Skip to main content
Erschienen in: Die Urologie 11/2022

23.10.2022 | Hormonsubstitution | CME

Testosterontherapie

verfasst von: Dr. med. Jens Rosellen, FEBU, FECSM, MHBA, Thorsten Diemer, Arne Hauptmann, Florian Wagenlehner

Erschienen in: Die Urologie | Ausgabe 11/2022

Einloggen, um Zugang zu erhalten

Zusammenfassung

Beim männlichen Hypogonadismus handelt es sich um eine kongenitale oder erworbene Erkrankung, die durch den vorliegenden relativen oder absoluten Testosteronmangel einen negativen Einfluss auf verschiedene Organfunktionen ausübt und die Lebensqualität massiv beeinträchtigen kann. Zur Substitutionsbehandlung stehen verschiedene Präparate zur Verfügung, welche sich in der Darreichungsform und den Einnahmeintervallen unterscheiden. Zur Durchführung der Testosterontherapie existieren mehrere Leitlinien mit klaren und praktischen Handlungsanweisungen zu Indikationsstellung, Kontraindikationen, Therapiedurchführung und -monitoring. Hierbei sind insbesondere kardiovaskuläre Aspekte und Erkrankungen der Prostata von Bedeutung, was die zentrale Stellung des Urologen in der Behandlung verdeutlicht.
Literatur
3.
Zurück zum Zitat Giannetta E et al (2012) Subclinical male hypogonadism. Best Pract Res Clin Endocrinol Metab 26:539PubMedCrossRef Giannetta E et al (2012) Subclinical male hypogonadism. Best Pract Res Clin Endocrinol Metab 26:539PubMedCrossRef
4.
Zurück zum Zitat Lunenfeld B et al (2013) Recommondations on the diagnosis, treatment and monitoring of late-onset hypogonadism in men—a suggested update. Aging Male 16:143–150PubMedCrossRef Lunenfeld B et al (2013) Recommondations on the diagnosis, treatment and monitoring of late-onset hypogonadism in men—a suggested update. Aging Male 16:143–150PubMedCrossRef
5.
Zurück zum Zitat Snyder PJ et al (2018) Lessons from the testosterone trials. Endocr Rev 1;39(3):369–386 (Jun)CrossRef Snyder PJ et al (2018) Lessons from the testosterone trials. Endocr Rev 1;39(3):369–386 (Jun)CrossRef
6.
Zurück zum Zitat Miller WL et al (2011) The molecular biology, biochemistry, and physiology of human steroidogenesis and its disorders. Endocr Rev 32:81PubMedCrossRef Miller WL et al (2011) The molecular biology, biochemistry, and physiology of human steroidogenesis and its disorders. Endocr Rev 32:81PubMedCrossRef
7.
Zurück zum Zitat Rosner W et al (2010) Toward excellence in testosterone testing: a consensus statement. J Clin Endocrinol Metab 95:4542PubMedCrossRef Rosner W et al (2010) Toward excellence in testosterone testing: a consensus statement. J Clin Endocrinol Metab 95:4542PubMedCrossRef
9.
Zurück zum Zitat Morelli A et al (2007) Which patients with sexual dysfunction are suitable for testosterone replacement therapy? J Endocrinol Invest 30:880PubMedCrossRef Morelli A et al (2007) Which patients with sexual dysfunction are suitable for testosterone replacement therapy? J Endocrinol Invest 30:880PubMedCrossRef
10.
Zurück zum Zitat Wu FC et al (2008) Hypothalamic-pituitary-testicular axis disruptions in older men are differentially linked to age and modifiable risk factors: the European Male Aging Study. J Clin Endocrinol Metab 93:2737PubMedCrossRef Wu FC et al (2008) Hypothalamic-pituitary-testicular axis disruptions in older men are differentially linked to age and modifiable risk factors: the European Male Aging Study. J Clin Endocrinol Metab 93:2737PubMedCrossRef
11.
Zurück zum Zitat Grossmann M et al (2017) A perspective on middle-aged and older men with functional Hypogonadism: focus on holistic management. J Clin Endocrinol Metab 102:1067PubMedPubMedCentralCrossRef Grossmann M et al (2017) A perspective on middle-aged and older men with functional Hypogonadism: focus on holistic management. J Clin Endocrinol Metab 102:1067PubMedPubMedCentralCrossRef
12.
Zurück zum Zitat Wu FC et al (2010) Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med 363:123PubMedCrossRef Wu FC et al (2010) Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med 363:123PubMedCrossRef
