Alternatives to Testosterone Therapy: A Review

Sex Med Rev. 2018 Jan;6(1):106-113. doi: 10.1016/j.sxmr.2017.09.004. Epub 2017 Nov 27.


Introduction: Although testosterone therapy (TTh) is an effective treatment for hypogonadism, recent concerns regarding its safety have been raised. In 2015, the US Food and Drug Administration issued a warning about potential cardiovascular risks resulting from TTh. Fertility preservation is another reason to search for viable alternative therapies to conventional TTh, and in this review we evaluate the literature examining these alternatives.

Aims: To review the role and limitations of non-testosterone treatments for hypogonadism.

Methods: A literature search was conducted using PubMed to identify relevant studies examining medical and non-medical alternatives to TTh. Search terms included hypogonadism, testosterone replacement therapy, testosterone therapy, testosterone replacement alternatives, diet and exercise and testosterone, varicocele repair and testosterone, stress reduction and testosterone, and sleep apnea and testosterone.

Main outcome measures: Review of peer-reviewed literature.

Results: Medical therapies examined include human chorionic gonadotropins, aromatase inhibitors, and selective estrogen receptor modulators. Non-drug therapies that are reviewed include lifestyle modifications including diet and exercise, improvements in sleep, decreasing stress, and varicocele repair. The high prevalence of obesity and metabolic syndrome in the United States suggests that disease modification could represent a viable treatment approach for affected men with hypogonadism.

Conclusions: These alternatives to TTh can increase testosterone levels and should be considered before TTh. Lo EM, Rodriguez KM, Pastuszak AW, Khera M. Alternatives to Testosterone Therapy: A Review. Sex Med Rev 2018;6:106-113.

Keywords: Aromatase Inhibitors; Human Chorionic Gonadotropin; Selective Estrogen Receptor Modulator; Testosterone; Testosterone Therapy; Varicocele.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Androgens / adverse effects*
  • Androgens / therapeutic use
  • Aromatase Inhibitors / therapeutic use*
  • Cardiovascular Diseases / chemically induced*
  • Cardiovascular Diseases / physiopathology
  • Heart Rate / drug effects
  • Hormone Replacement Therapy / adverse effects*
  • Humans
  • Hypogonadism / drug therapy*
  • Male
  • Selective Estrogen Receptor Modulators / therapeutic use*
  • Testosterone / adverse effects*
  • Testosterone / therapeutic use
  • Treatment Outcome


  • Androgens
  • Aromatase Inhibitors
  • Selective Estrogen Receptor Modulators
  • Testosterone