Androgens in Health and Disease.pdf - E Library

Chapter 16/Androgen Treatment of the Hypogonadal Male 313
16
Androgen Treatment
of the Hypogonadal Male
Alvin M. Matsumoto, MD
CONTENTS
INTRODUCTION
DIAGNOSTIC AND TREATMENT CONSIDERATIONS
IN MALE HYPOGONADISM
THERAPEUTIC GOALS AND BENEFITS OF T TREATMENT
FORMULATIONS AVAILABLE FOR T-REPLACEMENT THERAPY
ANDROGEN FORMULATIONS UNDER DEVELOPMENT
POTENTIAL RISKS OF T TREATMENT AND MONITORING
SUMMARY AND CONCLUSIONS
REFERENCES
INTRODUCTION
Male hypogonadism is a common clinical condition that results in androgen deficiency
and affects the health and well-being of boys and men of all ages. For example,
androgen deficiency of varying degrees is a major manifestation of the Klinefelter syndrome,
an XXY chromosomal disorder that affects approx 1 in 500 males (1). Testosterone
(T)-replacement therapy has proven beneficial effects in androgen-deficient
hypogonadal men, and male hypogonadism is the main clinical indication for T treatment.
Unfortunately, in a large proportion of hypogonadal men, androgen deficiency is
undiagnosed, diagnosed long after its onset, or treated inappropriately.
The spectrum of clinical states associated with androgen deficiency is broad. Serum
T levels are commonly low in men with chronic illness (e.g., chronic renal failure,
obstructive pulmonary disease, and liver disease), acute illness (burns, surgery, critical
medical illness), wasting syndromes (e.g., associated with human immunodeficiency
virus [HIV] infection and cancer), the use of certain medications (e.g., glucocorticoids
and central-nervous-system-acting medications, such as opiates), and in normal aging
men (referred to as “andropause”) (2). These conditions are also associated with clinical
manifestations of androgen deficiency, such as reduced muscle mass and strength,
decreased bone mineral density, sexual dysfunction, diminished energy and well-being,
and depressed mood. Preliminary studies suggest potential beneficial anabolic and
behavioral effects of androgen therapy in men with these conditions (3–8). Although the
From: Contemporary Endocrinology: Androgens in Health and Disease
Edited by: C. Bagatell and W. J. Bremner © Humana Press Inc., Totowa, NJ
313