In all forms of male hypogonadism androgen therapy forms the core of the treatment. If there is a desire for fertility it may be necessary to temporarily interrupt the treatment and use other procedures instead. However, when fertility is no longer desired, androgen therapy for correction of the testosterone deficiency should be resumed.
The chief indications for androgen therapy are correction of the testosterone deficiency in primary and secondary hypogonadism. Androgen therapy may also be indicated in age-related hypogonadism. There are also some therapeutic indications.
A number of different androgen preparations and dosage forms are available.
Androgen therapy is characterized by a wide margin of safety and good tolerability.
Before beginning treatment the diagnosis must be confirmed and contraindications ruled out. Close monitoring of the treatment is essential.
Androgen Preparations
Androgen therapy is, above all, testosterone therapy. Orally administered native testosterone is absorbed in the duodenum and transported to the liver where it is rapidly broken down to biologically inactive metabolites by an efficient first pass effect. Oral administration of testosterone thus only leads to a very brief, clinically ineffective increase in serum testosterone.
Two methods are used to overcome this problem:
The most frequently used options for androgen therapy are:
Intramuscular
Transdermal
Oral
Buccal System