Introduction

Androgen Replacement Therapy

Androgen replacement therapy is essential for the management of male hypogonadism, in which deficient testicular production of testosterone has clinical consequences including fatigability, flushing, sexual dysfunction, diminished muscle strength, osteoporosis and anaemia.

Male hypogonadism is most frequently due to primary testicular disease e.g. Klinefelter’s syndrome, but may result from diminished hypothalamic - pituitary function, leading to various forms of hypogonadotrophic hypogonadism. Male hypogonadism is estimated to have a prevalence of 5 per 1000 men (Handelsman DJ, 2001 in De Groot's Textbook), making it the commonest form of hormonal deficiency in men.

Physiological androgen replacement aims to restore circulating testosterone concentration to normal in men with hypogonadism. The use of testosterone in the management in ageing men without specific causes of hypogonadism, commonly referred to as ADAM (the Androgen Deficient Aging Male), is one of the most rapidly expanding area of medical practice.