15th April 2024

Management

The two most common indications for testosterone replacement in those with low serum testosterone levels

• Treatment of hypogonadism with reduced testosterone levels in men with a significant physiological interruption of the HPG axis, for example, after a hypophysectomy or in those with atrophic or absent testicles
• Patients with low testosterone levels presenting with symptoms of low testosterone regardless of their age

Contraindications to testosterone replacement include:

• Unevaluated prostatic nodule/induration
• Breast cancer
• History of prostatic cancer
• Prostatic-specific antigen above 4ng/ml
• Severe lower urinary tract symptoms (LUTS) along with benign hyperplastic hyperplasia

Furthermore, testosterone therapy can lead to a reduction in spermatogenesis, if a man is planning a pregnancy testosterone therapy should not be given.

Pharmacological management

There are various formulations of testosterone which can be given to patients. These include oral, buccal, transdermal, subcutaneous and IM formulations. Oral formulations are easier to use than others, however, the (17-alpa-alkylated derivates) are associated with a risk of hepatotoxicity.

Adverse effects of testosterone therapy

Side effects of testosterone therapy include:

• Gynaecomastia
• Hepatotoxicity (with oral formulations)
• Impaired sperm production/fertility
• Raised RBC count
• Acne
• Oedema