Table 3.

Summary of treatment options in male adult affected by Isolated Hypogonadotropic Hypogonadism.

ADULT MALE HYPOGONADISM			PROs	CONTRAs
Testosterone enanthate, cypionate or mixture of esters	150-250 mg IM every 2-4 weeks	Titrating dose based on clinical signs and symptoms, serum testosterone levels	Self-injection Easily available	Higher risk of erythrocytosis Frequent serum testosterone peaks Frequent injections
Testosterone undecanoate	750-1000 mg every 10-14 weeks		Longer interval injections Stable serum testosterone levels	injection by a health care provider risk of pulmonary oil microembolism
Testosterone gel	40 mg-80 mg/daily		Easy avoidable side effects Non invasive Mimics physiology	Daily administration Skin irritation Possible skin to skin transfer of therapy
Testosterone patch	2.5–5 mg/day		Mimics physiology	Skin irritation, Possible issues with frequent showering or certain lifestyle
Oral testosterone	Undecanoate testosterone 158–396 mg twice daily		Oral administration	Daily multiple doses; need lipid rich meals; gastrointestinal side effects; hypertension
Intranasal testosterone	11 mg twice/die		Easy to administer	Sense of taste alteration
Testosterone pellets	75 mg pellets, 3-4 every 4-6 months		Easier compliance	Risk of local side effects (extrusion, fibrosis, infection) Higher cost
ADULT SPERMATOGENESIS INDUCTION
Gonadotropins	Starting dose: hCG 500 UI SC thrice/week + FSH 75-150 UI thrice/week	Titrating dose: - hCG increase based on serum testosterone - FSH increase based on serum FSH and sperm count	Self-injections	Require optimal compliance Need frequent injections
Pulsatile GnRH	SC pump: 25 ng/kg per pulse every 120 min	Dose e adapted based on serum testosterone levels	Most physiological	Not easily available Pituitary resistance (rare)

Adapted from Young et al., 2019 and Nordenstrom et al., 2022.

SC, subcutaneous; IM, intramuscular; hCG, Human chorionic gonadotropin; FSH, Follicle stimulating hormone.