Aim of testosterone replacement therapy (TRT) is to improve symptoms and signs of testosterone deficiency including decreased libido, erectile dysfunction, depressed mood, anaemia, loss of muscle and bone mass, by increasing serum testosterone levels to physiologic range. TRT has been used in the last 70 years and overtime, numerous preparations and formulations have been developed to improve pharmacokinetics (PKs) and patient compliance. The routes of delivery approved for use in western world include buccal, nasal, sub dermal, transdermal, and intramuscular (IM). The aim of this narrative review is to describe and compare all available and approved testosterone preparations according to pharmacology, PKs, and adverse effects. Attention was reserved to the use of different testosterone preparations to treat testosterone deficiency in older men. Contraindications and monitoring of TRT were analysed by comparing available guidelines released in the last five years. We provide a review of advantages and disadvantages of different modalities of TRT and how to monitor treatment to minimize the risks. TRT is associated with multiple benefits highly relevant to the patient. However, the recommendations given in different guidelines on TRT are based on data from a limited number of randomized controlled trials (RCTs), as well as non-randomised clinical studies and observational studies. This is the case for the safety of a long term TRT in later onset hypogonadism. A cautious approach to TRT is recommended in older men with a history of heart failure.
Andrology. 2020 Feb 18 [Epub ahead of print]
Arcangelo Barbonetti, Settimio D'Andrea, Sandro Francavilla
Andrology Unit, Department of Life, Health and Environment Sciences, University of L'Aquila, Italy.