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Alternative Treatment Modalities for the Hypogonadal Patient

  • Men’s Health (R Carrion and C Yang, Section Editors)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Testosterone (T) deficiency syndrome (TDS) is a prevalent condition, commonly managed with exogenous T. Despite an abundance of T formulations, alternative treatments are often sought for various reasons. To evaluate outcomes of alternative therapies, a PubMed search was performed of all publications that included men with TDS from 1990 through October 2013, with results summarized. Proposed mechanisms of action were also reviewed to provide a pathophysiologic basis for reported outcomes. Nonpharmacologic therapies that increase endogenous T are weight loss, exercise, and varicocelectomy, while medications used off-label include aromatase inhibitors, human chorionic gonadotropin, and selective estrogen receptor modulators. All reported therapies increase T, while changes in estradiol and adverse events vary by therapeutic class. Although limited data preclude direct comparisons between therapies, exercise and weight loss alone or in combination with medications may be considered first line. The role for surgical therapy in TDS remains undefined and requires further study.

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Abbreviations

AE:

Adverse events

AI:

Aromatase inhibitors

BMI:

Body mass index

DHT:

Dihydrotestosterone

E2:

Estradiol

ER-α:

Estrogen receptor alpha

ER-β:

Estrogen receptor beta

FSH:

Follicle stimulating hormone

GnRH:

Gonadotropin-releasing hormone

HAART:

Highly active antiretroviral therapy

HCG:

Human chorionic gonadotropin

HPG:

Hypothalamic pituitary gonadal axis

IM:

Intramuscular

LH:

Luteinizing hormone

PC:

Placebo controlled

RCT:

Randomized controlled trial

SERM:

Selective estrogen receptor blockers

T:

Testosterone

TDS:

Testosterone deficiency syndrome

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Dr. Landon W. Trost and Dr. Mohit Khera each declare no potential conflicts of interest.

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  1. Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

    Landon W. Trost

  2. Baylor College of Medicine, Houston, TX, USA

    Mohit Khera

  3. Baylor Clinic, 6620 Main St., Suite 1325, Houston, TX, 77030, USA

    Mohit Khera

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  1. Landon W. Trost
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Correspondence to Mohit Khera.

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Trost, L.W., Khera, M. Alternative Treatment Modalities for the Hypogonadal Patient. Curr Urol Rep 15, 417 (2014). https://doi.org/10.1007/s11934-014-0417-2

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