Clinical Hypogonadism and Androgen Replacement Therapy: An Overview

Dana A. Ohl; Susanne A. Quallich


Urol Nurs. 2006;26(4):253-259,269. 

In This Article

Abstract and Introduction


Testosterone has a complex variety of roles in male physiology. It is a common belief that testosterone in men declines with age. While this is true, there are several aspects to this decline which make it difficult to diagnose definitively, as other endocrine components can contribute to a patient's symptoms. There are some guidelines to help determine when to begin treatment, based on laboratory assays and symptomatology. Testosterone replacement in men can improve overall quality of life, can reverse some of the effects of hypogonadism, and can be done very safely with available pharmacologic agents.


Men throughout recorded history have sought to preserve and enhance their virility, and have approached this in several creative ways. In antiquity, the testes were thought to be the seat of both vigor and longevity for men. Greek and Roman men consumed a substance called "satyricon," a combination of goat and wolf testicular extracts. In the 19th and 20th centuries, there was an emergence of therapies derived from organs: consumption of thyroid extract and animal testicular extract were thought to aid in maintaining virility. In the 1930s, technology progressed and it became possible to isolate various androgens (testosterone propionate, androsterone, methyltestoster one) from animal tissue. These substances began to be applied in clinical situations (Freeman, Bloom, & McGuire, 2001).

Present day offers more sophisticated methods for diagnosing and treating men with low testosterone levels. There are a variety of formulations that are commercially available, supplied as tablets, injections, or transdermal gels. The indications for treatment continue to evolve as clinicians work to define terms such as andropause, androgen decline in the aging male (ADAM), and late onset hypogonadism.

In November 2003, the Institute of Medicine (IOM) issued a statement regarding the need for research on testosterone replacement therapies. Method ologic weaknesses identified in previous research included lack of long-term studies of men undergoing replacement therapy. Indeed, it was noted that the longest study to date of patients who received testosterone re placement has been only 36 months in duration. It was recommended that more large-scale clinical trials be conducted on the order of the Women's Health Initiative (which involved over 160,000 women aged 50 to 79). Additionally, the IOM was critical of the lack of consensus for using testosterone as a treatment vs. using it as a possible preventive measure. The lack of standardized treatment guidelines or clarity regarding specific patient populations that would benefit from treatment also have limitations.

Reservations concerning the use of testosterone arise due to the possibility of significant side effects. Current treatment is further complicated by the fact that it is difficult to compare previously published studies on testosterone therapy. Variations in the definition of hypogonadism as well as differences in replacement doses make such comparisons difficult, which in turn causes difficulty in establishing a goal for treatment.


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