Expert Opinion on Pharmacotherapy最新文献_第2页

Positioning gestrinone among the progestins: a narrative review of pharmacology, efficacy, safety, and tolerability. 定位黄体酮在孕激素：药理学，疗效，安全性和耐受性的叙述回顾。

IF 3.4 3区医学

Expert Opinion on Pharmacotherapy Pub Date : 2026-10-15 DOI: 10.1080/14656566.2026.2749635

Leonardo Jacobsen

{"title":"Positioning gestrinone among the progestins: a narrative review of pharmacology, efficacy, safety, and tolerability.","authors":"Leonardo Jacobsen","doi":"10.1080/14656566.2026.2749635","DOIUrl":"https://doi.org/10.1080/14656566.2026.2749635","url":null,"abstract":"Introduction: Gestrinone is an androgenic progestin derived from 19-nortestosterone, in use for four decades in endometriosis and other estrogen-dependent conditions. It has largely disappeared from contemporary progestin taxonomies and is sometimes described as an anabolic-androgenic steroid. This review examines its pharmacology and the evidence for its use.Areas covered: Narrative review without a prespecified protocol, based on searches of PubMed, trial registries and regulatory sources, without date or language limits. It integrates chemistry and multireceptor pharmacology, pharmacokinetics, comparative efficacy against danazol, gonadotropin-releasing hormone (GnRH) agonists and other progestins, and safety, by indication, route and formulation.Expert opinion: Gestrinone was active in every controlled setting tested, and the direct comparisons against danazol and a GnRH agonist detected no difference in the principal pain outcomes, in trials too small to establish equivalence; no direct comparison with dienogest exists. Its hallmark is an androgenic-metabolic signature, and its androgenic effects are not consistently milder than those of danazol. Skeletal findings varied between studies and doses and do not establish long-term protection or the absence of a need for add-back therapy. Priorities are formulation-specific exposure data and contemporary comparisons.","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":" ","pages":"1-16"},"PeriodicalIF":3.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Targeted pharmacotherapy of NF1-associated plexiform neurofibromas: current evidence and future perspectives. nf1相关丛状神经纤维瘤的靶向药物治疗：目前的证据和未来的观点。

IF 3.4 3区医学

Expert Opinion on Pharmacotherapy Pub Date : 2026-10-15 DOI: 10.1080/14656566.2026.2750237

Laura Fertitta, Eric Pasmant

{"title":"Targeted pharmacotherapy of NF1-associated plexiform neurofibromas: current evidence and future perspectives.","authors":"Laura Fertitta, Eric Pasmant","doi":"10.1080/14656566.2026.2750237","DOIUrl":"10.1080/14656566.2026.2750237","url":null,"abstract":"Introduction: Neurofibromatosis type 1 (NF1) is a common autosomal dominant tumor-predisposition syndrome caused by loss-of-function NF1 variants. Somatic inactivation of the remaining allele in Schwann cell precursors drives plexiform neurofibromas (PN), benign but often disfiguring tumors that can progress to malignant peripheral nerve sheath tumors. Driven by constitutive RAS-MAPK activation, PN are among the most pharmacologically tractable manifestations of NF1.Areas covered: This review covers the pharmacotherapy of NF1-associated PN: RAS-MAPK activation in Schwann cells; the approved MEK inhibitors selumetinib, mirdametinib and luvometinib, their clinical pharmacology and the next-generation pipeline; mechanisms of MEK-inhibitor resistance; strategies targeting additional RAS-network nodes (SOS1, SHP2, mTOR) or acting independently; preclinical models; and practical considerations across pediatric and adult populations. It is based on a PubMed and ClinicalTrials.gov search (January 2010-September 2026).Expert opinion: MEK inhibitors have transformed PN management, but responses remain incomplete, regrowth after discontinuation is common, and optimal treatment duration is undefined. The central challenge is now to move from tumor shrinkage toward long-term disease modification while limiting chronic toxicity. Rational combinations targeting pathway reactivation offer a compelling route toward deeper, durable responses, whereas checkpoint- and stimulator of interferon genes (STING)-directed immunotherapy and gene-replacement strategies remain preclinical.","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":" ","pages":"1-15"},"PeriodicalIF":3.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Current management and emerging pharmacotherapeutic strategies in acute promyelocytic leukemia. 急性早幼粒细胞白血病的当前管理和新兴药物治疗策略。

