Androgens cause masculinization; they may be used as replacement therapy in castrated adults and in those who are hypogonadal due to either pituitary or testicular disease. In the normal male, they inhibit pituitary gonadotrophin secretion and depress spermatogenesis. Androgens also have an anabolic action which led to the development of anabolic steroids. When given to patients with hypopituitarism they can lead to normal sexual development and potency but not to fertility.
TESTOSTERONE AND ESTERS
TESTOSTERONE UNDECANOATE:
Indications: Androgen deficiency.
Contraindications: breast cancer in men, prostate cancer, history of primary liver tumors, hypercalcemia, pregnancy, breastfeeding, nephrotic syndrome.
Dose and Administration: 120–160 mg daily for 2–3 weeks; maintenance 40– 120 mg daily.
TESTOSTERONE ENANTATE:
Indications: hypogonadism.
Contraindications: breast cancer in men, prostate cancer, history of primary liver tumors, hypercalcemia, pregnancy, breastfeeding, nephrotic syndrome.
Dose and Administration: By slow intramuscular injection, hypogonadism, initially 250 mg every 2–3 weeks; maintenance 250 mg every 3–6 weeks. Breast cancer, 250 mg every 2–3 weeks.
TESTOSTERONE UNDECANOATE:
Indications: hypogonadism in men over 18 years.
Contraindications: breast cancer in men, prostate cancer, history of primary liver tumors, hypercalcemia, pregnancy, breastfeeding, nephrotic syndrome.
Dose and Administration: By deep intramuscular injection, hypogonadism in men over 18 years, 1 g every 10–14 weeks; if necessary, the second dose may be given after 6 weeks to achieve rapid steady-state plasma testosterone levels and then every 10–14 weeks.
TESTOSTERONE:
Indications: hypogonadism in men over 18 years.
Contraindications: breast cancer in men, prostate cancer, history of primary liver tumors, hypercalcemia, pregnancy, breastfeeding, nephrotic syndrome.
Dose and Administration: Hypogonadism due to androgen deficiency in men (over 18 years), 50 mg testosterone (5 g gel) to be applied once daily; subsequent application adjusted according to response in 25-mg (2.5 g gel) increments to a max. 100 mg (10 g gel) daily
MESTROLONE:
Indications: Androgen deficiency and male infertility associated with hypogonadism.
Contraindications: breast cancer in men, prostate cancer, history of primary liver tumors, hypercalcemia, pregnancy, breastfeeding, nephrotic syndrome.
Dose and Administration: 25 mg 3–4 times daily for several months, reduced to 50–75 mg daily in divided doses for maintenance; child not recommended.
Anti-androgens CYPROTERONE ACETATE:
Indications: hypersexuality and sexual deviation in the male. also used as an adjunct in prostatic cancer, and in the treatment of acne and hirsutism in women.
Contraindications: hepatic disease, severe diabetes (with vascular changes); sickle-cell anemia, malignant or wasting disease, severe depression, history of thrombo-embolic disorders; youths under 18 years
Dose and Administration: Male hypersexuality, 50 mg twice daily after food.
DUTASTERIDE:
Indications: benign prostatic hyperplasia
Contraindications: severe hepatic impairment, women, children, and
adolescents.
Dose and Administration: 500 micrograms daily (may require 6 months’
treatment before benefit is obtained).
FINASTERIDE:
Indications: benign prostatic hyperplasia; male-pattern baldness in men
Contraindications: severe hepatic impairment, women, children, and adolescents. also obstructive uropathy.
Dose and Administration: 5 mg daily, review treatment after 6 months (may require several months’ treatment before benefit is obtained).
