24.11.2020

Hormone replacement therapy in men: testosterone

Preparations on the basis of testosterone used for over 70 years, but with the improvement of the quality of their pharmacology is different: when conducting hormone replacement therapy currently, the number of side effects is less and the efficiency is incomparably better.

The first synthetic testosterone was produced only in tablet form and had a negative effect on the organs of the biliary system; their main metabolism occurred in the liver, a large part of the testosterone is destroyed, and the risk of toxic hepatitis, peloza and liver cancer were significant.

Preparations on the basis of methyltestosterone, fluoxymesterone no longer used, and they were replaced by modern drugs for hormone replacement therapy.

The diversity of forms of production allows to choose the drug that best meets the indications for the use. In pharmacies with a prescription you can buy tablets, capsules, gels, creams, patches, injections; the route of administration may be oral, transdermal, and injectable translocally.

Abroad use implants placed under the skin. Validity period – 6 months.

What drugs for hormone replacement therapy in men better

Oral formulations are less efficiency, even when using large doses. With a slight hormonal deficiency to use them. One of the known drugs Andriol, which mostly enters the systemic circulation and is not subject to inactivation by the liver. The concentration needed for effect develops rapidly, but also quickly, within 3-4 hours of the action ending. Therefore, to achieve the desired therapeutic effect of Andriol taken 2-3 times a day, mostly from fatty foods. Suitable for the treatment of moderate androgen deficiency and hypogonadism.

The injectable form is better for carrying out of hormone replacement therapy in men. Famous representatives – Sustanon, Omnadren, of the medications based on testosterone cypionate and enanthate. After injection, the maximum concentration is achieved in 48-72 hours, and then gradually decreases, and after 2 weeks comes to a minimum.

Please note

When treatment with injectable forms of the described effect of “roller coaster” after the introduction on the second day increases mood, stamina, libido, and then the influence of drugs leveled, and requires another dose. Negative aspects include supra-physiological effect, when the concentration of hormones exceeds the required threshold.

The change in condition of the patient under the influence of injections is one of the side effects of injections of testosterone.

Low cost and relative accessibility allows, in spite of adverse effects, use of these drugs today.

Nebido (testosterone undecanoate) is the most efficient drug to prolong from this group. Frequency of administration – 1 injection is 2.5-3 months. Andrologists and endocrinologists like Nebido for the absence of hormonal surges (it has a peak enhancement concentration), ease of implementation, the full range of actions and minimizing the negative impact on the liver.

Transdermal forms appeared on the market relatively recently, they provide a physiological “smooth” level of testosterone. Many patients previously experiencing the problems of testosterone enanthate, received pharmacologically effective replacement.

The disadvantages are not quite easy to use. So, the patch of Testoderm attached to the scrotum, and of Androderm, which is mounted on the skin, in addition to the active substance, contains a helper which with prolonged use can cause irritation.

Certain problems in the application create the following:

  • water treatments can take only 6 hours;
  • skin diseases, prevent the use of transdermal preparations;
  • the hot climate and associated increased perspiration reduce the effectiveness of the action. In addition, there is a risk of transfer of the active substance when touched partner.

It is important

The 6-year European study of men treated for hypogonadism, long-term transdermal testosterone treatment did not increase the level of prostate-specific antigen (PSA) and did not affect the risk of developing prostate cancer.

Indications for hormone replacement therapy in men

Hormonal replacement therapy is justified under the following conditions:

Contraindications

Relative:

  • chronic nicotine intoxication;
  • obstructive pathology of lungs;
  • polycythemia;
  • benign hyperplasia of the prostate.

Please note

You can not use testosterone cypionate interchangeably with testosterone propionate.

Side effects from hormone replacement therapy

It is important

To take hormones at its discretion and without examination is not recommended.

A list of adverse events is impressive:

  • acne;
  • apnea;
  • changing mental reactions: irritability, aggressive behavior, amnesia, insomnia;
  • alopecia;
  • anaphylaxis;
  • dysuric disorders;
  • engorgement of the breast, gynecomastia;
  • headache;
  • the tides;
  • increase of level of cholesterol;
  • priapism;
  • itchy skin and rashes;
  • seborrhea;
  • fluid retention;
  • thromboembolism;
  • increase in blood pressure;
  • azoospermia;
  • the reduction in the size of their own eggs in the presence of atrophy;
  • the progression of benign prostatic hyperplasia.
Androgen deficiency in aged men

Syndrome androgen deficiency in men – a combination of clinical manifestations with a violation of the biochemical parameters, which is caused by age-related changes with the decline in testosterone levels.

It is known that 98% of testosterone in the body is associated with the protein form and free testosterone accounts for only 2%. Testosterone has a high activity and is considered a prohormone (precursor). For the transition into the active form (dihydrotestosterone) need the enzyme 5-alpha-reductase.

