Male Hormone Replacement Treatments.

The major type of treatment for Kallmann syndrome and other forms of HH is hormone replacement therapy.

Testosterone is an important hormone for the healthy working of the body and has other uses apart from maintaining normal male sexual function.

The aim of the treatment is to ensure that the testosterone level is maintained at the levels normally seen in a person that age.

There are a range of treatments available for the delivery of testosterone. Each method of treatment has its own advantages and disadvantages. Not all may be available in every country and may go by another trade name.

Once started on treatment it is important that regular blood tests are taken to ensure that the testosterone levels are maintained throughout the treatment cycle.

These different types of treatments normally involve using different versions of testosterone. They all have the same effect as testosterone but some are longer lasting than others and are more potent in their effect.

Oral:

Restandol® Testocaps (Organon)

Tablets of testosterone undecanoate in oily solution, usually taken in either 40mg or 120mg doses every day.

Not normally prescribed for Kallmann's syndrome or HH as the levels reached are low and the duration of their effect is quite short.

Usually used to maintain testosterone levels in older men. In some cases the higher dosage is used to induce puberty in cases where a delay of puberty is suspected rather than Kallmann's or HH.

Buccal patches:

Striant® (Ardana)

Adhesive tablets attached to the gum. 30 mg tablets lasting about 12 hours.

The small patches adhere to the upper gum above the front teeth and slowly release testosterone. The testosterone is slowly absorbed through the lining of the mouth.

Intra-muscular injections:

Testosterone Enantate (Cambridge)

250 mg oily injection taken normally every 2 – 3 weeks if just starting treatment. May be taken every 6 weeks sometimes if used to maintain levels rather than initiate puberty. Can be self administered in some situations if shown the correct procedure.

N.B. Testosterone Enantate used to be provided in the UK under the trade name Primoteston Depot®. The drug is now a non-proprietary medication and is available under various different names in other countries.

Sustanon 100® or Sustanon 250® (Organon)

Oily injection of testosterone propionate, testosterone phenylpropionate and testosterone isocaproate.

Usually taken every 2 or 3 weeks as an injection into thigh or buttocks. The injection can be self-administered in certain situations if shown the correct procedure.

N.B. this preparation does contain peanut oil, so may not be suitable for certain people.

Nebido® (Schering Health)

Oily injection of 1000mg testosterone undecanoate. Large volume injection (4ml) which lasts for up to 3 months, giving a slow release of a long lasting form of testosterone. Not available world wide yet but was due for release in the USA in 2008.

Virormone® (Nordic)

Oily injection of 50mg testosterone propionate. Usually taken weekly, sometimes used to stimulate delayed puberty but not normally used for replacement therapy.

Implants:

Testosterone (Organon)

100 mg or 200 mg pellet implants given under local anaesthetic under sterile conditions into the deep fat tissue of the buttocks or abdomen which last for up to 6 months.

Transdermal applications:

Andropatch® (GSK)

Self adhesive small patches worn on the skin, replaced daily releasing testosterone through the skin throughout the day. Normally taken in 2.5 mg to 7.5 mg doses depending on the levels required.

Testim ® (Ipsen)

Tube of gel containing 50 mg dose of testosterone applied daily to the skin, normally the shoulders or upper arm. The gel quickly dries and is absorbed through the skin to give a steady dose of testosterone all day.

Testogel® (Schering Health)

25 mg, 50 mg or 100 mg sachets of testosterone gel to be applied to the skin every day. Gel dries quickly and is absorbed through the skin to allow for gradual release of testosterone throughout the day.

Tostran® (ProStrakan)

Testosterone gel in a metered dispenser. Gel is rubbed onto clean skin, normally the abdomen or inner thighs and allowed to dry.

Nasal administration:

Nasobol®

Currently undergoing clinical trials in the USA and available in certain parts of Europe. A nasal spray of testosterone in very fine droplet form is sprayed into each nostril once a day. It remains to be seen if this method would provide sufficient levels for treatment in KS / HH patients who require a far higher level than other hypogonadism patients.