Alternative non-hormonal methods of correction of male hypogonadism from the standpoint of evidence-based medicine (literature review)

Testosterone deficiency in men (male hypogonadism) poses a serious threat to men’s health and life expectancy, therefore, it should be diagnosed and corrected in a timely manner using hormonal treatment methods. However, until now, a certain part of the male population is afraid of hormone therapy or has concomitant diseases that make it unsafe. In this case, hypogonadal men usually turn to alternative (non-hormonal) methods of restoring low testosterone levels based on the use of various non-hormonal drugs or therapeutic procedures. This review analyzes the steroidogenic effectiveness of surgical treatment of varicocele (varicocelectomy) and the use of trace elements, vitamins and insulin sensitizers (metformin) in order to increase testosterone levels in men based on evidence–based studies and meta-analyses over the past 5 years. The review showed significant heterogeneity and inconsistency of the research results: while varicocelectomy shows its effectiveness in terms of improving spermatogenic and steroidogenic testicular functions in infertile hypogonadal men, its effectiveness as a method of increasing testosterone levels in fertile hypogonadal men or in normogonadal infertile men remains unproven. The steroidogenic effectiveness of trace elements, vitamins and metformin is very low and does not lead to reliable significant clinical results in terms of increased testosterone in hypogonadal men. Thus, none of the described non-hormonal approaches to the correction of low testosterone levels in men can be considered as a proven and effective alternative to the classic hormonal methods of male hypogonadism treatment in routine clinical practice.