Developments and challenges for new and emergent preparations for male hypogonadism treatment

IntroductionThe specific role of testosterone (T) replacement therapy in patients with late onset hypogonadism is still conflicting. Several available preparations have been developed to restore either fertility and normal testosterone (T) levels (secondary hypogonadism) or just T levels (primary hypogonadism).Areas coveredAdvantages and limitations related to available new treatments will be discussed in detail. In addition, possible news related to preparations in the pipeline will be discussed.Expert opinionThe selection of a specific T preparation should be adequately discussed with each subject. Transdermal T preparations are those that can preserve, after a unique morning administration, the circadian rhythmicity of T secretion. Conversely, short-acting preparations (such as oral or intranasal) need two- or three-times daily administration, potentially reducing patient compliance. Long acting T preparations, such as injectable T undecanoate have the advantage of bimestrial or trimestral administration, reducing the required number of administrations. The use of non-steroidal selective androgen receptor modulators (SARM), a heterogeneous class of compounds selectively acting on androgen receptor targets, remains investigational due to the lack of the full spectrum of T's action and the possible risk of side effects, despite their potential use in the treatment of muscle wasting and osteoporosis.

Automated summary

The specific role of testosterone replacement therapy in late onset hypogonadism is still debated. Different preparations have been developed for different purposes, and their advantages and limitations are discussed. The selection of a specific testosterone preparation should be discussed with each patient. Transdermal preparations can maintain the circadian rhythmicity of testosterone secretion, while short-acting preparations may require more frequent administration. Long-acting preparations, such as injectable testosterone undecanoate, offer the advantage of less frequent administration. The use of non-steroidal selective androgen receptor modulators (SARMs) is still investigational, despite their potential use in the treatment of muscle wasting and osteoporosis.