Therapeutic goals of t treatment
The therapeutic goals of T replacement therapy in male hypogonadism are to improve the clinical manifestations of androgen deficiency that vary with the stage of sexual development of the individual. Therefore, the specific goals of T treatment vary depending on whether the hypogonadal condition occurs in prepubertal boys or adults.
Males with prepubertal T deficiency usually present as adolescents or young adults with delayed puberty, manifesting varying degrees of eunuchoidism characterized by a small penis, a poorly developed scrotum, small testes (< 5 mL), and prostate, lack of male hair growth (facial, chest, axillary, pubic, perianal, and extremity hair), body habitus characterized by long arms and legs relative to height, poorly developed muscle mass, prepubertal fat distribution; reduced bone mass, high-pitched voice, poor libido (sexual interest and desire) and sexual function, reduced energy, mood alterations and lack of motivation, benign breast enlargement (gynecomastia), failure to produce an ejaculate (aspermia) and initiate spermatogenesis (azoospermia), and a relatively low hematocrit (in the female range).
Therefore, in boys with delayed puberty, the therapeutic goals of T treatment are to promote:
- the development of secondary sexual characteristics, including growth of the penis, the scrotum, and a male hair pattern;
- stimulate the acquisition of peak bone mass, long bone growth, and eventual closure of epiphyses [through the
- aromatization of T to estradiol (E2)] without compromising adult height;
- increase muscle mass and strength and reduce fat mass;
- induce laryngeal enlargement and deepening of the voice;
- stimulate libido and erections;
- improve energy, mood, and motivation;
- increase red-blood-cell production into the normal adult male range.
By stimulating accessory sex glands (seminal vesicles and prostate), T treatment stimulates seminal fluid production and an increase in ejaculate volume, but it does not stimulate sperm production sufficient for induction of fertility. Because the most common cause of delayed puberty is not pathological but rather constitutional, T therapy in boys with delayed puberty is usually intermittent and continued only until spontaneous puberty occurs.
Unless severe, T deficiency in adult males is usually more difficult to diagnose because the clinical manifestations are often subtle and attributable to other causes. T-deficient men usually present with poor sexual performance manifested by reduced libido and erectile dysfunction – viagra in canada (ED) as their major complaints, although T deficiency is not the primary etiology in the majority of men with ED.
- They may also manifest gynecomastia;
- infertility due to impaired sperm production;
- diminished chest, axillary, and pubic hair;
- decreased muscle bulk and strength;
- low BMD that may result in osteopenia or osteoporosis;
- low energy and motivation;
- irritability and a depressed mood;
- a mild hypoproliferative anemia in the normal female range – female viagra australian.
Testis size is usually normal but may be small (< 15 mL) in men with profound reductions in sperm production. Hot flushes may occur in men with a rapid onset of severe androgen deficiency.