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Testosterone is one of the prerequisites for male differentiation during embryonic development. Physiologic serum testosterone levels are also necessary for many organ and cell functions by stimulatory effects on bones, bone marrow, muscles, liver, skin with sebaceous glands and melanocytic cells, hair, spermatogenesis, prostate gland, penis and renal erythropoietin producing cells. Treatment of male patients with coronary heart disease has been shown to improve clinical and ECG parameters.
Testosterone was found to be effective in the treatment of diseases associated with hypogonadism such as AIDS and rheumatoid arthritis. In addition, data from clinical studies have demonstrated a reduction of body weight, body fat and erectile dysfunction in patients with type II diabetes but without clearly defined hypogonadism.
However, the main indication of testosterone substitution is the treatment of hypogonadism in adult men leading to an improvement in bone mineral density, quality of life, muscle mass, libido and mood.
The majority of studies in aging men has shown positive effects on visceral fat mass, blood pressure, insulin resistance and the symptom complex related to partial androgen deficiency of the aging male. Testosterone substitution causes significant increases of hematocrit and haemoglobin and induces growth of the prostate gland until the size of that of age-matched eugonadal controls. Long-term treatment of older hypogonadal men with testosterone has not been associated with increased risk of prostate gland cancer or hepatotoxicity.
Inconsistent changes of serum lipid levels have been observed during testosterone therapy, with increase, decrease or no changes of total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol.
In addition to the intramuscular injection of testosterone esters, oral, buccal, and transdermal substitution therapy or implantation of pellets has been established. In case of side effects or new contraindications, testosterone serum levels will decrease within very short periods after discontinuation of oral and transdermal testosterone treatment.
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