13.
Zurück zum Zitat Guay A et al (2008) Does early morning versus late morning draw time influence apparent testosterone concentration in men aged 〉 or =45 years? Data from the Hypogonadism In Males study. Int J Impot Res 20:162PubMedCrossRef Guay A et al (2008) Does early morning versus late morning draw time influence apparent testosterone concentration in men aged 〉 or =45 years? Data from the Hypogonadism In Males study. Int J Impot Res 20:162PubMedCrossRef
14.
Zurück zum Zitat Travison TG et al (2017) Harmonized reference ranges for circulating testosterone levels in men of four cohort studies in the United States and europe. J Clin Endocrinol Metab 102:1161PubMedPubMedCentralCrossRef Travison TG et al (2017) Harmonized reference ranges for circulating testosterone levels in men of four cohort studies in the United States and europe. J Clin Endocrinol Metab 102:1161PubMedPubMedCentralCrossRef
15.
Zurück zum Zitat Corona G et al (2016) Therapy Of Endocrine Disease: Testosterone supplementation and body composition: results from a meta-analysis study. Eur J Endocrinol 174:R99PubMedCrossRef Corona G et al (2016) Therapy Of Endocrine Disease: Testosterone supplementation and body composition: results from a meta-analysis study. Eur J Endocrinol 174:R99PubMedCrossRef
16.
Zurück zum Zitat Boeri L et al (2017) Does calculated free testosterone overcome total testosterone in protecting from sexual symptom impairment? Findings of a cross-sectional study. J Sex Med 14:1549PubMedCrossRef Boeri L et al (2017) Does calculated free testosterone overcome total testosterone in protecting from sexual symptom impairment? Findings of a cross-sectional study. J Sex Med 14:1549PubMedCrossRef
17.
Zurück zum Zitat Rastrelli G et al (2016) How to define hypogonadism? Results from a population of men consulting for sexual dysfunction. J Endocrinol Invest 39:473PubMedCrossRef Rastrelli G et al (2016) How to define hypogonadism? Results from a population of men consulting for sexual dysfunction. J Endocrinol Invest 39:473PubMedCrossRef
18.
19.
Zurück zum Zitat Beutel ME et al (2005) Correlations between hormones, physical, and affective parameters in aging urologic outpatients. Eur Urol 47:749–755PubMedCrossRef Beutel ME et al (2005) Correlations between hormones, physical, and affective parameters in aging urologic outpatients. Eur Urol 47:749–755PubMedCrossRef
20.
Zurück zum Zitat Dean JD et al (2015) The international society of sexual medicine’s process of care for the assessment and management of testosterone deficiency in adult men. J Sex Med 12:1660–1686PubMedCrossRef Dean JD et al (2015) The international society of sexual medicine’s process of care for the assessment and management of testosterone deficiency in adult men. J Sex Med 12:1660–1686PubMedCrossRef
22.
Zurück zum Zitat Rastrelli G et al (2019) Testosterone and benign prostatic Hyperplasia. Sex Med Rev 7:259PubMedCrossRef Rastrelli G et al (2019) Testosterone and benign prostatic Hyperplasia. Sex Med Rev 7:259PubMedCrossRef
23.
Zurück zum Zitat Wang C et al (2009) ISA, ISSAM, EAU, EAA and ASA recommendations: investigation, treatment and monitoring of late-onset hypogonadism in males. Int J Impot Res 21:1–8PubMedCrossRef Wang C et al (2009) ISA, ISSAM, EAU, EAA and ASA recommendations: investigation, treatment and monitoring of late-onset hypogonadism in males. Int J Impot Res 21:1–8PubMedCrossRef
24.
Zurück zum Zitat Kadihasanoglu M et al (2021) SARS-coV‑2 pneumonia affects Male reproductive hormone levels: a prospective, cohort study. J Sex Med 18:256PubMedCrossRef Kadihasanoglu M et al (2021) SARS-coV‑2 pneumonia affects Male reproductive hormone levels: a prospective, cohort study. J Sex Med 18:256PubMedCrossRef
25.
