Androgen deficiency

Androgen deficiency
Androgen deficiency
Other names	Hypoandrogenism, androgen deficiency syndrome, men with hypogonadism[1]

Androgen deficiency is a medical condition characterized by insufficient androgenic activity in the body. Androgenic activity is mediated by androgens (a class of steroid hormones with varying affinities for the androgen receptor), and is dependent on various factors including androgen receptor abundance, sensitivity and function.

Signs and symptoms

Symptoms of the condition in males consist of loss of libido, impotence, infertility, shrinkage of the testicles, penis, and prostate, diminished masculinization (e.g., decreased facial and body hair growth), low muscle mass, anxiety, depression, fatigue, vasomotor symptoms (hot flashes), insomnia, headaches, cardiomyopathy and osteoporosis. In addition, symptoms of hyperestrogenism, such as gynecomastia and feminization, may be concurrently present in males.

In females, hypoandrogenism consist of loss of libido, decreased body hair growth, depression, fatigue, vaginal vasocongestion (which can result in cramps), vasomotor symptoms (e.g., hot flashes and palpitations), insomnia, headaches, osteoporosis and reduced muscle mass.[2][3][4] As estrogens are synthesized from androgens, symptoms of hypoestrogenism may be present in both sexes in cases of severe androgen deficiency.

Causes

Hypoandrogenism is primarily caused by either dysfunction, failure, or absence of the gonads (hypergonadotropic) or impairment of the hypothalamus or pituitary gland (hypogonadotropic). This in turn can be caused by a multitude of different stimuli, including genetic conditions (e.g., GnRH/gonadotropin insensitivity and enzymatic defects of steroidogenesis), tumors, trauma, surgery, autoimmunity, radiation, infections, toxins, drugs, and many others. It may also be the result of conditions such as androgen insensitivity syndrome or hyperestrogenism. Old age may also be a factor in the development of hypoandrogenism, as androgen levels decline with age.

Diagnosis

Diagnosis of androgenic deficiency in males is based on symptoms together with at least two measurements of testosterone done first thing in the morning after a period of not eating.[1] In those without symptoms, testing is not generally recommended.[1] Androgen deficiency is not usually checked for diagnosis in healthy women.[5]

Treatment

Treatment may consist of hormone replacement therapy with androgens in those with symptoms.[1] Treatment mostly improves sexual function in males.[1]

Gonadotropin-releasing hormone (GnRH)/GnRH agonists or gonadotropins may be given (in the case of hypogonadotropic hypoandrogenism). The Food and Drug Administration (FDA) stated in 2015 that neither the benefits nor the safety of testosterone have been established for low testosterone levels due to aging.[6] The FDA has required that testosterone pharmaceutical labels include warning information about the possibility of an increased risk of heart attacks and stroke.[6]

Androgen replacement therapy formulations and dosages used in men
Route	Medication	Major brand names	Form	Dosage
Oral	Testosterone^a	–	Tablet	400–800 mg/day (in divided doses)
	Testosterone undecanoate	Andriol, Jatenzo	Capsule	40–80 mg/2–4x day (with meals)
	Methyltestosterone^b	Android, Metandren, Testred	Tablet	10–50 mg/day
	Fluoxymesterone^b	Halotestin, Ora-Testryl, Ultandren	Tablet	5–20 mg/day
	Metandienone^b	Dianabol	Tablet	5–15 mg/day
	Mesterolone^b	Proviron	Tablet	25–150 mg/day
Sublingual	Testosterone^b	Testoral	Tablet	5–10 mg 1–4x/day
Sublingual	Methyltestosterone^b	Metandren, Oreton Methyl	Tablet	10–30 mg/day
Buccal	Testosterone	Striant	Tablet	30 mg 2x/day
Buccal	Methyltestosterone^b	Metandren, Oreton Methyl	Tablet	5–25 mg/day
Transdermal	Testosterone	AndroGel, Testim, TestoGel	Gel	25–125 mg/day
		Androderm, AndroPatch, TestoPatch	Non-scrotal patch	2.5–15 mg/day
		Testoderm	Scrotal patch	4–6 mg/day
		Axiron	Axillary solution	30–120 mg/day
	Androstanolone (DHT)	Andractim	Gel	100–250 mg/day
Rectal	Testosterone	Rektandron, Testosteron^b	Suppository	40 mg 2–3x/day
Injection (IM or SC)	Testosterone	Andronaq, Sterotate, Virosterone	Aqueous suspension	10–50 mg 2–3x/week
	Testosterone propionate^b	Testoviron	Oil solution	10–50 mg 2–3x/week
	Testosterone enanthate	Delatestryl	Oil solution	50–250 mg 1x/1–4 weeks
	Testosterone enanthate	Xyosted	Auto-injector	50–100 mg 1x/week
	Testosterone cypionate	Depo-Testosterone	Oil solution	50–250 mg 1x/1–4 weeks
	Testosterone isobutyrate	Agovirin Depot	Aqueous suspension	50–100 mg 1x/1–2 weeks
	Testosterone phenylacetate^b	Perandren, Androject	Oil solution	50–200 mg 1x/3–5 weeks
	Mixed testosterone esters	Sustanon 100, Sustanon 250	Oil solution	50–250 mg 1x/2–4 weeks
	Testosterone undecanoate	Aveed, Nebido	Oil solution	750–1,000 mg 1x/10–14 weeks
	Testosterone buciclate^a	–	Aqueous suspension	600–1,000 mg 1x/12–20 weeks
Implant	Testosterone	Testopel	Pellet	150–1,200 mg/3–6 months
Notes: Men produce about 3 to 11 mg testosterone per day (mean 7 mg/day in young men). Footnotes: ^a = Never marketed. ^b = No longer used and/or no longer marketed. Sources: See template.

