Treatment for Late Onset Hypogonadism
Andriol (Testosterone undecanoate 40 mg) cap at 120mg-160mg is give for the initial 2-3 weeks, and then maintained at 40mg-120 mg per day. Results of therapy may be observed as early as after the first week. Other forms of alkylated androgen preparations such as 17a-methyl testosterone may cause liver toxicity and should no longer be prescribed.
Oral testosterone replacement
Testosterone replacement is the mainstay treatment for LOH. A clear indication based on a clinical picture together with biochemical evidence of low serum testosterone should exist prior to the initiation of testosterone replacement. The serum levels to be achieved over the 24 hours of the day must come close to normal reference values.
Presently, oral, injectable, transdermal and implant forms of testosterone replacement are available in Singapore.
Injectable testosterone is administered by intra muscular injections. Depo-testosterone
(Testosterone cypionate) 200mg is given every 2-4 weeks while Sustanon 250 inj (comprising of a mixture of Testosterone propionate 30mg,T. phenylpropionate 60mg,T. isocaproate 60mg, T. decanoate 100mg) is given every 3 weeks. Nebido (Testosterone
Undecanoate 1000mg) is a newer form of injectable which only requires 3 monthly injection.
Injectable testosterone replacement
Androgel 25,50 mg (Testosterone 1% gel) is applied once a day over the skin. The exact amount of testosterone delivered is less predictable due to the variable absorption from the skin.
Transdermal testosterone replacement
Testosterone implants of between 100mg to 600mg can be placed under the skin of the arm or abdomen. These implants can deliver testosterone in a steady manner for upto 6 months. However, the placement of the implant requires a minor surgical incision under local anaesthesia.
Careful, regular monitoring is necessary at 3-6 month intervals for the first year and at 6-12 month intervals thereafter. The urologist would assess for clinical response, a digital rectal examination, blood tests for testosterone, hemoglobin, hematocrit, and prostate specific antigen (PSA) and lipid profile.Monitoring should be tailored to the indications for the initiation of treatment, and to the individual needs of the patient. If the indication for ART is osteoporosis, then serial Bone Mineral Density determinations at 2-yearly intervals can be used to monitor response to therapy.For patients receiving injections, a serum testosterone level should be measured at the midpoint between injections to ensure that the value is near the middle of the normal range.
Monitoring and follow-up
Men's Health Services
Updated 8 Aug 08
S H HO UROLOGY AND LAPAROSCOPY CENTRE