Basic HTML Version
© The Canadian Journal of Urology™; 18(Supplement 1); April 2011
hypothalamic-pituitary axis, where low levels promote
pituitary secretion of follicle stimulating hormone (FSH)
and luteinizing hormone (LH) thereby stimulating
testosterone synthesis. Total serumlevels of testosterone
exist in three types: unbound (free and active, 2%),
bound to sex hormone binding globulin (inactive,
30%), and the rest bound to albumin (bioavailable).
32
Levels begin to gradually decline by the end of the
third decade of life. The rate of decline has been found
to be approximately 10% per decade after the age of
40.
33
Therefore, aging males are subject to a variety of
symptoms associated with low levels of testosterone.
The diagnosis of male hypogonadism requires the
presence of both clinical symptoms and documented
biochemical evidence of low serum testosterone.
Pat ient symptoms of hypogonadism include
ED, diminished libido, depressed mood, fatigue,
anemia, and osteoporosis. Laboratory examination
should be drawn with a morning total testosterone.
Hypogonadism can be divided into two categories,
primary or secondary depending on the etiology.
Primary hypogonadism(congenital or acquired) occurs
as a result of testicular failure to produce testosterone
secondary to conditions such as cryptorchidism,
bilateral testicular torsion, orchitis, vanishing testis
syndrome, orchiectomy, Klinefelter ’s syndrome,
chemotherapy, or toxic damage from alcohol or heavy
metals. Laboratory findings in these men include low
serum testosterone concentrations with FSH and LH
levels above the normal range. Secondary causes of
hypogonadism are due to insufficient FSH and LH
production by the pituitary gland. Hypogonadotropic
hypogonadism (congenital or acquired) can be the
result of idiopathic gonadotropin or luteinizing
30
TABLE 6.
Testosterone replacement therapy (TRT) for male hypogonadism
Name (Brand)
Route
Dose
Notes*
Testosterone
Buccal
30-mg buccal tablets BID
Apply to gum over incisor;
(Striant [US, not Canada])
tablets
do not chew or swallow
Testosterone cypionate
IM injection 200 mg-400 mg every 3-4 weeks
(Depo-Testosterone)
(100 mg-150 mg every 2 weeks
preferred)
Testosterone enanthate
IM injection 100 mg-400 mg every 4 weeks
(Delatestryl)
(100 mg-150 mg every 2 weeks
preferred)
Testosterone gel
Topical
5 g-10 g daily (max)
Apply to clean dry shoulder
(AndroGel 1%)
area, upper arm, or abdomen
Testosterone gel
Topical
5 g-10 g daily (max)
Apply to clean dry area on
(Testim 1%)
shoulder or upper arm
Testosterone gel
Topical
10 mg-70 mg daily (max)
Apply to inner thigh area only
(Fortesta [US, not Canada])
Testosterone topical solution Topical
30 mg-120 mg daily (max)
Apply once daily to axillary
(Axiron, [US, not Canada])
region
Testosterone patch
Transdermal 2.5 mg-7.5 mg daily
Apply to clean dry area on
(Androderm)
back or arm; rotate site; remove
for MRI as patch contains metal
Testosterone implant
Implantable 150 mg-450 mg SC implant
Implant in upper buttock under
(Testopel)
pellets
every 3-6 months
local anesthesia
[US, not Canada]
75 mg/each 2 pellets for each 25 mg
testosterone required weekly
Testosterone undecanoate
Oral
40 mg-160 mg daily,
Take with food
(Andriol)[Canada, not US]
Divided in two doses
Testosterone undecanoate
IM injection 1000 mg every 6-12 weeks
(Nebido) [US, not Canada]
*Monitor levels of serum testosterone for all agents.
LIU ET AL.