References

Bhasin, S; Brito, JP; Cunningham, GR; Hayes, FJ; Hodis, HN; Matsumoto, AM; Snyder, PJ; Swerdloff, RS; Wu, FC; Yialamas, MA (1 May 2018). "Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline". The Journal of Clinical Endocrinology and Metabolism. 103 (5): 1715–1744. doi:10.1210/jc.2018-00229. PMID 29562364.
Jakiel G, Baran A (2005). "[Androgen deficiency in women]". Endokrynologia Polska (in Polish). 56 (6): 1016–20. PMID 16821229.
Bachmann GA (April 2002). "The hypoandrogenic woman: pathophysiologic overview". Fertility and Sterility. 77 Suppl 4: S72–6. doi:10.1016/S0015-0282(02)03003-0. PMID 12007907.
Bremner WJ (27 May 2003). Androgens in Health and Disease. Humana Press. pp. 365–379. ISBN 978-1-58829-029-8. Retrieved 11 June 2012.
Wierman ME, Arlt W, Basson R, Davis SR, Miller KK, Murad MH, Rosner W, Santoro N (October 2014). "Androgen therapy in women: a reappraisal: an Endocrine Society clinical practice guideline". The Journal of Clinical Endocrinology and Metabolism. 99 (10): 3489–510. doi:10.1210/jc.2014-2260. PMID 25279570.
Staff (3 March 2015). "Testosterone Products: Drug Safety Communication - FDA Cautions About Using Testosterone Products for Low Testosterone Due to Aging; Requires Labeling Change to Inform of Possible Increased Risk of Heart Attack And Stroke". FDA. Retrieved 5 March 2015.

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[Bha2018-1] Bhasin, S; Brito, JP; Cunningham, GR; Hayes, FJ; Hodis, HN; Matsumoto, AM; Snyder, PJ; Swerdloff, RS; Wu, FC; Yialamas, MA (1 May 2018). "Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline". The Journal of Clinical Endocrinology and Metabolism. 103 (5): 1715–1744. doi:10.1210/jc.2018-00229. PMID 29562364.

[pmid16821229-2] Jakiel G, Baran A (2005). "[Androgen deficiency in women]". Endokrynologia Polska (in Polish). 56 (6): 1016–20. PMID 16821229.

[pmid12007907-3] Bachmann GA (April 2002). "The hypoandrogenic woman: pathophysiologic overview". Fertility and Sterility. 77 Suppl 4: S72–6. doi:10.1016/S0015-0282(02)03003-0. PMID 12007907.

[Bremner2003-4] Bremner WJ (27 May 2003). Androgens in Health and Disease. Humana Press. pp. 365–379. ISBN 978-1-58829-029-8. Retrieved 11 June 2012.

[Women2014-5] Wierman ME, Arlt W, Basson R, Davis SR, Miller KK, Murad MH, Rosner W, Santoro N (October 2014). "Androgen therapy in women: a reappraisal: an Endocrine Society clinical practice guideline". The Journal of Clinical Endocrinology and Metabolism. 99 (10): 3489–510. doi:10.1210/jc.2014-2260. PMID 25279570.

[FDA2015-6] Staff (3 March 2015). "Testosterone Products: Drug Safety Communication - FDA Cautions About Using Testosterone Products for Low Testosterone Due to Aging; Requires Labeling Change to Inform of Possible Increased Risk of Heart Attack And Stroke". FDA. Retrieved 5 March 2015.