Treatment of Hypogonadism

Abstract

Hypogonadism is a frequent condition, in particular during adult age. Whereas no doubts exist on the opportunity of treating patients with hypogonadism deriving from definite conditions affecting the hypothalamic-pituitary-testicular axis, more concerns are present for treatment of men with age-related testosterone (T) decline, the so-called late-onset hypogonadism (LOH). Several options are available for treating hypogonadism, and the choice should be done according to rationale, indications, and expected outcomes, taking also into account the advantages and disadvantages associated with each molecule and preparation. Although GnRH and gonadotropins are the cornerstone of therapy in secondary hypogonadism (sHG) men requiring fertility, few data are present on their use in LOH. Testosterone replacement therapy (TRT) is the most studied therapy in this particular and controversial condition. Randomized clinical trials (RCTs) on TRT are few and short lasting. However, there is substantial consistence on the efficacy of TRT in improving sexual function, increasing lean mass, and decreasing fat mass. The results are more controversial on the effectiveness of TRT in improving glycolipid profile and mood. Concerning bone mineral density, the evidence is scarce and those concerning fractures are nonexisting. An intense debate is ongoing on the putative risk of cardiovascular (CV) events associated with TRT. Pending results from RCTs specifically designed for assessing this outcome, available evidence reassures on CV safety of TRT, but caution should be used in older and frail men.