AB04. Novel approaches for testosterone replacement therapy

Surging interest in addressing male hypogonadism in recent years has resulted in the identification and development of novel pharmacotherapeutic approaches that may yield increased serum testosterone levels. Testosterone replacement therapy is controversial with concerns surrounding its proper indications and potential side effects. However, interest remains strong to explore treatment options that may address the signs and symptoms of male hypogonadism. Several testosterone preparations are commercially available at this time, and these encompass assorted routes of delivery with specific generic names and dosage recommendations. Routes of delivery include oral, intramuscular, subcutaneous, transdermal and buccal preparations. The routes of administration confer various advantages and disadvantages with respect to efficacy, physiologic levels, duration of effect, ease of administration, and cost. Besides testosterone formulations, alternative options are in development or are used in an off-label mode such as selective androgen receptor modulators (SARMS), selective estrogen receptor modulators (SERMS; clomiphene citrate, enclomiphene), aromatase inhibitors, dihydrotestosterone and human chorionic gonadotropin. These alternatives are hoped to reduce side effects believed to be associated with exogenous testosterone therapy and may be particularly advantageous in the young male with primary hypogonadism whose interest is to preserve normal spermatogenesis (which may be impaired by feedback control mechanisms resulting from exogenous testosterone therapy). Ongoing investigation may reveal select roles for these therapies in the management of male hypogonadism.