Date of Award


Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)


Physician Assistant Studies

First Advisor

Russ Kauffman


Hypogonadism; Testosterone replacement therapy (TRT); Selective estrogen receptor modulators (SERMs); Aromatase inhibitors (AIs); Literature review


The prevalence of male hypogonadism increases with age, although it can occur in any age group. Patients with hypogonadism can experience a wide range of symptoms including mood changes, decreased libido, decreased muscle mass, erectile dysfunction and bone loss. Traditionally, management of this condition has been accomplished through some form of testosterone replacement therapy (TRT). While TRT has proven effective at attenuating the symptoms of hypogonadism, it is not without side effects. TRT can at times be expensive, painful, cause gynecomastia, acne, water weight gain and infertility. Recently, medications such as selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs) have gained favor as alternative treatments in the presence of secondary hypogonadism. With the addition of these medications, it remains to be seen which of these three forms of treatment is the most efficacious at managing patient symptoms. After a thorough literature review which included searches of Clinical Key, Dynamed Plus, Cochrane Library, PubMed and CINAHL databases, multiple studies were reviewed to determine the effectiveness of the aforementioned treatment modalities. The results of the review discovered that TRT and SERMs are both efficacious at raising testosterone levels, improving libido, lean muscle mass, strength and endurance. SERMs appear to have one advantage over TRT in that they preserve male fertility. The efficacy of the coadministration of AIs and TRT was also examined, however, at the present there is not enough research to determine the efficacy of this treatment. With the addition of off-label therapies such as SERMs, providers will be able to customize a treatment plan for their patients that will provide a continuous steady level of testosterone all the while preserving fertility with the same benefits of TRT.