Male hypogonadism (reduced testosterone secretion) – How is it treated?

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Article by Doctor Trinh Ngoc Anh - Endocrinologist - Department of General Internal Medicine - Vinmec Times City International General Hospital.

1. How to treat male hypogonadism?

Hypogonadism can result from any degree of hypothalamic-pituitary-gonadal axis damage. The treatment of the disease also depends on the extent and location of the lesion and the need to give birth to choose the appropriate measure
*Non-drug treatment
Lifestyle changes, weight loss (in obese patients, metabolic syndrome) and treat comorbid conditions (diabetes, renal failure, hypothyroidism or hypopituitarism) before testosterone therapy Quit smoking Limit alcohol Regularly exercise * Treat Testosterone replacement
As therapy given in cases of primary hypogonadism, secondary hypogonadism when clinical symptoms in men no longer want to have children, hypopituitarism, hypogonadism accompanied by metabolic diseases: metabolic syndrome, diabetes...

Contraindication to Testosterone use in cases of prostate cancer, breast cancer, male infertility, desire to have children, Hct >55%, heart failure NYHA 4 Use with caution in case of prostate enlargement symptomatic gland, sleep apnea syndrome, severe renal failure, Hct >52% Testosterone replacement therapies: Treatment of primary or secondary hypogonadism includes testosterone replacement therapy, especially on patients who no longer want to have children. Here are some preparations:
+ Natural Testosterone, although well absorbed from the gastrointestinal tract, is rapidly metabolized in the liver, so it has no effect on maintaining therapeutic blood levels. Alkylated testosterone currently has many side effects, so its use is not recommended.
+ For the purpose of androgen replacement, Testosterone enanthate or Testosterone decanoate is usually used, a testosterone esther that accumulates in the subcutaneous fat-muscle layer and slowly releases testosterone into the bloodstream after injection: the drug is usually injected deep intramuscularly, with a knife dose. Active depending on the type from 3-10 weeks / time
Oral form: Testosterone undecanoate take 3-4 tablets / day for the first 2-3 weeks then maintain 1-3 tablets / day. The drug should be taken during or immediately after a meal (because the drug is absorbed through the lymphatic route, restriction through the liver can cause bleeding in the liver). Cons: Blood testosterone fluctuates a lot due to changes in absorption process. Androgel package containing gel 50mg/5g can be used topically once a day at a certain hour, so in the morning. This method of treatment helps maintain a good level of Testosterone in the blood, with less fluctuation compared to injection or oral form, but care should be taken to avoid contact or rubbing the applied skin with other people. Measurement of blood testosterone to evaluate treatment outcomes Efficacy: testosterone overcomes libido and stimulates erection, increases muscle mass, increases bone density Risks of Testosterone replacement therapy: Breast cancer, cancer prostate cancer, cardiovascular disease, decreased spermatogenesis.

*Other treatments:
Hypothalamic-pituitary hormone replacement: applied to patients with secondary hypogonadism who can be treated for infertility by injecting GnRH or hCG (placental sex hormone). Clomiphene citrate is a weak estrogen receptor antagonist (SERM) that can stimulate gonadotropin secretion in both men and women, competitively binding to estrogen receptors in the hypothalamus and pituitary, resulting in these sites signal estrogen deficiency and increased LH production, leading to increased endogenous Testosterone levels. *Prognosis and follow-up
Treatment must be for at least 3 months to be clinically effective. Normal testosterone levels with treatment improve symptoms as well as the appearance of male sexual characteristics. After the first year of treatment, you can see a significant increase in muscle mass and bone density. Usually by 24 months, men with osteoporosis will be able to achieve and maintain normal bone density. Increases in muscle mass, prostate volume, red blood cell count, energy as well as sexual function are usually achieved after treatment within the first 6 months Follow-up: Quantitative testosterone will help assess effectiveness treatment and should be checked approximately 1-2 months after initial treatment. Vinmec IVF Reproductive Center is the address of infertility treatment - infertility chosen by many couples. So far, the Center has performed fertility support for over 1000 infertile couples with a success rate of over 40%. This rate is equivalent to developed countries such as the UK, USA, Australia, etc. The center gathers a team of leading experts in the field of obstetrics and gynecology in the country and internationally, trained in leading centers. leading in the world such as in the US, Singapore, Japan, Australia and famous fertility centers in the world.
With a high level of expertise and extensive experience, Vinmec IVF Center's experts are capable of synchronously and comprehensively deploying the most advanced assisted reproductive techniques today, helping realize the dream of becoming a parent of hundreds of families across Vietnam.
>> See more: Male hypogonadism (reduced testosterone secretion) - A disease that is often forgotten - Written by resident doctor Trinh Ngoc Anh - Department of Internal Medicine - Vinmec Times City International Hospital

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