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Review
. 2022 Mar;51(1):77-98.
doi: 10.1016/j.ecl.2021.11.005. Epub 2022 Feb 8.

Testosterone Replacement Therapy in Hypogonadal Men

Christina Wang  1 , Ronald S Swerdloff  2
Affiliations
Review

Testosterone Replacement Therapy in Hypogonadal Men

Christina Wang et al. Endocrinol Metab Clin North Am. 2022 Mar.

Abstract

All approved testosterone replacement methods, when used according to recommendations, can restore normal serum testosterone concentrations, and relieve symptoms in most hypogonadal men. Selection of the method depends on the patient's preference with advice from the physician. Dose adjustment is possible with most delivery methods but may not be necessary in all hypogonadal men. The use of hepatotoxic androgens must be avoided. Testosterone treatment induces reversible suppression of spermatogenesis; if fertility is desired in the near future, human chronic gonadotropin, selective estrogen receptor modulator, estrogen antagonist, or an aromatase inhibitor that stimulates endogenous testosterone production may be used.

Keywords: Endogenous testosterone stimulators; Implants; Intramuscular injections; Modified androgens; Oral capsules; Selective androgen receptor modulators; Transdermal gels.

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Conflict of interest statement

Disclosure Drs. C. Wang and R.S. Swerdloff received research support from the Testosterone Replacement Therapy Manufacturers Consortium, Clarus Therapeutics, Chiasma, Crinetics Pharmaceuticals, and Corcept Therapeutics.

Figures

Figure 1.
Figure 1.
Chemical structure of testosterone and is conversion to 5α-dihydrotestosterone and estradiol. Addition of a methyl group at 17α position testosterone results in methyl-testosterone that is hepatotoxic. Removal of a methyl group at the 19-position from testosterone results in 19-nortestosterone. 19-nortestosterone and its derivatives are not hepatotoxic.
See this image and copyright information in PMC

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