Emerging medication for the treatment of male hypogonadism

  title={Emerging medication for the treatment of male hypogonadism},
  author={Giovanni Corona and Giulia Rastrelli and Linda Vignozzi and Mario Maggi},
  journal={Expert Opinion on Emerging Drugs},
  pages={239 - 259}
Introduction: Since the phenotype and clinical need of the hypogonadal individuals changes dramatically over time, versatile therapies are needed. Areas covered: The authors review the available evidence on possible therapies. Expert opinion: In the case of primary hypogonadism starting early in life, substitution with testosterone (T) is the only choice. For secondary congenital hypogonadism, we recommend starting with gonadotrophins to allow the testes to reach pubertal size. Thereafter, T… 

Pharmacological management of late-onset hypogonadism

The present data indicate that antiestrogens are able to increase testosterone levels without changing gonadotropins or even increasing them, and that TTh is able to improve sexual function and body composition, with more evident results obtained with transdermal and injectable preparations.

The safety of available treatments of male hypogonadism in organic and functional hypogonadism

Considering the significant improvement in body composition, glucose metabolism and sexual activity, TRT should not be limited to ‘organic’ HG, but also offered for ‘functional’.

Emerging medication for the treatment of male hypogonadism

The main treatment of male hypogonadism is T replacement therapy (TRT), but for some of the patients, alternative drugs may be more suitable, and gonadotropins can be started to stimulate testicular growth and spermatogenesis.

The pharmacotherapy of male hypogonadism besides androgens

For primary HG only TRT is advisable, whereas for the secondary form several alternative possibilities can be offered, and the possibility of increasing Leydig cell steroid production, independently from Gn stimulation, seems unreliable.

Phase II drugs currently being investigated for the treatment of hypogonadism

There remains a need for newer therapies that are more cost-effective, preserve ease of use and administration, mitigate undesirable effects and closely mimic physiological levels of testosterone.

Different Medications for Hypogonadotropic Hypogonadism.

Gonadotropins and GnRH, besides inducing secondary sexual characteristics, can also induce testicular maturation and spermatogenesis, and other molecules, such as kisspeptin and neurokinin B agonists, are now under evaluation as new therapeutic options for treating DP.

Risks and Benefits of Late Onset Hypogonadism Treatment: An Expert Opinion

Available evidence suggests that TRT might ameliorate central obesity and glycometabolic control in patients with metabolic syndrome and type 2 diabetes, and TRT has been associated with an increase in bone mineral density in men with osteoporosis and with an improvement in lean body mass in subjects with human immunodeficiency virus infection or chronic obstructive pulmonary disease.

Testosterone Replacement Therapy: Long-Term Safety and Efficacy

A large amount of evidence has documented that sexual symptoms are the most specific correlates of T deficiency, supporting the scientific demonstration that LOH does exist according to an “ex-juvantibus” criterion and the efficacy of TTh in non-organic HG and its long term safety.

Male hypogonadism – brief review of symptoms, types and ways of treatment

Hypogonadism of primary, secondary, functional or late-onset origin may be recognised, as it concerns susceptible matter of sexual and reproductive health, it requires special interest of differently clinicians, i.e. endocrinologists, andrologists or urologists.

Diagnosis and treatment of late-onset hypogonadism: systematic review and meta-analysis of TRT outcomes.




Update in testosterone therapy for men.

TRT, alone or in combination with phosphodiesterase type 5 inhibitors, is considered the first-line therapy in hypogonadal subjects with erectile dysfunction and is associated with a reduction of fat mass, an increase of lean mass, and a possible positive effect on lipid profile and glycometabolic control.

Which patients with sexual dysfunction are suitable for testosterone replacement therapy?

The main purpose of this review is to discuss the role of testosterone (T) in men’s sexual function, including epidemiology, pathophysiology, diagnostic procedures, and treatment efficacy in patients affected by erectile dysfunction (ED).

Use of clomiphene citrate to reverse premature andropause secondary to steroid abuse.

Dihydrotestosterone: a rationale for its use as a non-aromatizable androgen replacement therapeutic agent.

Clomiphene citrate effects on testosterone/estrogen ratio in male hypogonadism.

Low dose clomiphene citrate is effective in elevating serum testosterone levels and improving the testosterone/estradiol ratio in men with hypogonadism, and represents an alternative to testosterone therapy by stimulating the endogenous androgen production pathway.

Recovery of persistent hypogonadism by clomiphene in males with prolactinomas under dopamine agonist treatment.

Clomiphene restores normal testosterone levels and improves sperm motility in most male patients with prolactinomas and persistent hypogonadism under DA therapy.

Effect of raising endogenous testosterone levels in impotent men with secondary hypogonadism: double blind placebo-controlled trial with clomiphene citrate.

There can be a functional secondary hypogonadism in men on an out-patient basis, but correlation of the hormonal status does not universally reverse the associated erectile dysfunction to normal, thus requiring closer scrutiny of claims of cause and effect relationships.

American Association of Clinical Endocrinologists Medical Guidelines for clinical practice for the evaluation and treatment of hypogonadism in adult male patients--2002 update.

These therapies may be combined with assisted reproductive technologies such as in vitro fertilization with intracytoplasmic sperm injection, which may allow pregnancy to occur with very low numbers of sperm.

Treatment with human chorionic gonadotropin for PADAM: A preliminary report

It is concluded that hCG injection may be considered as a treatment for PADAM and laboratory tests showed that only red blood cell count, hematocrit and hemoglobin level increased significantly after treatment, however, these values remained within the normal range.

Clomiphene fails to revert hypogonadism in most male patients with conventionally treated nonfunctioning pituitary adenomas.

Compared with hypogonadal men with prolactinomas under dopaminergic therapy, clomiphene treatment failed to restore normal testosterone levels in most patients with conventionally treated NFPA.