In this special issue of IJIR: Your Sexual Medicine Journal, topics covered include advancements in the evaluation and treatment of Testosterone Deficiency (TD). TD, formerly male hypogonadism, is defined as low serum testosterone combined with symptoms such as reduced libido, fatigue, obesity, depression, loss of bone density and muscle mass . Causes of TD range from issues arising either from the testes themselves (primary hypogonadism) or the hypothalamic-pituitary axis (secondary hypogonadism) .
In their retrospective analysis, Gurayah et al. explores the relationship between secondary TD and elevated body mass index (BMI) . They found that obese men and underweight men had higher incidence of TD compared with men with normal BMI. The authors suggested routine screening and individualized approach to patients suffering from secondary TD.
One treatment for TD is testosterone replacement or testosterone therapy (TTh) and guidelines for therapy are relatively recent . Rostom et al. dives into detail on the history of TTh and how our current guidelines were formed . Even with the current guidelines, there is still evolution regarding optimal dosing for the various formulations. El-Khatib et al. conducted a study to compare two regimens of intramuscular testosterone one of the most used formulations . There is constant change of available formulations and alternatives to maximize patient satisfaction and minimize side effects . The introduction and description of a novel oral TTh, Jatenzo® produced by Clarus Therapeutics (USA) and approved by the FDA in 2019 is covered by Patel et al. . Jatenzo®’s effectiveness combined with its ease of administration has the potential to completely shift the TTh paradigm. Alternative treatments to TTh are also being explored with the investigation of Selective Androgen Receptor Modulators (SARMs) by Efimenko et al. . The rationale is their ability to achieve many of the anabolic effects sought after with TTh while avoiding many of the side effects.
TTh has already been shown to have great benefit for those who suffer from TD . However, there are multiple fronts on which improvements can be made from varying dosages to different routes of administration and alternatives to testosterone itself. This special issue covering TTh updates will hopefully serve as a calibration to motivate further research to optimize therapy.
Mulhall JP, Trost LW, Brannigan RE, Kurtz EG, Redmon JB, Chiles KA, et al. Evaluation and management of testosterone deficiency: AUA Guideline. J Urol. 2018;200:423–32. https://doi.org/10.1016/j.juro.2018.03.115. Epub 2018/03/31PubMed PMID: 29601923
Basaria S. Male hypogonadism. Lancet. 2014;383:1250–63. https://doi.org/10.1016/S0140-6736(13)61126-5. Epub 2013/10/15PubMed PMID: 24119423
Gurayah AA, Mason MM, Masterson JM, Kargi AY, Ramasamy R. U-shaped association between prevalence of secondary hypogonadism and body mass index: a retrospective analysis of men with testosterone deficiency. Int J Impot Res. 2022. Epub 2022/02/05. https://doi.org/10.1038/s41443-022-00533-z. PubMed PMID: 35115681.
Rostom M, Ramasamy R, Kohn TP History of testosterone therapy through the ages. Int J Impot Res. 2022. Epub 2022/01/26. https://doi.org/10.1038/s41443-021-00493-w. PubMed PMID: 35075296.
El-Khatib FM, Huynh LM, Kopelevich A, Osman MM, Choi E, Nguyen JT, et al. Comparative assessment of outcomes and adverse effects using two different intramuscular testosterone therapy regimens: 100 mg IM weekly or 200 mg IM biweekly. Int J Impot Res. 2021. Epub 2021/07/15. https://doi.org/10.1038/s41443-021-00449-0. PubMed PMID: 34257404.
Kresch E, Patel M, Lima TFN, Ramasamy R. An update on the available and emerging pharmacotherapy for adults with testosterone deficiency available in the USA. Expert Opin Pharmacother. 2021;22:1761–71. https://doi.org/10.1080/14656566.2021.1918101. Epub 2021/04/20PubMed PMID: 33866902
Patel M, Muthigi A, Ramasamy R. JATENZO(R): Challenges in the development of oral testosterone. Int J Impot Res. 2021. https://doi.org/10.1038/s41443-021-00461-4. Epub 2021/08/07PubMed PMID: 34354245
Efimenko IV, Valancy D, Dubin JM, Ramasamy R. Adverse effects and potential benefits among selective androgen receptor modulators users: a cross-sectional survey. Int J Impot Res. 2021. https://doi.org/10.1038/s41443-021-00465-0. Epub 2021/09/03PubMed PMID: 34471228
As P, Nn T, Ka O, Jc H. Benefits and consequences of testosterone replacement therapy: a review. Eur Endocrinol. 2013;9:59–64. https://doi.org/10.17925/EE.2013.09.01.59. Epub 2013/03/01PubMed PMID: 30349612; PubMed Central PMCID: PMCPMC6193518
The authors did not receive compensation and declare that the article was written in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Kresch, E., Patel, P. & Ramasamy, R. Advancements in the evaluation and treatment for Testosterone Deficiency. Int J Impot Res 34, 621–622 (2022). https://doi.org/10.1038/s41443-022-00570-8