Selective estrogen receptor modulators and aromatase inhibitors in the treatment of functional male hypogonadism

Functional hypogonadism is a syndrome characterized by low testosterone levels and clinical features of hypogonadism without organic disease of the hypothalamus-pituitary-gonadal axis. It is most prevalent among middle-aged and older men as late-onset hypogonadism as well as in a wide range of conditions such as obesity, type 2 diabetes, opioid use, or exogenous steroid abuse. As a potentially reversible condition, lifestyle modifications are the basis of initial management of functional hypogonadism. However, if behavioral interventions cannot be expected to be successful in raising testosterone levels in a reasonable amount of time, then both testosterone and alternative treatments must be considered. In young men seeking fertility, testosterone is contraindicated; hence, selective estrogen receptor modulators and aromatase inhibitors might be offered; however, the available literature concerning their use in male functional hypogonadism is rather scarce. This review aims to update information about selective estrogen receptor modulators and aromatase inhibitors in the treatment of functional male hypogonadism.