Alternatives to Testosterone Therapy: A Review

Abstract

Introduction

Although testosterone therapy (TTh) is an effective treatment for hypogonadism, recent concerns regarding its safety have been raised. In 2015, the US Food and Drug Administration issued a warning about potential cardiovascular risks resulting from TTh. Fertility preservation is another reason to search for viable alternative therapies to conventional TTh, and in this review we evaluate the literature examining these alternatives.

Aims

To review the role and limitations of non-testosterone treatments for hypogonadism.

Methods

A literature search was conducted using PubMed to identify relevant studies examining medical and non-medical alternatives to TTh. Search terms included hypogonadism, testosterone replacement therapy, testosterone therapy, testosterone replacement alternatives, diet and exercise and testosterone, varicocele repair and testosterone, stress reduction and testosterone, and sleep apnea and testosterone.

Main Outcome Measures

Review of peer-reviewed literature.

Results

Medical therapies examined include human chorionic gonadotropins, aromatase inhibitors, and selective estrogen receptor modulators. Non-drug therapies that are reviewed include lifestyle modifications including diet and exercise, improvements in sleep, decreasing stress, and varicocele repair. The high prevalence of obesity and metabolic syndrome in the United States suggests that disease modification could represent a viable treatment approach for affected men with hypogonadism.

Conclusions

These alternatives to TTh can increase testosterone levels and should be considered before TTh.

Testosterone, Aromatase Inhibitors, Selective Estrogen Receptor Modulator, Varicocele, Testosterone Therapy, Human Chorionic Gonadotropin