title: The pharmacotherapy of male hypogonadism besides androgens.
abstract: BACKGROUND
  Adulthood male hypogonadism (HG) is the most common form of HG. Although testosterone (T) replacement therapy (TRT) is the most common way of treating HG, other options are available depending on patient's needs and expectations.
  
  
  METHODS
  We analyze alternative options to TRT as a medical intervention in treating HG. Gonadotropin (Gn) therapy is the treatment of choice in men with secondary HG (sHG), who require fertility. Gonadotropin-releasing hormone therapy represents an alternative to Gn for inducing spermatogenesis in patients with sHG, however, its use is limited by the poor patient compliance and high cost. In obese HG men, lifestyle modifications and, in particular, weight loss should be the first step. Recent data suggest that antiestrogens represent a successful treatment for sHG. Other potential therapeutic options include the stimulation of hypothalamic activity (i.e., kisspeptin and neurokinin-B agonists). Conversely, the possibility of increasing Leydig cell steroid production, independently from Gn stimulation, seems unreliable.
  
  
  CONCLUSIONS
  Understanding the nature of male HG and patient's needs are mandatory before choosing among treatment options. For primary HG only TRT is advisable, whereas for the secondary form several alternative possibilities can be offered.
authors.affiliation: University of Florence, Maggiore-Bellaria Hospital, Medical Department, Endocrinology Unit , Azienda-Usl Bologna, Bologna , Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Corona
authors.forename: Giulia
authors.initials: G
authors.lastname: Rastrelli
authors.forename: Giulia
authors.initials: G
authors.lastname: Ratrelli
authors.forename: Mario
authors.initials: M
authors.lastname: Maggi
mesh_terms: D000728:Androgens / Q000627:therapeutic use*; D005298:Fertility; D007987:Gonadotropin-Releasing Hormone / Q000378:metabolism / Q000627:therapeutic use; D006062:Gonadotropins / Q000627:therapeutic use; D006801:Humans; D007006:Hypogonadism / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D008019:Life Style; D008297:Male; D010902:Pituitary Gland / Q000187:drug effects / Q000503:physiopathology; D015995:Prevalence; D012725:Sexual Behavior; D013737:Testis / Q000378:metabolism; D013739:Testosterone / Q000096:biosynthesis / Q000627:therapeutic use
chemical_list: D000728:Androgens; D006062:Gonadotropins; D007987:Gonadotropin-Releasing Hormone; D013739:Testosterone
keywords: antiestrogens; gonadotropin; male hypogonadism; testosterone