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Concerns that TRT increases risk of cardiovascular events have been raised in some studies. It is reasonable to convert older adolescents totestosterone gel preparations at adult dosages when their IM dosage has reached the equivalent of 100 to 200 mg every 2 weeks. It is reasonable to convert older adolescents to deficiency receive long-acting testosterone enanthate or testosterone cypionate at a dose that is increased gradually over 18 to 24 months, every 1 to 2 weeks. Older adolescents withtestosterone deficiency receive long-acting testosterone enanthate or testosterone cypionate at a dose that is increased gradually over 18 to 24 months, every 1 to 2 weeks.
Target cells that contain 5α-reductase are concentrated in the prostate, reproductive system and skin. Approximately 20% of the DHT in the circulation is produced directly by testicular secretion, with the remaining 80% being derived from conversion from testosterone in the peripheral tissues (10). Testosterone is converted to dihydrotestosterone (DHT) by 5α-reductase enzymes or to estradiol by aromatase in target cells.
It has been estimated that only 5–35% of hypogonadal males actually receive treatment for their condition (19,20). This is found in men with sickle-cell disease, thalassemia, alcoholism, glucocorticoid treatment, and in older men (2). For this reason, primary hypogonadism is also known as hypergonadotropic hypogonadism. Primary hypogonadism is caused by testicular failure and is characterised by low serum testosterone and high LH and FSH concentrations.
The Sertoli cells of the testes, in addition to stimulating spermatogenesis, also secrete the glycoprotein hormone inhibin, which provides negative feedback to the pituitary, inhibiting the secretion of FSH (11). For this reason, free and albumin-bound testosterones together are termed bioavailable testosterone (BAT). Testosterone binds strongly to SHBG, and it is therefore largely the free and albumin-bound testosterone that is available for biological action (10). FSH, follicle-stimulating hormone; GnRH, gonadotropin-releasing hormone; LH, luteinizing hormone LH acts on the interstitial Leydig cells of the testes, stimulating them to produce testosterone, whereas FSH stimulates spermatogenesis and Sertoli cell function (6,7).
A fuller explanation may be that prostate cancer is very sensitive to changes in serum testosterone when at low concentrations, but is insensitive at higher concentrations because of saturation of the androgen receptors (93). In fact, prostate cancer is correlated with age in men, and older men tend to have less, not more, testosterone. The authors demonstrated that, as a result of this, approximately 35% of hypogonadal patients did not receive treatment (20). However, the increase in size of the prostate needs to carefully monitored, and the patient needs to be made aware that there might be increased voiding symptoms during treatment (2,4,9,79,89). BMD measurement in a male with osteopenia/osteoporosis or low trauma fracture can be repeated in 1–2 years after testosterone replacement therapy is initiated (2,79).
In addition, research has uncovered that enclomiphene increases total and free testosterone levels without increasing dihydrotestosterone disproportionately, suggesting that it \"normalizes endogenous testosterone production pathways and restores normal testosterone levels in men with secondary hypogonadism.\" They wrote that while testosterone replacement therapy often resulted in side effects such as transference risk, supranormal testosterone levels, suppressed spermatogenesis, suppressed testicular function, and testicular atrophy, none of these risks are present in enclomiphene. Men with secondary hypogonadotropic hypogonadism have abnormally low testosterone levels due to low-normal levels of luteinizing hormone (LH) and follicular stimulating hormone (FSH).
Several treatment options are available. The right treatment depends on what’s causing your low sex drive. While hormones and anatomy can influence libido, low sex drive can affect anyone. A carefully formulated TRT treatment plan should avoid many of these undesirable side effects. TRT can be very important for helping teenage males with hypogonadism experience typical masculine development. A good first step is increasing activity levels and maintaining a healthy diet in order to reduce body fat.
‡After 3 months, perform in accordance with guidelines for prostate cancer screening, depending on the age and race of the patient. Men using a testosterone gel should be advised by their healthcare provider on the ways of minimising the risk of testosterone transfer to women and children. Some studies have shown that insulin resistance may also improve following testosterone treatment (87,88). Testosterone pellets currently are the only long-acting testosterone treatment approved for use in the United States. This risk can be minimised by having patients wash their hands with soap and water after applying the gel, by covering the site of application with clothing after the gel has dried, and by washing the application site when skin-to-skin contact is expected.

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