Testosterone deficiency, called hypogonadism, is categorized as primary, secondary, or combined. Many causative conditions, like obesity and chronic alcoholism, are reversible, however. According to a recent study, over 2.4 million men aged 40 to 69 years have some type of hypogonadism, with a prevalence rate of 25%. There are many forms of testosterone drugs, used to treat testosterone deficiency (Seminara et al. 2000).
What is Testosterone?
Testosterone is a sex hormone produced in the testicles and ovaries. The adrenal system also produces minute amounts. For men, testosterone is necessary for bone growth and development, reproduction, voice deepening, facial and body hair, and normal system function. The FDA regulates testosterone drugs as category X, meaning they can lead to serious birth defects in unborn babies (Drugs.com, 2013).
List of Testosterone Drugs
- Androderm Transdermal â€“ This is a topical patch that stays on for 24 hours.
- Testopel Pellet â€“ These are small pellets that are implanted in the skin.
- Testosterone Cypionate â€“ This is an oil-based injectable solution.
- Depo-Testosterone â€“ This is an injection available in 100 and 200 mg/mL.
- Testosterone Enanthate â€“ This is another oil-based solution for injection.
- Delatestryl â€“ This is a 200 mg/mL injectable solution.
- AndroGel â€“ This is a topical gel that goes on the skin.
- Foretesta â€“ This transdermal gel comes in 10mg/0.5g.
- Testim â€“ A 1% gel that is applied topically.
- Testosterone Buccal â€“ This is an oral gel.
- Striant â€“ This is a mucoadhesive buccal preparation.
- Axiron â€“ This is a 30mg transdermal solution.
- Viafen â€“ This is an herbal natural testosterone supplement.
Pharmacology of Testosterone Drugs
The various forms of testosterone all work the same way. They promote both the growth and formation of the male reproductive organs, increase protein anabolism, and maintain secondary sex characteristics. The transdermal patches work over an eight to twenty-four hour period. The buccal applications work over a ten to twelve hour span, and the injectable forms are absorbed slowly (Drugs.com, 2013).
Symptoms of Testosterone Deficiency
The symptoms and signs of testosterone deficiency vary, but most men have loss of libido, low energy, decreased muscle mass, loss of body hair, and depression. Because these clinical manifestations are subtle, they are often ignored and undertreated by physicians. The low levels of this androgen result from a gradual desensitization and number of Leydig cells, necessary for luteinizing hormone (LH) secretion. LH signals the brain and testes to produce testosterone. Additionally, other hormones levels decline with age, including dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS) (Carey, 1998; Snyder, 1980).
Forms of Hypogonadism
The most common form of hypergonadotropic hypogonadism in men is Klinefelter syndrome, with an incidence of 1 in 1,000 of the population affected. For prepubertal boys with hypogonadism, hormonal replacement therapy is necessary to stimulate testicular growth and confer fertility. Those with hypogonadotropic hypogonadism are often treated with pulsatile luteinizing hormone releasing hormone (LHRH) or human gonadotropin (hCG), both which encourage testicular growth. To induce fertility, physicians sometimes give follicle stimulating hormone (FSH) along with these two treatments. For males with the hypergonadotropic form of this condition, fertility is not achievable (Viswanathan & Eugster, 2009).
Researchers find Testosterone Replacement Treats Depression
Testosterone deficiency was found to create depression symptoms in many men, according to researchers Carrier and Kabbaj (2012). They studied the specific pathway in the brain that regulated stress responses and memory formation. This area, the hippocampus, plays a key role in mediating the effects of testosterone. Women have more depression than men, but men with low testosterone suffer with both anxiety and depression. Additionally, the scientists found that testosterone booster therapy helped enhance mood. They used rat subjects who were neutered in an experiment. They gave some of the rat subjects testosterone replacement. After careful evaluation, they found that the male rats who received this replacement had beneficial effects. However, the female rats did not show improvement.
Testosterone deficiency affects millions of men in the U.S. There are many testosterone replacement options for those with hypogonadism and deficiency of this androgen. The biggest obstacles in treatment for testosterone deficiency remains to be awareness of the problem, and in the case of many young men, actually persuading them to seek treatment can be an enormous task. Treatment, once sought, is simple and effective.
Carey PO, Howards SS, Vance ML. Transdermal testosterone treatment of hypogonadal men.Â J Urol. Jul 1988;140(1):76-9.
Carrier N & Kabbaj RÂ Extracellular Signal-Regulated Kinase 2 Signaling in the Hippocampal Dentate Gyrus Mediates the Antidepressant Effects of Testosterone.Â Biological Psychiatry, 2012; 71 (7): 642 DOI:10.1016/j.biopsych.2011.11.028
Drugs.com (2013). Testosterone. Retrieved from:Â http://www.drugs.com/ppa/testosterone.html
Seminara SB, Oliveira LM, Beranova M, et al. Genetics of hypogonadotropic hypogonadism.Â J Endocrinol Invest. Oct 2000;23(9):560-5.
Snyder PJ, Lawrence DA. Treatment of male hypogonadism with testosterone enanthate.Â J Clin Endocrinol Metab. Dec 1980;51(6):1335-9.Â [Medline].
Viswanathan V, Eugster EA. Etiology and treatment of hypogonadism in adolescents.Â Endocrinol Metab Clin North Am. Dec 2009;38(4):719-38.