Symptoms and signs of androgen deficiency in men and in boys with delayed sexual maturation warrant evaluation. The most sensitive means for establishing the diagnosis is to measure serum levels of non-testosterone-binding globulin bound testosterone between 8 and 10 a.m. Androgen replacement should be considered for hypogonadal men and for boys whose sexual development has been delayed. Effective treatment of hypogonadal men may improve libido, potency, and muscle strength and decrease the risk of developing osteoporosis. Replacement therapy for boys with sexual delay should attempt to simulate normal puberty. Enthusiasm for treating older males must be tempered by risks of worsening benign prostatic hyperplasia, prostate cancer, sleep apnea, polycythemia, and dyslipidemia. In the United States, intramuscular administration of testosterone enanthate or testosterone cypionate provides the safest and most effective regimen. Less adequate replacement can be achieved with oral administration of testosterone undecanoate, a preparation only available in other countries. Several new agents are under investigation. If patients are monitored carefully, the benefits of androgen replacement appear to outweigh the risks.
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