Treatment for male hypogonadism depends on the cause and if you're concerned about fertility.
For hypogonadism caused by testicular failure, doctors use male hormone replacement (testosterone replacement therapy, or TRT). Although there's often no effective treatment to restore fertility in a man with primary hypogonadism, assisted reproductive technology (ART) may be helpful. ART covers a variety of techniques designed to help couples who have been unsuccessful achieve conception.
If a pituitary problem is the cause, pituitary hormones may succeed in stimulating sperm production and restoring fertility. Testosterone replacement therapy (TRT) can be used if fertility is not an issue. A pituitary tumor may require surgical removal, medication or the replacement of other hormones.
In boys, TRT can stimulate puberty and the development of secondary sex characteristics, such as increased muscle mass, beard and pubic hair growth, and growth of the penis. Pituitary hormones may be used to stimulate testicle growth. An initial low dose of testosterone with gradual increases may help to avoid adverse psychological effects.
In adult men, TRT can restore sexual function and muscle strength and prevent bone loss. In addition, men receiving TRT often experience an increase in energy, sex drive and well-being. Some anti-aging enthusiasts claim that increasing the level of testosterone in older men improves energy, well-being and sex drive, but such claims remain unproved. High doses of testosterone may result in prostate problems, elevated cholesterol and infertility. The long-term benefits or risks of TRT in healthy older men are unclear.
Several testosterone delivery methods exist. Choosing a specific therapy depends on your preference of a particular delivery system, the side effects and the cost.
Injection
Intramuscular testosterone injections are safe and effective. Injections are given approximately every 2 weeks. You may experience fluctuations in symptom relief between doses. You or a family member can learn to administer this method of TRT at home. If you're uncomfortable doing this, a nurse or doctor can give the injection.
Testosterone Gel
You rub testosterone gel (AndroGel, Testim) into your skin on your lower abdomen, upper arm or shoulder. As the gel dries, your body absorbs testosterone through your skin. Avoid showering or bathing for several hours after an application to ensure adequate absorption. A potential side effect of the gel is the possibility of transferring the medication to your partner. You can avoid this by waiting approximately 5 hours after an application or covering the area before having skin-to-skin contact.
Testosterone Patch
Men also have the option of using a testosterone patch to receive their hormone in two different application modes.
The scrotal patch (testoderm): Thin scrotal skin is much more permeable to testosterone absorption than other skin sites. You apply this patch in the morning and remove it before bathing or sexual intercourse. Itching and skin irritation can occur, but they're usually mild and diminish with continued use.
Nonscrotal patch (Androderm) This patch is applied each night to your back, abdomen, upper arm or thigh. The site of the application is rotated to maintain 7-day intervals between applications to the same site. Up to 50 percent of men experience some skin reaction to this product, with approximately 7 percent having a severe reaction.
