Androgen therapy in hypogonadal adolescent males.
ABSTRACT Androgen treatment represents a main aspect of clinical management of boys with hypogonadism from adolescence onwards. Androgen replacement therapy is required to induce secondary sexual characteristics and adult male body composition, to optimize the accrual of bone mineral content and muscle mass, and to promote physical and social well-being. Testosterone is the only sex steroid hormone suitable for treatment in hypogonadal boys as it fulfils all the physiological requirements. However, the optimal regimens for androgen replacement therapy during adolescence remain to be defined. The new testosterone formulations (patch, gel, transbuccal and long-acting) have been designed for use in adults and the available dosages are probably too high to induce and manage puberty in adolescents properly. The aim of this paper is to provide practical indications for androgen treatment in male adolescents with hypogonadism.
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Article: Androgen in adolescent reviewAndrology 11/2014; 3(2). · 3.37 Impact Factor
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ABSTRACT: The medical term disorders of sex development (DSDs) is used to describe individuals with an atypical composition of chromosomal, gonadal and phenotypic sex, which leads to differences in the development of the urogenital tract and reproductive system. A variety of genetic factors have been identified that affect sex development during gonadal differentiation or in specific disorders associated with altered androgen biosynthesis or action. The diagnosis of DSDs in individuals and the subsequent management of patients and their families requires a targeted and structured approach, involving a multidisciplinary team with effective communication between the disciplines. This approach includes distinct clinical, imaging, laboratory and genetic evaluations of patients with DSDs. Although treatment of patients with DSDs can include endocrine and surgical options, many patients have concerns that arise from past incorrect treatments that were founded on the traditional binary concept of the sexes. To dispel these concerns, it is necessary to create centres of expertise for DSDs that include physicians, surgeons, psychologists and specialists in diagnostic procedures to manage patients and their families. Additionally, the inclusion of trained peer support in the multidisciplinary DSD team seems to be integral to the supportive management of patients with DSDs. Most importantly, dealing with DSDs requires acceptance of the fact that deviation from the traditional definitions of gender is not necessarily pathologic.Nature Reviews Endocrinology 07/2014; · 11.03 Impact Factor
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ABSTRACT: Constitutional Delay of Growth and Puberty (CDGP) and hypogonadism are the two most common indications for Testosterone (T) therapy in adolescents. CDGP is a transient state of hypogonadotropic hypogonadism associated with prolongation of childhood phase of growth, delayed skeletal maturation, delayed and attenuated pubertal growth spurt. In pre-pubertal male with CDGP, T therapy can be used to induce pubertal development, accelerate growth and relieve the psychosocial complaints. However, some issues in the management are still unresolved. These include type, optimal timing, dose and duration of sex steroid treatment and the possible use of adjunctive or alternate therapy. In adolescents with permanent hypogonadism T therapy is used to induce then maintain pubescent development. Testosterone therapy enables the patient to decrease mood disturbances, fatigue, impaired virilization and osteoporosis. The use of anabolic drugs to enhance athletic performance has become a major concern for professional sport organizations, sport governing bodies and governments. This mini review aims at providing an update for androgen therapy in adolescents. Endocrinologists and physicians should be acquainted with the indications, the forms, optimal timing, monitoring, dose titration and possible side-effects of T therapy to accomplish the best pharmacological outcome. In addition, it is believed that through education and research we can mitigate the abuse of androgens by adolescent athletes.Andrology 11/2014; 3(2). · 3.37 Impact Factor