Medication Summary
Treatment of patients with hypergonadotropic hypogonadism involves replacement of sex steroids in both males and females.
For treatment of patients with hypogonadotropic hypogonadism, the usual approach is replacement of sex steroids that initiate development and maintain secondary sex characteristics.
Sex steroid replacement does not result in increased testicular size in males or fertility in either males or females. Gonadotropin or GnRH replacement is offered to the patient when fertility is desired.
Many oral contraceptives can provide estrogen and progesterone in a combination that meets the replacement needs of the patient. Selection of a specific oral contraceptive agent needs to be individualized. All of the contraindications, cautions, and drug interactions for estrogens and progesterones apply, as listed in the tables below.
Testosterone agents
Class Summary
These agents are used for sex steroid replacement in males. All testosterone preparations are regulated as Schedule III controlled substances according to the Anabolic Steroids Control Act.
Testosterone (Aveed, Depo-Testosterone, Jatenzo, Testopel, Xyosted, Tlando, Kyzatrex)
Testosterone is available as various salts (eg, enanthate, cypionate, undecanoate). It is also available in a variety of dosage forms. Depo-Testosterone and Aveed are administered IM. Xyosted is injected SC. Testopel is an implant that is placed under the skin SC. Jatenzo, Tlando, and Kyzatrex are all available as oral capsule formulations. Oral formulations for testosterone undecanoate are not substitutable with each other. Testosterone promotes and maintains secondary sex characteristics in androgen-deficient males.
Testosterone transdermal (Androderm, AndroGel, Axiron, Fortesta, Testim)
Androgenic anabolic steroid indicated for testosterone replacement. Several preparations are available as topical gels or transdermal patches. Patches are changed daily. Testosterone is a schedule III controlled substance.
Estrogen agents
Class Summary
These agents are used for sex steroid replacement in females.
Estradiol (Alora, Climara, Esclim, Estrace, FemPatch, Vivelle)
Transdermal: May initiate puberty in girls. Initially, a 0.05-mg patch may be applied 1-2 times/wk. After 6-12 mo, dose may be increased and cycled. After first 6 mo, adding progestogen is often helpful. A very low starting dose of estrogen is desired in young girls with bone ages at or below 12-13 y. Starting at higher doses may cause rapid epiphyseal maturation. If necessary, patches with a matrix-release mechanism (eg, Climara, Vivelle) may be cut to deliver a smaller dose. In the case of the Vivelle dot, half of the dot may be covered in order to lower the amount of estrogen absorbed.
PO: A small unopposed dose (0.02 mg) is administered daily for 3-6 mo, then the dose is increased and cycled. After the first 6 mo, adding progestogen is often helpful.
Conjugated estrogen (Premarin)
May initiate puberty in girls. A small unopposed dose is administered for 3-6 mo, then the dose is increased. After the first 6 mo, adding progestogen is often helpful.
Progesterone agents
Class Summary
These agents are added during the last 12-14 days of the menstrual cycle.
Norethindrone acetate (Aygestin)
Transforms proliferative into secretory endometrium.
Medroxyprogesterone (Provera, Amen, Cycrin)
Transforms proliferative into secretory endometrium.
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Types of idiopathic hypogonadotropic hypogonadism.