Zurück zum Zitat Corona G et al (2017) Testosterone treatment and cardiovascular and venous thromboembolism risk: what is ‘new’? J Investig Med 65:964PubMedCrossRef Corona G et al (2017) Testosterone treatment and cardiovascular and venous thromboembolism risk: what is ‘new’? J Investig Med 65:964PubMedCrossRef
26.
Zurück zum Zitat Gagnon DR et al (1994) Hematocrit and the risk of cardiovascular disease—the Framingham study: a 34-year follow-up. Am Heart J 127:674PubMedCrossRef Gagnon DR et al (1994) Hematocrit and the risk of cardiovascular disease—the Framingham study: a 34-year follow-up. Am Heart J 127:674PubMedCrossRef
27.
Zurück zum Zitat Colpi GM et al (2018) European Academy of Andrology guideline Management of oligo-astheno-teratozoospermia. Andrology 6:513PubMedCrossRef Colpi GM et al (2018) European Academy of Andrology guideline Management of oligo-astheno-teratozoospermia. Andrology 6:513PubMedCrossRef
28.
Zurück zum Zitat Grossmann M (2018) Hypogonadism and male obesity: Focus on unresolved questions. Clin Endocrinol (Oxf) 89:11CrossRef Grossmann M (2018) Hypogonadism and male obesity: Focus on unresolved questions. Clin Endocrinol (Oxf) 89:11CrossRef
29.
Zurück zum Zitat Corona G et al (2013) Body weight loss reverts obesity-associated hypogonadotropic hypogonadism: a systematic review and meta-analysis. Eur J Endocrinol 168:829PubMedCrossRef Corona G et al (2013) Body weight loss reverts obesity-associated hypogonadotropic hypogonadism: a systematic review and meta-analysis. Eur J Endocrinol 168:829PubMedCrossRef
31.
Zurück zum Zitat Isidori AM et al (2015) Outcomes of androgen replacement therapy in adult male hypogonadism: recommendations from the Italian society of endocrinology. J Endocrinol Invest 38:103PubMedCrossRef Isidori AM et al (2015) Outcomes of androgen replacement therapy in adult male hypogonadism: recommendations from the Italian society of endocrinology. J Endocrinol Invest 38:103PubMedCrossRef
32.
Zurück zum Zitat Rastrelli G et al (2018) Pharmacological management of late-onset hypogonadism. Expert Rev Clin Pharmacol 11:439PubMedCrossRef Rastrelli G et al (2018) Pharmacological management of late-onset hypogonadism. Expert Rev Clin Pharmacol 11:439PubMedCrossRef
33.
Zurück zum Zitat Ohlander SJ et al (2018) Erythrocytosis following testosterone therapy. Sex Med Rev 6:77PubMedCrossRef Ohlander SJ et al (2018) Erythrocytosis following testosterone therapy. Sex Med Rev 6:77PubMedCrossRef
34.
Zurück zum Zitat Rastrelli G et al (2014) Factors affecting spermatogenesis upon gonadotropin-replacement therapy: a meta-analytic study. Andrology 2:794PubMedCrossRef Rastrelli G et al (2014) Factors affecting spermatogenesis upon gonadotropin-replacement therapy: a meta-analytic study. Andrology 2:794PubMedCrossRef
35.
Zurück zum Zitat Calof OM et al (2005) Adverse events associated with testosterone replacement in middle-aged and older men: a meta-analysis of randomized, placebo-controlled trials. J Gerontol A Biol Sci Med Sci 60:1451PubMedCrossRef Calof OM et al (2005) Adverse events associated with testosterone replacement in middle-aged and older men: a meta-analysis of randomized, placebo-controlled trials. J Gerontol A Biol Sci Med Sci 60:1451PubMedCrossRef
36.
Zurück zum Zitat Boyle P et al (2016) Endogenous and exogenous testosterone and the risk of prostate cancer and increased prostate-specific antigen (PSA) level: a meta-analysis. BJU Int 118:731PubMedCrossRef Boyle P et al (2016) Endogenous and exogenous testosterone and the risk of prostate cancer and increased prostate-specific antigen (PSA) level: a meta-analysis. BJU Int 118:731PubMedCrossRef
41.
Zurück zum Zitat Teeling F et al (2019) Testosterone therapy for high-risk prostate cancer survivors: a systematic review and meta-analysis. Urology 126:16PubMedCrossRef Teeling F et al (2019) Testosterone therapy for high-risk prostate cancer survivors: a systematic review and meta-analysis. Urology 126:16PubMedCrossRef
42.