IF 3.4 3区医学

Expert Opinion on Pharmacotherapy Pub Date : 2026-10-15 DOI: 10.1080/14656566.2026.2749650

Alessandro Laganà, Emilia Scalzulli, Maria Laura Bisegna, Ida Carmosino, Costanza Andriola, Deborah Kasmi, Federica Sisti, Maria Stefania De Propris, Massimo Breccia

{"title":"Current management and emerging pharmacotherapeutic strategies in acute promyelocytic leukemia.","authors":"Alessandro Laganà, Emilia Scalzulli, Maria Laura Bisegna, Ida Carmosino, Costanza Andriola, Deborah Kasmi, Federica Sisti, Maria Stefania De Propris, Massimo Breccia","doi":"10.1080/14656566.2026.2749650","DOIUrl":"10.1080/14656566.2026.2749650","url":null,"abstract":"Introduction: Acute promyelocytic leukemia (APL) has evolved from one of the most rapidly fatal neoplasms into the most curable acute myeloid leukemia subtype, following the sequential clinical introduction of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO). Despite cure rates now approaching 100% in non-high-risk disease, early death occurring before or shortly after treatment initiation and relapse/refractory APL cases remain the principal obstacles to achieving a definitive cure.Areas covered: This review summarizes current standard-of-care APL management, including risk stratification, induction, consolidation and maintenance strategies. It then reviews emerging pharmacotherapeutic strategies, including oral arsenic formulations, tamibarotene, anti-CD33 antibody-based and cellular therapies, and other investigational agents. A literature search of PubMed/MEDLINE was performed from the 1950s to 2026 using terms including 'acute promyelocytic leukemia,' 'ATRA,' 'arsenic trioxide,' 'oral arsenic,' 'tamibarotene,' 'gemtuzumab ozogamicin,' and other keywords, prioritizing recent randomized trials, prospective studies and expert consensus guidelines.Expert opinion: Reducing early mortality through faster diagnostic suspicion, extending chemotherapy-free regimens to high-risk disease, and transitioning toward oral, outpatient-based arsenic formulations represent the most promising paths toward a definitive cure. Tailored strategies for rare variant and resistant APL subtypes, including targeted triplet combinations represent a promising treatment for complex APL case, but warrant structured evaluation in prospective clinical trials.","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":" ","pages":"1-13"},"PeriodicalIF":3.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pharmacotherapy for MASLD/MASH: approved therapies, drug repurposing, and emerging mechanism-based candidates. MASLD/MASH的药物治疗：批准的疗法、药物再利用和新兴的基于机制的候选药物。

IF 3.4 3区医学

Expert Opinion on Pharmacotherapy Pub Date : 2026-10-14 DOI: 10.1080/14656566.2026.2749643

Majid Mufaqam Syed-Abdul

{"title":"Pharmacotherapy for MASLD/MASH: approved therapies, drug repurposing, and emerging mechanism-based candidates.","authors":"Majid Mufaqam Syed-Abdul","doi":"10.1080/14656566.2026.2749643","DOIUrl":"https://doi.org/10.1080/14656566.2026.2749643","url":null,"abstract":"Introduction: Metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction-associated steatohepatitis (MASLD/MASH) pharmacotherapy is changing rapidly after the approval of resmetirom and semaglutide for selected adults with noncirrhotic MASH and F2-F3 fibrosis; management must also address obesity, type 2 diabetes, dyslipidemia, cardiovascular risk, and kidney disease.Areas covered: This structured narrative review evaluates approved, comorbidity-directed, repurposed, and emerging therapies according to mechanism, regulatory status, endpoint strength, safety, interactions, and implementation. PubMed and ClinicalTrials.gov were searched without a lower date limit through September 2026 and supplemented by U.S. and European regulatory documents, society guidance, randomized trials, systematic reviews, meta-analyses, and selected mechanistic studies. Therapies include thyroid hormone receptor-beta agonism, incretin and glucagon-containing agonists, peroxisome proliferator-activated receptor pathways, sodium-glucose cotransporter 2 inhibition, de novo lipogenesis/fatty acid synthase inhibition, fibroblast growth factor 21 analogues, lipid/remnant pharmacology, farnesoid X receptor signaling, antioxidants, and lower-evidence repurposing candidates.Expert opinion: Resmetirom and semaglutide anchor approved MASH-directed treatment in eligible F2-F3 disease, while comorbidity-directed therapy should be individualized by liver stage and cardiometabolic priorities. Tirzepatide, FGF21 analogues, denifanstat, and rational combinations may broaden treatment, but cross-trial comparisons and surrogate endpoints require cautious interpretation.","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Gut microbiota-considered pharmacotherapeutic management of hepatocellular carcinoma. 考虑肠道微生物群的肝细胞癌药物治疗管理。

