April 18th, 2014
Testosterone is considered an essential male sexual hormone that is required for the development of secondary sexual characteristics at the time of puberty and maintenance of male reproductive functions throughout life. Testosterone replacement therapy would be needed when for conditions we will discuss in this article. In addition, normal testosterone secretion is also required for:
It has been observed that a moderate decrease in testosterone secretion can significantly affect the overall sense of well-being, sexual appetite and may lead to erectile dysfunction.
The secretion of testosterone decreases with physiological aging. The decline usually begins after the age 30 and continues for the rest of the life (though the pace is usually slow and unnoticeable).
Most cardinal sign and symptoms that may arose the suspicion of testosterone deficiency are:
Research report published in Journal of Andrology (1) suggested that testosterone replacement therapy improves erectile dysfunction directly as well as indirectly by improving the response to PDE5 inhibitors. If testosterone deficiency is symptomatic; healthcare providers may advise testosterone replacement therapy after serial serum measurements.
Testosterone Intramuscular Injections:
In most cases, the injections are introduced twice monthly or once in three weeks. The bioavailability or hormone is high and reduces the hassle of daily application. However, there are a few limitations; such as:
These gels can be topically applied to abdomen, shoulders or chest region. Although there are many benefits (such as easy application) caution must be maintained to avoid the risk of accidental transfer to partner or any person in close physical contact.
Report published in Journal of Urology (2) suggested that testosterone replacement gel is also helpful in managing erectile dysfunction in males who are unresponsive to Sildenafil alone.
Testosterone replacement gel is the most frequent modality for replacement therapy, followed by injectable testosterone, testosterone replacement patches and oral tablets (3).
Testosterone replacement patch is applied daily on the scrotum/ abdomen/ buttocks/thighs or back. Besides many advantages; one of the most commonly encountered problem is the high risk of rash or skin irritation.
Oral Testosterone Pills:
Oral testosterone formulations are not frequently used mainly because of the lower bioavailability (that can be managed by alkylation); however, the benefits of therapy are offset by the risk of liver cirrhosis or dysfunction. Other potential complications of oral testosterone replacement therapy are:
Some oral formulations of testosterone are; 17-methyltestosterone, Mesterolone, and fluoxymesterone. A relatively safer option is Testosterone undecanoate that has a better safety profile and bioavailability.
Regardless of the mode of testosterone intake; some common therapy related side effects are:
Research report by Calof (4) suggested that testosterone replacement therapy is associated with a significant increase in hematocrit (greater than 50%) and also increase the risk of prostate events.
1. Shabsigh, R., Kaufman, J. M., Steidle, C., & Padma-Nathan, H. (2004). Randomized study of testosterone gel as adjunctive therapy to sildenafil in hypogonadal men with erectile dysfunction who do not respond to sildenafil alone. The Journal of urology, 172(2), 658-663.
2. Yassin, A. A., & Saad, F. (2008). Testosterone and erectile dysfunction. Journal of andrology, 29(6), 593-604.
3. Calof, O. M., Singh, A. B., Lee, M. L., Kenny, A. M., Urban, R. J., Tenover, J. L., & Bhasin, S. (2005). Adverse events associated with testosterone replacement in middle-aged and older men: a meta-analysis of randomized, placebo-controlled trials. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 60(11), 1451-1457.
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