Androgens in Health and Disease.pdf - E Library

Chapter 22/Androgens in Primary Care 431
Table 6
Commercially Formulations of Testosterone Therapy
Treatment Cost
Dosage serum testosterone Adverse drug effects per mo
Androderm ®
5-mg patch on Low- to mid- ~35–70% develop ~$110
patch (Watson) torso, arms,
or legs daily
normal range skin rash
Testoderm ®
5-mg patch on Low- to mid- Poor adherence to ~$95
scrotal patch shaved scrotal normal range scrotal skin
(Alza) skin daily
Testoderm TTS ®
4- or 6-mg patch on Low- to mid- ~10% develop ~$100
patch (Alza) torso, arms, or
buttocks daily
normal range skin rash
Androgel ®
5–10 g on upper arm Mid- to upper- Possible transfer to ~$150
(Unimed) or abdomen daily normal range female partners
Testosterone 100–250 mg im Mid- to slightly Pain with injections $2–4 ±
cypionate or every 7–14 d supraphysio- office
testosterone
enanthate
logical range visit
Source: Data from refs. 52–54.
above the normal male range 24–48 h after administration, and then serum levels
gradually decline and remain in the normal eugonadal range over the next 2 wk (55,56).
Serum gonadotropins are often suppressed by exogenous intramuscular testosterone
therapy, and serum gonadotropins cannot be used as reliable markers to adjust the
dosage of androgen replacement (unlike TSH in hypothyroidism). Therefore, adjustment
of the dosage of intramuscular testosterone is generally based on a patient’s
symptomatology and not on serum hormone levels. Some experts recommend checking
a serum total-testosterone on the day halfway between injections to verify that
levels are in the midnormal range, but this is not essential (57). In general, the starting
dosage of intramuscular testosterone is 150–200 mg every 2 wk. For older men or
younger men with very low serum testosterone levels, rapid normalization of serum
androgen levels may be unpleasant (analogous to the abrupt onset of a second puberty).
In these clinical situations, it is prudent to start with lower dosages of intramuscular
testosterone ester (50–100 mg every 2 wk) or to use transdermal androgen-replacement
therapy. Because older men are more likely to develop erythrocytosis while
being administered intramuscular testosterone, 150 mg biweekly is often the maximum
tolerable dosage (58). Some men who are receiving intramuscular testosterone
150–200 mg every 14 d will notice disturbing fluctuations in mood, energy, and sexual
function associated with rapidly fluctuating testosterone levels. Reducing the interval
between injections to 75–100 mg every 7 d or switching to a transdermal therapy that
gives more physiologic variations in testosterone levels might be useful.
Intramuscular testosterone injections are generally well tolerated (59). In fact, anecdotal
reports suggest that many hypogonadal men seem to prefer the higher peak test-