IF 3.4 3区医学

Expert Opinion on Pharmacotherapy Pub Date : 2026-10-14 DOI: 10.1080/14656566.2026.2749646

Alessandro Pizzi, Elisabetta Creta, Maria Pallozzi, Leonardo Stella, Antonio Gasbarrini, Francesca Romana Ponziani, Lucia Cerrito

{"title":"Gut microbiota-considered pharmacotherapeutic management of hepatocellular carcinoma.","authors":"Alessandro Pizzi, Elisabetta Creta, Maria Pallozzi, Leonardo Stella, Antonio Gasbarrini, Francesca Romana Ponziani, Lucia Cerrito","doi":"10.1080/14656566.2026.2749646","DOIUrl":"https://doi.org/10.1080/14656566.2026.2749646","url":null,"abstract":"Introduction: Treatment efficacy for hepatocellular carcinoma (HCC) remains limited. Increasing evidence indicates that gut microbiota may influence treatment response, toxicity and clinical outcomes.Areas covered: Our review synthesizes recent literature from PubMed and Wiley Online Library regarding gut microbiota, microbial metabolites, HCC and immunotherapy by critically analyzing the main research frameworks and identifying current research gaps. Clinical studies suggest that microbial diversity and specific taxa, including Akkermansia, Bifidobacterium, Faecalibacterium, and Ruminococcus may be associated with improved responses to immune checkpoint inhibitors (ICIs). Microbiota-targeted approaches, including fecal microbiota transplantation (FMT), probiotics, engineered bacteria, dietary interventions, selective antimicrobial strategies, and postbiotics, are biologically promising but remain experimental in HCC.Expert opinion: Despite the encouraging results about the modulation of ICIs response by FMT in other solid tumors (melanoma, colorectal cancer, renal cell carcinoma and mixed solid-tumor), whether this strategy is effective and safe in HCC remains to be established in prospective HCC-specific trials. The availability of a preliminary detailed characterization of gut microbial before undertaking HCC treatment would be tempting, especially if it could lead to a more precision-tailored approach with the possibility to foresee, within certain limits, the therapeutic outcome. Moreover, the eventual discovery of specific bacterial patterns in responders and non-responders to ICIs could open the possibility to administer FMT as a standard of care at least in selected patients with the target of re-stablishing HCC response to ICIs.","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Contemporary systemic therapy of medullary thyroid cancer. 当代甲状腺髓样癌的全身治疗。

IF 3.4 3区医学

Expert Opinion on Pharmacotherapy Pub Date : 2026-10-14 DOI: 10.1080/14656566.2026.2749641

Omar Abdel-Rahman

引用次数: 0

Combination therapies for the treatment of locally advanced and advanced cervical cancer. 局部晚期和晚期宫颈癌的联合治疗。

IF 3.4 3区医学

Expert Opinion on Pharmacotherapy Pub Date : 2026-10-13 DOI: 10.1080/14656566.2026.2749633

Alfonso Dueñas-González, Pamela Pastrana-Peralta, Adriana Romo-Perez, Alma Chavez-Blanco, Guadalupe Domínguez-Gómez, Aurora Gonzalez-Fierro, Jaime Coronel-Martinez, Lucely Cetina-Perez, Alfredo Cortes-Algara, Jose Correa, Francisco Gutierrez-Delgado

