Tobias C. Steen



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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. Most men with hypogonadism are commonly treated with testosterone replacement therapy (TRT). While TRT has proven effective at attenuating the symptoms of hypogonadism, it is not without side effects. TRT can 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 for secondary hypogonadism. After a thorough literature review that included searches of Clinical Key, Dynamed Plus, Cochrane Library, PubMed, and CINAHL databases, multiple studies were reviewed to determine the aforementioned treatment modalities' effectiveness. Works chosen for the review were published after 2007 and included randomized control trials (RCTs) and metanalyses. After all exclusions, this literature review included 9 journal articles. The literature review results discovered that TRT and SERMs are 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 co-administration of AIs and TRT results lacked enough evidence to determine its efficacy. With the addition of off-label therapies such as SERMs, providers can customize a treatment plan for their patients that provides a continuous steady level of testosterone while preserving fertility with the same benefits as TRT.


Physician Assistant Studies

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Testosterone Replacement therapy (TRT), Aromatase Inhibitor, selective estrogen receptor modulator SERMs, Hypogonadism, testicles, libido, erectile function

The Efficacy of Testosterone Replacement vs Aromatase Inhibitors and SERMs in the Presence of Hypogonadism