Androgen therapy in hypogonadotrophic hypogonadism: time course of erotosexual functions

Endocrine withdrawal syndromes

Hypersecretion of endogenous hormones or chronic administration of high doses of the same hormones induces varying degrees of tolerance and dependence. Elimination of hormone hypersecretion or discontinuation of hormone therapy may result in a mixed picture of two syndromes: a typical hormone deficiency syndrome and a generic withdrawal syndrome. Thus, hormones with completely different physiological effects may produce similar withdrawal syndromes, with symptoms and signs reminiscent of those observed with drugs of abuse, suggesting shared mechanisms. This review postulates a unified endocrine withdrawal syndrome, with changes in the hypothalamic-pituitary-adrenal axis and the central opioid peptide, in which noradrenergic and dopaminergic systems of the brain act as common links in its pathogenesis. Long-term adaptations to hormones may involve relatively persistent changes in molecular switches, including common intracellular signaling systems, from membrane receptors to transcription factors. The goals of therapy are to ease withdrawal symptoms and to expedite weaning of the patient from the hormonal excess state. Clinicians should resort to the fundamentals of tapering hormones down over time, even in the case of abrupt removal of a hormone-producing tumor. In addition, the prevention of stress and concurrent administration of antidepressants may ameliorate symptoms and signs of an endocrine withdrawal syndrome.

Testosterone replacement therapy for male hypogonadism with a radiation-polymerized testicular prosthesis

BACKGROUND

The effect of an artificial testicular prosthesis on sexual disturbance in hypogonadal men was investigated.

METHODS

Twelve hypogonadal men were treated with testosterone replacement therapy delivered via radiation-polymerized testicular prostheses surgically implanted in their scrotums.

RESULTS

An average serum testosterone level of over 200 ng/dL was maintained for 48 months. Most patients treated with this prosthesis were satisfied with the improvement of their sexual activity. Moreover, the patients were psychologically more satisfied with the enlarged scrotum achieved with the implanted prosthesis.

CONCLUSION

We recommend this prosthesis as the first choice among testosterone-replacement therapies for hypogonadal men.