This definition presents a challenging problem for patients without other medical problems but with symptoms of low testosterone (T) who do not meet the biochemical criteria for therapy. There are recent studies indicating agents that stimulate endogenous testosterone production (e.g., partial estrogen antagonists, aromatase inhibitors) in hypogonadal men who have secondary hypogonadism but with residual gonadotropin secretion. Long-term testosterone replacement studies showed no increase in lower urinary obstruction symptoms or prostate volume.
There are also reports that testosterone replacement therapy improves depression 77,78; however the studies are few and controversial. A number of studies have found that testosterone replacement therapy results in decreases in total cholesterol and LDL cholesterol 53,58,62. While the significant weight loss requires careful confirmation, randomized controlled trials showed that testosterone replacement therapy reduced body fat mass, regional fat distribution and waist circumference in hypogonadal men with and without obesity 48,53-61. Testosterone therapy has not been approved by the FDA for treatment of osteoporosis as there are no well-controlled data showing that testosterone replacement therapy reduces fracture rate. In pre-pubertal hypogonadal boys, testosterone replacement therapy will initiate puberty and induce development of secondary sexual characteristics. Direct immunoassay for free testosterone does not provide more information than total testosterone and the levels measured are much lower than free testosterone levels estimated by equilibrium dialysis and should not be used for the diagnosis of hypogonadism 24,25.
We evaluated changes in hormones (T, LH, FSH, and estradiol), HCT, HbA1c, and PSA before and after initiating hCG monotherapy. We retrospectively analyzed the charts of 28 men with previous exogenous T use who visited our urology clinic and were subsequently on hCG monotherapy for at least one month with follow-up labs. Patients were excluded if they were on other forms of T therapy (such as clomiphene, anastrozole, or T) concurrently with hCG or did not have a follow-up testosterone laboratory result after at least one month.
Exogenous T is not recommended for men interested in future fertility due to a high risk of developing azoospermia, and the AUA guidelines recommend hCG as an alternative. Pre- and post-hCG treatment laboratory results are displayed in Figure 1. Analyzed as an entire cohort ("All Patients") and by their status of baseline labs having been collected while a patient is on or off T The Student's t-test analysis was used to compare pre- and post-treatment values; statistical significance was set at p Men who were within the expected therapeutic time window of their respective T therapy for baseline labs when switching from T to hCG were categorized as baseline "On T" for the purpose of data analysis but were not excluded. We included males with previous exogenous T use (including intramuscular injections, nasal gels, transdermal gels, and subcutaneous pellets) who visited our urology clinic between August 2015 and October 2021.
Because of the presence of 5 α reductase enzyme in the gut and conversion of the administered TU to DHT TU, serum DHT to testosterone levels may be slightly higher than other testosterone preparations . All gel/lotion formulations are able to produce a steady serum testosterone concentration within the physiological range of adult men in most hypogonadal men. While not an issue in younger men, a potential disadvantage with TU is that testosterone levels cannot be reduced quickly if serum PSA levels begin to rise. In secondary hypogonadism, gonadotropin treatment may stimulate or reinitiate spermatogenesis and fertility. Guidelines recommend against starting therapy in adult patients with androgen dependent cancer, which includes prostate and male breast (very rare) cancer (Table 2). Testosterone replacement in hypogonadal men does not increase the risk of voiding symptoms of benign prostatic hyperplasia but may increase prostate size to that of eugonadal men . An increase in serum DHT even to very high levels for up to 2 years does not increase intraprostatic androgens, PSA and prostate volume 98-100.
Some doctors believe that using testosterone along with hCG may help improve symptoms of testosterone deficiency while preventing some of testosterone’s side effects. According to the American Urological Association, hCG is appropriate for those MAABs with testosterone deficiency who also desire to maintain fertility. Human chorionic gonadotropin (hCG) is sometimes called "the pregnancy hormone" because of its important role in maintaining pregnancy. Our convenient online consultations and direct-to-patient medication delivery make optimizing your hormone health easier than ever.