An update on the available and emerging pharmacotherapy for adults with testosterone deficiency available in the USA

ABSTRACT

Introduction: Testosterone deficiency (TD) is defined as low serum testosterone associated with symptoms and signs. There has been an increasing prevalence of TD in recent decades, especially in males aged 15–39. Many of these men will require long-term testosterone therapy (TT). Although the end-goals for all treatments are essentially the same, strategies for increasing serum testosterone should be decided individually.

Areas covered: This review focuses on the pharmacological management of TD in adults which includes TT with different routes of administration, such as transdermal, buccal, intramuscular and subcutaneous injections, pellets, nasal gel, and oral (pills). The authors review the options for TT available in the USA with emphasis on newer therapies. Furthermore, they examine the efficacy of these therapies with comparison between potential advantages or disadvantages related to dosing, administration method, and adverse events.

Expert opinion: Treating TD can be difficult due to the wide range of available medications, diverse side effects related to testosterone replacement and route-of-administration, and necessity for long-term therapy. The combination of pharmacological and non-pharmacological therapies can improve symptoms of TD and patient satisfaction. Each patient should be managed individually, and clinicians should consider available treatment regimens based on the route-of-administration, efficacy, safety, and cost based on a shared decision-making approach.

KEYWORDS:

• Testosterone therapy
• testosterone deficiency
• hypogonadism

Article highlights

• Testosterone deficiency is a common diagnosis among males with an increasing number of patients seeking treatment.

• There are many options for testosterone therapy with various routes of administration including transdermal, buccal, nasal, IM and subcutaneous injections, subcutaneous implants, and oral formulations.

• For those seeking fertility preservation, forms of TT other than exogenous testosterone replacement are available.

• Different formulations will allow patients to reach normal testosterone levels, but each has unique advantages and disadvantages.

• Each patient should be treated individually, and clinicians should discuss the route of administration, side effects, benefits, safety, dosing, and costs prior to making a decision on the appropriate medication.

This box summarizes key points contained in the article.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declaration of interest

R Ramasamy is a consultant for Acerus Pharmaceuticals and Endo Pharmaceuticals. 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 manuscript has not been funded.