Testosterone Substitution: Current Modalities and Perspectives

Journal für Reproduktionsmedizin und Endokrinologie - Journal of Reproductive Medicine and Endocrinology 2006; 3 (2): 109-116

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Keywords: Androgenrezeptor,  Hypogonadismus,  Testosteron,  androgen deficiency,  androgen receptor,  hypogonadism,  testosterone substitution

The clinical picture of male hypogonadism is associated with typical symptoms, such as disturbances of mood and cognitive abilities as well as sexual functions; furtheron, a decrease in muscle mass and strength, an accumulation of body fat and osteopenia/osteoporosis are observed. There are indications that insulin sensitivity is mitigated in a state of androgen depletion. In older men, symptoms of androgen deficiency (late-onset hypogonadism) may exhibit a differential profile due to accompanying other chronic illnesses. Restoring serum testosterone levels by replacement therapy can markedly attenuate, if not relieve, the clinical picture of hypogonadism. Recently, new treatment modalities have been introduced, which include short-acting transdermal or buccal modalities as well as the long-acting depot preparation of testosterone undecanoate. This review summarises the pathways of diagnosis of male hypogonadism and discusses the various modern methods of initiation and surveillance of testosterone substitution therapy. Future perspectives regarding pharmacogenetic aspects are discussed.