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Treatment
Treatment involves hormone replacement therapy. The method of delivery is determined by age and duration of deficiency.
Treatment for adults is aimed at maintaining secondary sex characteristics, improving energy, strength, mood, and feelings of well-being, and preventing bone degeneration. Modes of delivery include transdermal, injection, and oral.
Transdermal delivery (through the skin) is used to administer therapeutic agents for hormone replacement. Transdermal replacement therapy with a testosterone patch is becoming the most common method of treatment for testosterone deficiency in adults. It establishes and maintains adequate serum levels without causing significant side effects in as many as 92% of men treated. A patch is worn, either on the scrotum or elsewhere on the body, and testosterone is released through the skin at controlled intervals. Patches, like Testoderm® (scrotal) or Androderm® (nonscrotal), are typically worn for 12 or 24 hours and can be worn during exercise, bathing, and strenuous activity. The Androderm® patch is applied to the abdomen, lower back, thigh, or upper arm.
The most common side effects associated with transdermal patch therapy include itching, discomfort, and irritation at the site of application. Some men may experience fluid retention, acne, and temporary gynecosmastia.
Androgel® is a transdermal gel that is applied once daily to the clean dry skin of the upper arms or abdomen. It delivers testosterone for 24 hours when used properly. The gel must be allowed to dry on the skin before dressing and must be applied at least 6 hours before showering or swimming. It cannot be applied to the genitals. Side effects may include adverse reaction at the site of application, acne, headache, and alopecia (hair loss).
Kallmann syndrome in adults may be treated with chorionic gonadotropin, which can cure cryptorchidism and infertility.
Instramuscular injection is used less frequently because it is associated with erratic testosterone levels. Levels that get too high and then drop too low before the next dose may cause fluctuating moods, energy levels, and libido.
Children and adolescents with low testosterone and delayed puberty may be treated with low doses of testosterone through intramuscular injection (IM) to induce puberty. Adolescents may receive gradually increasing doses that last longer in the body, because, with age, there is less risk for affecting normal growth patterns.
Oral testosterone (methyltestosterone, Testred®) is prescribed sparingly, because it is associated with liver toxicity and liver tumors.
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