Zurück zum Zitat Kardoust Parizi M et al (2019) Oncological safety of testosterone replacement therapy in prostate cancer survivors after definitive local therapy: A systematic literature review and meta-analysis. Urol Oncol 37:637PubMedCrossRef Kardoust Parizi M et al (2019) Oncological safety of testosterone replacement therapy in prostate cancer survivors after definitive local therapy: A systematic literature review and meta-analysis. Urol Oncol 37:637PubMedCrossRef
43.
Zurück zum Zitat Malkin CJ et al (2010) Low serum testosterone and increased mortality in men with coronary heart disease. Heart 96:1821PubMedCrossRef Malkin CJ et al (2010) Low serum testosterone and increased mortality in men with coronary heart disease. Heart 96:1821PubMedCrossRef
44.
Zurück zum Zitat Kapoor D et al (2007) Clinical and biochemical assessment of hypogonadism in men with type 2 diabetes: correlations with bioavailable testosterone and visceral adiposity. Diabetes Care 30:911PubMedCrossRef Kapoor D et al (2007) Clinical and biochemical assessment of hypogonadism in men with type 2 diabetes: correlations with bioavailable testosterone and visceral adiposity. Diabetes Care 30:911PubMedCrossRef
45.
Zurück zum Zitat Kalinchenko SY et al (2010) Effects of testosterone supplementation on markers of the metabolic syndrome and inflammation in hypogonadal men with the metabolic syndrome: the double-blinded placebo-controlled Moscow study. Clin Endocrinol (Oxf) 73:602CrossRef Kalinchenko SY et al (2010) Effects of testosterone supplementation on markers of the metabolic syndrome and inflammation in hypogonadal men with the metabolic syndrome: the double-blinded placebo-controlled Moscow study. Clin Endocrinol (Oxf) 73:602CrossRef
46.
Zurück zum Zitat Kapoor D et al (2006) Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hypercholesterolaemia in hypogonadal men with type 2 diabetes. Eur J Endocrinol 154:899PubMedCrossRef Kapoor D et al (2006) Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hypercholesterolaemia in hypogonadal men with type 2 diabetes. Eur J Endocrinol 154:899PubMedCrossRef
47.
Zurück zum Zitat Corona G et al (2011) Hypogonadism as a risk factor for cardiovascular mortality in men: a meta-analytic study. Eur J Endocrinol 165:687PubMedCrossRef Corona G et al (2011) Hypogonadism as a risk factor for cardiovascular mortality in men: a meta-analytic study. Eur J Endocrinol 165:687PubMedCrossRef
48.
Zurück zum Zitat Malkin CJ et al (2006) Testosterone therapy in men with moderate severity heart failure: a double-blind randomized placebo controlled trial. Eur Heart J 27:57PubMedCrossRef Malkin CJ et al (2006) Testosterone therapy in men with moderate severity heart failure: a double-blind randomized placebo controlled trial. Eur Heart J 27:57PubMedCrossRef
49.
Zurück zum Zitat Mathur A et al (2009) Long-term benefits of testosterone replacement therapy on angina threshold and atheroma in men. Eur J Endocrinol 161:443PubMedCrossRef Mathur A et al (2009) Long-term benefits of testosterone replacement therapy on angina threshold and atheroma in men. Eur J Endocrinol 161:443PubMedCrossRef
50.
Zurück zum Zitat Corona G et al (2014) Cardiovascular risk associated with testosterone-boosting medications: a systematic review and meta-analysis. Expert Opin Drug Saf 13:1327PubMedCrossRef Corona G et al (2014) Cardiovascular risk associated with testosterone-boosting medications: a systematic review and meta-analysis. Expert Opin Drug Saf 13:1327PubMedCrossRef
51.
Zurück zum Zitat Sharma R et al (2015) Normalization of testosterone level is associated with reduced incidence of myocardial infarction and mortality in men. Eur Heart J 36:2706PubMedCrossRef Sharma R et al (2015) Normalization of testosterone level is associated with reduced incidence of myocardial infarction and mortality in men. Eur Heart J 36:2706PubMedCrossRef
52.
