Hypogonadism, although in general refers to the condition of Low testosterone, could also refer to low sperm production. 

Depending on the cause of hypogonadism, other treatment modalities and investigations may be warranted. However, in general, most hypogonadism would require ‘Testosterone Replacement Therapy (TRT)’ 

TRT can be given in many forms.

What is Hypogonadism?

There are two types of hypogonadism, which are primary and secondary hypogonadism.

Simply put, primary hypogonadism is caused by the testes alone in producing adequate testosterone/sperm; whilst secondary hypogonadism is caused by inadequate chemicals stimulating the testes to function. Secondary hypogonadism may represent a problem in the brain as the hormones stimulating the testes are released from the brain. 

Grade 1

Penis is larger but not hard

Grade 2

Penis is hard but not enough for penetration

Grade 3

Penis is hard enough for penetration but not completely hard

Grade 4

Penis is completely hard
Medication
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Injection

The frequency of injection depends on type of Testosterone. Short acting testosterone could be administered weekly to bi-weekly while long acting testosterone could be administered three monthly.

Pro: 

• Infrequent dosing 

• Easy to discontinue 

• Cost efficient 

Con: 

• Pain at site of injection 

• T levels may fluctuate 

• Frequent office visits
(
If self administered, proper disposal is required)

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Gel

Frequency of application - to be applied on a daily basis

 

Pro: 

• Easy to apply 

• Easy to discontinue 

• Generic brands available 

 

Con: 

• Risk of exposure to others (possible of absorption by others via touch) 

• Possible skin irritation 

• T levels may need to be measured frequently to ensure adequate absorption

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Pellet

Frequency of application - Every 3-6 months

 

Pro: 

• Quick Onset

• Infrequent dosing 

• No transference 

 

Con: 

• Cannot easily adjust dosage 

• Risk of fibrosis at injection site 

• Requires physician and surgically approved site

Treatment

Surgery

Circumcision

Principle of therapy:
Circumcision is a procedure that removes the foreskin from the human penis. In the most common form of the operation, the foreskin is extended with forceps, then a circumcision device may be placed, after which the foreskin is excised.

Duration of Surgery:
45 minutes to 1 hour

Pre-procedure preparation: Advisable to come with a family member/friend. Prior topical anaesthesia will be given to be applied over penile shaft and base to reduce pain during surgery and nerve block injection.

Post-procedure care:
Minimal bleeding is normal post circumcision. Compression bandage and bed rest may be advised during first day post procedure. Wound would be bandaged for at least 3 days. Wound inspection would be done on day 3 after surgery, after which bandage would be removed and further follow up usually not required unless further complications should happen. Wound should be kept dry at all times after surgery. Make sure to dry/ blow dry with hair dryer after shower. Sutures used are usually absorbable suture – no need for removal.

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