Andrew Siegel MD 10/2/2021
Hypogonadism is a condition in which symptoms of low testosterone are present in conjunction with documented low serum testosterone. Classic management is testosterone replacement therapy (TRT) using one of a variety of different testosterone preparations including transdermal (patches and gels); intra-muscular injections; buccal (applied to the gums); nasal gel; and pellet implants. Each form of delivery has advantages and disadvantages.
Historically, oral testosterone preparations have been problematic because of variable absorption and poor bioavailability (the proportion of drug that enters the circulation and thus has an active effect) due to the first-pass effect of the liver (a phenomenon of drug metabolism in which oral medications are significantly inactivated before reaching the systemic circulation), and possible liver toxicity.
Recently, the FDA approved an oral testosterone capsule that does not have the issues associated with previous iterations. Testosterone undecanoate (Jatenzo) is a soft gelatin capsule that is swallowed without the need for injections, drying time, transference issues, or skin, gum or nasal irritation. It is specifically indicated for low testosterone due to structural or genetic causes and NOT age-related low testosterone. It is taken twice daily with food, available in the following dosages: 158 mg, 198 mg, 237 mg, 316 mg, 396 mg. (Yes, these are strange dosages!)
Warnings: As with all forms of TRT, Jatenzo has the potential for the following adverse effects:
- Increased blood pressure, potentially causing cardiovascular events
- Increased red blood cell count that increases blood viscosity with potential risk of deep venous thrombosis and pulmonary embolus
- Exacerbation of benign prostate growth and obstruction
- Acceleration of PSA (prostate specific antigen)
- Suppression of sperm production
- Male breast growth
- Exacerbation of obstructive sleep apnea
Contraindications: Breast cancer, suspected prostate cancer, female gender
My take: This is a nice addition to the TRT armamentarium and a convenient means of testosterone replacement therapy for symptomatic men with low testosterone levels. As with all new medications, price may be a huge concern and limiting factor.
Another major consideration with all forms of TRT is that exogenous (externally sourced) testosterone shuts down the testes, resulting in decreased sperm production, decreased natural testosterone production, and possibly smaller, atrophied testes in the long-term.
Along with many other urologists, for years I have been using an oral generic medication–clomiphene citrate (Clomid)–off-label for the management of low testosterone. Clomid is commonly used in females to stimulate ovulation and in males to stimulate sperm production. It is a selective estrogen receptor modulator that works by increasing levels of the pituitary hormones that trigger the testes to produce sperm and testosterone. Although it is only FDA-approved for fertility issues, it also raises testosterone levels and does so by stimulating the testes to secrete natural testosterone rather than shutting them down. It has no adverse effect on sperm count and can actually increase it. Furthermore, the price is right.
Wishing you the best of health,
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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery. He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States. He is the co-founder of PelvicRx and Private Gym. His latest book is Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families.
Video trailer for Prostate Cancer 20/20
Preview of Prostate Cancer 20/20
Andrew Siegel MD Amazon author page
PROSTATE CANCER 20/20 is now available at Audible, iTunes and Amazon as an audiobook read by the author (just over 6 hours).
Dr. Siegel’s other books:
PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food
MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health
THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health
Tags: Andrew Siegel MD, Jatenzo, oral testosterone, testosterone replacement therapy, testosterone undeconoate
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