{"title":"Combination therapies for the treatment of locally advanced and advanced cervical cancer.","authors":"Alfonso Dueñas-González, Pamela Pastrana-Peralta, Adriana Romo-Perez, Alma Chavez-Blanco, Guadalupe Domínguez-Gómez, Aurora Gonzalez-Fierro, Jaime Coronel-Martinez, Lucely Cetina-Perez, Alfredo Cortes-Algara, Jose Correa, Francisco Gutierrez-Delgado","doi":"10.1080/14656566.2026.2749633","DOIUrl":"https://doi.org/10.1080/14656566.2026.2749633","url":null,"abstract":"Introduction: Cervical cancer remains a significant global health challenge. This narrative review synthesizes evidence from PubMed/MEDLINE, Embase, and ClinicalTrials.gov (January 2010 to August 2026), focusing on randomized prospective trials of systemic combination therapies.Areas covered: In locally advanced cervical cancer, pivotal phase 3 trials such as INTERLACE (induction chemotherapy) and KEYNOTE-A18 (pembrolizumab plus chemoradiation) have shown improved survival. For advanced, persistent, recurrent, or metastatic disease, adding pembrolizumab (KEYNOTE-826) or atezolizumab (BEATcc) to chemotherapy, with or without bevacizumab, has increased median overall survival from 26 to over 37 months. In the second-line setting, tisotumab vedotin (innovaTV 301) has become a new Category 1 standard. Emerging strategies include neoadjuvant chemoimmunotherapy to downstage isolated pelvic recurrences for extended resection (LEER), regional dual-checkpoint blockade (cadonilimab), TROP2-directed antibody-drug conjugates (sacituzumab tirumotecan), and therapeutic vaccines.Expert opinion: Immune checkpoint inhibitors and antibody-drug conjugates have improved survival; however, high costs limit access, especially in low- and middle-income countries where disease burden is greatest. Key priorities include harmonizing predictive biomarkers, managing overlapping toxicities, and designing resource-conscious cooperative trials to evaluate shorter or lower-dose maintenance regimens. Addressing access disparities while refining patient selection is essential to achieving equitable global care.","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Considerations and challenges in microdosing of GLP-1-based receptor agonists. glp -1受体激动剂微剂量的考虑和挑战。

IF 3.4 3区医学

Expert Opinion on Pharmacotherapy Pub Date : 2026-10-05 DOI: 10.1080/14656566.2026.2740393

Haley Beck, Jennifer N Clements

{"title":"Considerations and challenges in microdosing of GLP-1-based receptor agonists.","authors":"Haley Beck, Jennifer N Clements","doi":"10.1080/14656566.2026.2740393","DOIUrl":"10.1080/14656566.2026.2740393","url":null,"abstract":"Introduction: This commentary summarizes the pharmacologic rationale, emerging evidence, clinical considerations, and limitations of microdosing glucagon-like peptide-1 (GLP-1)-based therapies. Microdosing of single or dual GLP-1 receptor agonists (RAs) has emerged as an off-label strategy to improve tolerability, reduce cost, and expand access during periods of medication shortages. Although standard doses of GLP-1-based RAs demonstrate robust efficacy for weight loss and glycemic control, many individuals experience dose-dependent gastrointestinal adverse effects or face financial and accessibility barriers. Because high-quality evidence is essentially absent, this commentary summarizes the pharmacologic rationale, real-world reports, clinical considerations, and limitations of microdosing.Areas covered: Microdosing - typically defined as the use of 25-50% of manufacturer-recommended starting doses or extended dosing intervals - has gained traction during recent shortages through patient communities, telemedicine-based weight loss programs, and clinician anecdotes. Techniques include 'click counting' with multidose pens or extended-interval dosing.Expert opinion: Early reports suggest potential benefits, including reduced nausea, improved adherence, and modest weight loss; however, high-quality clinical evidence remains limited, and safety concerns persist regarding compounded products, nonstandard dose measurement, and dosing accuracy.","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":" ","pages":"1-4"},"PeriodicalIF":3.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149037423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Contemporary first-line pharmacological management of Helicobacter pylori infection. 当代幽门螺杆菌感染的一线药理治疗。

IF 3.4 3区医学

Expert Opinion on Pharmacotherapy Pub Date : 2026-10-03 DOI: 10.1080/14656566.2026.2741491

