Emerging medication for the treatment of male hypogonadism

ABSTRACT

Introduction: Male hypogonadism is characterized by inadequate production of Testosterone (T) (hypoandrogenism) and deficiencies in spermatogenesis. The main treatment of male hypogonadism is T replacement therapy (TRT), but for some of the patients, alternative drugs may be more suitable.

Areas covered: The available literature of T and alternative treatments for male hypogonadism are discussed.

Expert opinion: Transdermal application of T gels are the most commonly used route of T administration. Some oral T formulations are either associated with hepatic toxicity (i.e. methyltestosterone) or short half-lives that require multiple doses per day (i.e. oral testosterone undecanoate). Short acting, injectable T formulations are also available. If the patient prefers not to use daily drugs or short acting injectable formulations, depot formulations such as injectable testosterone undecanoate (TU) may be a good alternative. If the patient has hypogonadotropic hypogonadism and desires fertility or if he is adolescent, instead of TRT, gonadotropins can be started to stimulate testicular growth and spermatogenesis. In obese patients or for the patients having high risks for TRT, off label aromatase inhibitors (AI) and clomiphene citrate (CC), may be considered to stimulate LH, FSH and T levels. In patients with high prostate disease risk, selective androgen receptor modulators may be an alternative treatment but these latter treatments have not had high level evidence.

KEYWORDS:

• Male hypogonadism
• testosterone gel 1.62%
• testosterone 2% gel
• testosterone 5% cream
• testosterone undecanoate (TU)
• dihydrotestosterone (DHT)
• human chorionic gonadotropin (hCG)
• aromatase inhibitors (AIs)
• clomiphene citrate (CC)
• dehydroepiandrosterone (DHEA)

Declaration of interest

R.S. Swerdloff has been a grant recipient or Consultant of Clarus Pharmaceutical, Lipocene, Antares, Repos Therapeutics, Besins TesoRx and AbbVie Corporation. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.