Zurück zum Zitat Madaeva IM et al (2017) Obstructive sleep apnea syndrome and age-related hypohonadism. Zh Nevrol Psikhiatr Im S S Korsakova 117:79PubMedCrossRef Madaeva IM et al (2017) Obstructive sleep apnea syndrome and age-related hypohonadism. Zh Nevrol Psikhiatr Im S S Korsakova 117:79PubMedCrossRef
53.
Zurück zum Zitat Brown DW et al (2001) Hematocrit and the risk of coronary heart disease mortality. Am Heart J 142:657PubMedCrossRef Brown DW et al (2001) Hematocrit and the risk of coronary heart disease mortality. Am Heart J 142:657PubMedCrossRef
54.
Zurück zum Zitat Baillargeon J et al (2015) Risk of venous Thromboembolism in men receiving testosterone therapy. Mayo Clin Proc 90:1038PubMedCrossRef Baillargeon J et al (2015) Risk of venous Thromboembolism in men receiving testosterone therapy. Mayo Clin Proc 90:1038PubMedCrossRef
55.
Zurück zum Zitat Smith AM et al (2005) Testosterone does not adversely affect fibrinogen or tissue plasminogen activator (tPA) and plasminogen activator inhibitor‑1 (PAI-1) levels in 46 men with chronic stable angina. Eur J Endocrinol 152:285PubMedCrossRef Smith AM et al (2005) Testosterone does not adversely affect fibrinogen or tissue plasminogen activator (tPA) and plasminogen activator inhibitor‑1 (PAI-1) levels in 46 men with chronic stable angina. Eur J Endocrinol 152:285PubMedCrossRef
57.
Zurück zum Zitat Rastrelli G et al (2019) Testosterone replacement therapy for sexual symptoms. Sex Med Rev 7:464PubMedCrossRef Rastrelli G et al (2019) Testosterone replacement therapy for sexual symptoms. Sex Med Rev 7:464PubMedCrossRef
58.
Zurück zum Zitat Corona G et al (2017) Meta-analysis of results of testosterone therapy on sexual function based on international index of erectile function scores. Eur Urol 72:1000PubMedCrossRef Corona G et al (2017) Meta-analysis of results of testosterone therapy on sexual function based on international index of erectile function scores. Eur Urol 72:1000PubMedCrossRef
59.
Zurück zum Zitat Cunningham GR et al (2016) Testosterone treatment and sexual function in older men with low testosterone levels. J Clin Endocrinol Metab 101:3096PubMedPubMedCentralCrossRef Cunningham GR et al (2016) Testosterone treatment and sexual function in older men with low testosterone levels. J Clin Endocrinol Metab 101:3096PubMedPubMedCentralCrossRef
60.
Zurück zum Zitat Smith JB et al (2018) Low serum testosterone in outpatient psychiatry clinics: addressing challenges to the screening and treatment of Hypogonadism. Sex Med Rev 6:69PubMedCrossRef Smith JB et al (2018) Low serum testosterone in outpatient psychiatry clinics: addressing challenges to the screening and treatment of Hypogonadism. Sex Med Rev 6:69PubMedCrossRef
61.
Zurück zum Zitat Walther A et al (2019) Association of testosterone treatment with alleviation of depressive symptoms in men: a systematic review and meta-analysis. JAMA 76:31 Walther A et al (2019) Association of testosterone treatment with alleviation of depressive symptoms in men: a systematic review and meta-analysis. JAMA 76:31
63.
Zurück zum Zitat Rochira V et al (2018) EAA clinical guideline on management of bone health in the andrological outpatient clinic. Andrology 6:272PubMedCrossRef Rochira V et al (2018) EAA clinical guideline on management of bone health in the andrological outpatient clinic. Andrology 6:272PubMedCrossRef
Metadaten
Titel
Testosterontherapie
verfasst von
Dr. med. Jens Rosellen, FEBU, FECSM, MHBA
Thorsten Diemer
Arne Hauptmann
Florian Wagenlehner
Publikationsdatum
23.10.2022
Verlag
Springer Medizin
Erschienen in
Die Urologie / Ausgabe 11/2022
Print ISSN: 2731-7064
Elektronische ISSN: 2731-7072
DOI
https://doi.org/10.1007/s00120-022-01957-7

Weitere Artikel der Ausgabe 11/2022

Die Urologie 11/2022 Zur Ausgabe

Mitteilungen der DGU

Mitteilungen der DGU

GeSRU

GeSRU

Termine

Termine

Einführung zum Thema

Urologie und Umwelt

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.