Evripidis Rizos, Sotirios D Georgopoulos

{"title":"Contemporary first-line pharmacological management of Helicobacter pylori infection.","authors":"Evripidis Rizos, Sotirios D Georgopoulos","doi":"10.1080/14656566.2026.2741491","DOIUrl":"10.1080/14656566.2026.2741491","url":null,"abstract":"Introduction: Eradication of Helicobacter pylori has become challenging as antimicrobial resistance has risen worldwide. The efficacy of clarithromycin-based triple therapy has declined to unacceptable levels in most regions, urging a fundamental evaluation of first-line treatment and emergence of several competing regimens whose relative benefits depend on local resistance and drug availability.Areas covered: This review assesses the pharmacological basis and clinical evidence for contemporary first-line H. pylori eradication regimens in treatment-naive adults - bismuth quadruple, non-bismuth quadruple concomitant, potassium-competitive acid blocker-based, and rifabutin-based therapy. The impact of antimicrobial resistance, relative effectiveness of these regimens, current guideline recommendations, susceptibility-guided treatment, and safety and tolerability are examined. PubMed, the Cochrane Library, and Google Scholar were searched from January 2012 through August 2026, emphasizing the past five years.Expert opinion: Bismuth quadruple therapy is the preferred first-line option where available, given its resilience across resistance profiles; where bismuth is unavailable, concomitant quadruple therapy is appropriate provided dual clarithromycin-metronidazole resistance is low. Potassium-competitive acid blocker-based dual therapy is well-tolerated, but the evidence remains predominantly Asian. Susceptibility-guided therapy is ideal but constrained by limited testing and infrastructure. Improving outcomes depends less on new regimens than on resistance surveillance and susceptibility testing directing existing regimens where effective.","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":" ","pages":"1-15"},"PeriodicalIF":3.4,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Current perspectives on the pharmacologic treatment of boys and adolescents with congenital hypogonadotropic hypogonadism. 男孩和青少年先天性促性腺功能减退症的药物治疗现状。

IF 3.4 3区医学

Expert Opinion on Pharmacotherapy Pub Date : 2026-09-30 DOI: 10.1080/14656566.2026.2741490

Rodolfo A Rey, Romina P Grinspon

{"title":"Current perspectives on the pharmacologic treatment of boys and adolescents with congenital hypogonadotropic hypogonadism.","authors":"Rodolfo A Rey, Romina P Grinspon","doi":"10.1080/14656566.2026.2741490","DOIUrl":"10.1080/14656566.2026.2741490","url":null,"abstract":"Introduction: Congenital hypogonadotropic hypogonadism (CHH) in boys and adolescents requires age- and developmentally appropriate treatment to address androgen deficiency, testicular maturation, pubertal development, and ultimately fertility. The dynamic physiology of the hypothalamic-pituitary-testicular axis necessitates therapeutic strategies that differ substantially between infancy and adolescence.Areas covered: This review examines current pharmacological approaches to CHH across childhood and adolescence, focusing on testosterone, dihydrotestosterone, gonadotropins, pulsatile gonadotropin-releasing hormone (GnRH), and emerging kisspeptin-based therapies. Literature search was made in Pubmed for the period 1990-2026.Expert opinion: Testosterone remains the standard approach for inducing secondary sexual characteristics and effectively promotes virilization, growth, bone accrual, and psychosocial well-being, but does not induce testicular maturation or spermatogenesis. Gonadotropin therapy, particularly sequential follicle-stimulating hormone followed by luteinizing hormone or human chorionic gonadotropin, more directly promotes Sertoli-cell maturation, testicular growth, and spermatogenesis. Early gonadotropin treatment in infancy can reproduce several features of physiological mini-puberty, although its long-term reproductive benefits remain uncertain. Pulsatile GnRH is physiologically attractive but limited by availability and treatment complexity, whereas kisspeptin remains investigational. Treatment should be individualized according to developmental stage, testicular phenotype, therapeutic goals, anticipated fertility, treatment burden, and patient preferences. Major unmet needs include pediatric-specific formulations, optimized regimens, comparative trials, biomarkers of treatment response, and long-term reproductive outcomes.","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":" ","pages":"1-13"},"PeriodicalIF":3.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0