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]

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]

• 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 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.

• 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.

• 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

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