New Treatments for Male Hypogonadism
Review from Researchers on Emerging Testosterone Treatments
Hypogonadal men have shifting clinical needs over time; in fact, the phenotype and clinical needs change dramatically, leading to a need for versatile therapies. To address this issue, authors from the University of Florence, Sexual Medicine and Andrology Unit (Florence, Italy) reviewed evidence on possible male hypogonadism treatments.
An article on the review was published in the June 2012 edition of Expert Opinion on Emerging Drugs; it is “Emerging medication for the treatment of male hypogonadism.”
The authors broke their review into different types of hypogonadism. They examined the most effective current therapies for each type.
For primary hypogonadism that starts early in a man’s life: The authors note that testosterone substitution is the only choice available.
For secondary congenital hypogonadism: The authors’ recommendation is initiation with gonadotrophins; this should allow the testes to reach pubertal size. Once this is reached, testosterone replacement therapy should be given, but it should be stopped when the man would like to have children. He should then be placed on gonadotrophins until he has a child. The authors point out that antiestrogens are a possible alternative, but they have not been adequately tested.
If there are symptoms of increased estrogen production: A short-term trial with non-aromatizable androgens (dihydrotestosterone mesterolone or oxandrolone) is recommended. After several months of this therapy, however, a man sould be switched to aromatizable preparations; otherwise, bone loss may occur.
If there is a concern for prostate safety: It is advisable to use steroidal or non-steroidal selective androgen receptor modulators; these are less susceptible to 5α reduction. Another option—one the authors call “attractive”—is to combine testosterone with 5α inhibitors.
One promising treatment is estrogen receptor-beta ligands; however, development of these compounds is still in the early stages.