Please note

A study conducted in Massachusetts, showed that testosterone levels are not stable throughout life and begins to decrease by 2-3% per year from the fourth decade of life, and after 50 0.8-1.6%.

Androgen deficiency is manifested clinically by a combination of symptoms:

  • decreased sex drive;
  • violation of erectile function;
  • drowsiness;
  • a decrease in bone density;
  • loss of pubic hair;
  • reducing abilities;
  • mood swings.

By themselves, the symptoms are not indicative of the final diagnosis of androgen deficiency, the final conclusions can be made after the results of the survey.

Two main groups for carrying out of hormone replacement therapy in men exogenous androgens and drugs that stimulate the production of testosterone.

Recently to combat hypoestrogenia examines the use of human chorionic gonadotropin affecting hypothalamo-pituitary system, and, indirectly, on the Leydig cells that synthesize testosterone.

As there is no sufficient information about the effect of HCG on the male body and side effects, for the correction of age-related hormone deficiency human chorionic gonadotropin does not apply. Exception when age man planning parenthood.

Treatment with human chorionic gonadotropin does not lead to a deterioration of semen.

The danger of self-medication
Side effects on the cardiovascular system

The most common negative effects of the nonsteroidal sex hormones on the cardiovascular system include:

  • increased heart rate;
  • increase in blood pressure;
  • violation of lipid metabolism: reduction of high density lipoprotein (HDL) and elevated low-density lipoprotein (LDL);
  • ventricular arrhythmias.
Side effects on the liver

All anabolic steroids to one degree or another possess hepatotoxic effects.

The higher dose of hormones, the greater the possibility of increased ALT/AST and bilirubin.

The use of hormonal drugs also leads to suppression of clotting factors II,V,VII and X and an increase in prothrombin time. Other life-threatening adverse effect from liver – peliosis which is characterized by the appearance krovenapolnenia, cystic structures. These cysts can be complicated by bleeding, withdrawal of drugs usually leads to recovery.

Anabolic steroids are considered as risk factors of nonalcoholic fatty liver disease.

Other hepatic adverse effects associated with the abuse of androgenic drugs include subcellular changes of hepatocytes, hepatocellular hyperplasia and total liver damage.

Side effects on the endocrine system

Endogenous testosterone and spermatogenic functions of the testes in patients receiving anabolic steroids are blocked, as suppressed production of FSH.

In addition, the uncontrolled administration of testosterone alters the function of the pancreas and thyroid glands.

Side effects on urogenital tract

The prostate is very sensitive to androgens in response to stimulation, it increases in size. The negative trend is particularly noticeable if initially there is BPH. On the background of disorders of urine outflow the expected recurrent urinary tract infection, hydronephrosis of the kidneys, bleeding and other complications.

Other negative effects include impotence, priapism and infertility.

It is important

Anabolic steroids in athletes often leads to the atrophy of the testicles and infertility.

The effect on the hematopoietic system

The direct reduction in the production of blood clotting factors leads to increased prothrombin time. In patients receiving anticoagulants and anabolic steroids, there is a risk of bleeding.

Side effects of the skin

Hairy part of the scalp is rich in receptors that are sensitive to testosterone. Hair loss is one of the reactions to exogenous testosterone.

In addition, impaired production of sebum that leads to acne.

Side effects from the nervous system

Research is being conducted, preliminary data which show that the abuse of hormones leads to neurotoxic lesions. Deteriorating cognitive abilities, visual memory is weakened.

Another study showed that Nandrolone and Methandrostenolone potentially increase the risk of Alzheimer’s disease and progression of neurodegenerative diseases.

Anabolic steroids modify the behavior that is typical:

  • mood swings;
  • aggressiveness;
  • anxiety;
  • depression;
  • violation of libido.
What to look for when hormone treatment

Given the many serious side effects, it is necessary to control the functions of organs and systems:

  • A study of liver samples: before ontogenetically therapy, 1 every 3 months in the first year, then 2 times a year, or immediately upon appearance of specific complaints.
  • Study of lipid profile before treatment, if you have the prerequisites for pathology – 1 time in 3-4 months.
  • Transrectal ultrasound examination, blood PSA, transrectal digital examination in men aged 40 or older – 1 every 3 months in the first year and then 6-12 months.
  • ECG 2 times a year.
  • Control of sperm in patients who expect paternity (if not absolute sterility, for example, on the background of genetic disease);
  • General analysis of blood coagulation.
  • OAM, urea and creatinine.
  • Ultrasound examination of abdominal cavity.
  • Study of hormonal profile of thyroid gland.
  • Control of blood sugar.

It is important

May require consultation with an endocrinologist, hematologist, urologist, oncologist, internist, neurologist, etc.

Hormone replacement therapy should appoint a doctor, taking into account many factors. The expected benefits from treatment exceed the possible risks. Self-interference in the hormonal background will inevitably lead to negative consequences, which are not always reversible.

Victoria Mishina, urologist, medical columnist

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