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Human Reproduction Update Advance Access originally published online on August 5, 2004
Human Reproduction Update 2004 10(5):409-419; doi:10.1093/humupd/dmh035
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Human Reproduction Update vol. 10 no. 5 © European Society of Human Reproduction and Embryology 2004; all rights reserved

Testosterone replacement therapy: current trends and future directions

E. Nieschlag1,9, H.M. Behre2, P. Bouchard3, J.J. Corrales4, T.H. Jones5, G.K. Stalla6, S.M. Webb7 and F.C.W. Wu8

1 Institute of Reproductive Medicine of the University Domagkstr 11, D-48129 Munster, 2 Andrology Unit, Department of Urology, Martin-Luther-University, Ernst-Grube-Strasse 40, D-06120 Halle, Germany, 3 Faculté de Médicine, 27 rue Chaligny, 75571 Paris Cedex 12, France, 4 Servicio de Endocrinología, Hospital Universitario, Paseo San Vicente n° 52, 37007-Salamanca, Spain, 5 Barnsley District General Hospital NHS Trust, Gawber Road, Barnsley, South Yorkshire, S75 2EP, UK, 6 Max-Planck-Institute of Psychiatry, Department of Endocrinology, Kraepelinstrasse 10, D-80804 Munich, Germany, 7 Servicio de Endocrinologia Hospital Sant Pau, Pare Claret 167, 08025-Barcelona, Spain and 8 Department of Endocrinology, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK

9 To whom correspondence should be addressed at: Institute of Reproductive Medicine, University of Münster, Domagkstrasse 11, D-48129 Münster, Germany. Email: nieschl{at}uni-muenster.de

Male hypogonadism is characterized by abnormally low serum testosterone levels associated with typical symptoms, including mood disturbance, sexual dysfunction, decreased muscle mass and strength, and decreased bone mineral density. By restoring serum testosterone levels to the normal range using testosterone replacement therapy, many of these symptoms can be relieved. For many years, injectable testosterone esters or surgically implanted testosterone pellets have been the preferred treatment for male hypogonadism. Recently, newer treatment modalities have been introduced, including transdermal patches and gels. The development of a mucoadhesive sustained-release buccal tablet is the latest innovation, which will provide patients with an additional option. The availability of new treatment modalities has helped to renew interest in the management of male hypogonadism, highlighting the need to address a number of important but previously neglected questions in testosterone replacement therapy. These include the risks and benefits of treatment in different patient populations (e.g. the elderly) and the need for evidence-based diagnosis and treatment monitoring guidelines. While some recommendations have been developed in individual countries, up-to-date, internationally accepted evidence-based guidelines that take into account national differences in clinical practice and healthcare delivery would optimize patient care universally.

Key words: male hypogonadism / testosterone replacement


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