androgen replacement therapy
androgen replacement therapy
The administration of androgens (e.g., testosterone or its congeners) in men with hypogonadal androgen-deficiency, which may be primary or secondary and either congenital or acquired. The intent of ART is to restore normal physiologic effects of testosterone, which depend on the stage of sexual development.In androgen-deficient boys, the goal of ART is to initiate and maintain androgen-dependent activities, including somatic development (e.g., development of skeletal muscle and increased strength, long bone growth, redistribution of body fat and erythropoiesis), sexual behaviour (increased libido and potency) and development of 2º sexual characteristics (e.g., male pattern of hair growth, penile and scrotal enlargement, laryngeal enlargement and thickening of the vocal cords, and deepening of the voice).
Androgen replacement therapies
Oral
Pros
Convenience.
Cons
The oral testosterones available in the US are methyl testosterone and fluoxymesterone; both are nonphysiological, 17-alkylated molecules with hepatotoxic potential.
Transdermal
Pros
Well-absorbed physiologic testosterone.
Cons
Inconvenience of shaving scrotal skin; impregnation of patches with absorption enhancers, such as alcohol, allows their application to nongenital skin, but causes local irritation in up to 53% of patients.
Injectable
Pros
Absorbed physiologic testosterone.
Cons
Painful.
Sublingual AndroTest-SL®
Pros
Convenience; physiologic testosterone.
Cons
None.