6.4.2 Male sex hormones and antagonists

Androgens

Testosterone
  • Capsule 40mg (£23.94 = 120mg daily)
  • Sustanon 250® injection in 1ml (£2.45 = 1ml)
  • Nebido® injection 250mg in 1ml (£21.78 = 4ml)
  • Gel 50mg/5g, 10mg / metered application (£32.00)

Indications

  • Androgen deficiency (40mg capsules or Sustanon 250®)
  • Hypogonadism (buccal tablets m/r 30mg, Nebido® injection, implants or gels)

Dose

  • Capsules, 120–160mg daily for 2–3 weeks; maintenance 40–120mg daily
  • Sustanon 250®, 1ml usually every 3 weeks
  • Nebido® by deep intramuscular injection over 2 minutes, 1g every 10–14 weeks; if necessary, second dose may be given after 6 weeks to achieve rapid steady state plasma testosterone levels and then every 10–14 weeks
  • Gel 50mg/5g, 5g applied once daily; subsequent application adjusted according to response; maximum 10g daily
  • Gel 10mg, 3g applied once daily; subsequent applications adjusted according to response; maximum 4g daily

Notes

  1. To be initiated by a consultant only
  2. Oral testosterone is often not sufficient to provide adequate testosterone replacement
  3. Testosterone should not be used for "male menopause" and should only be initiated following investigation by a consultant

Anti-androgens

Cyproterone acetate
  • Tablets 50mg, 100mg (£87.00 = 50mg x 168 tablets)

Indications

  • Polycystic ovary disease
  • Hirsutism in women

Notes

  • Direct hepatic toxicity including jaundice, hepatitis and hepatic failure has been reported (usually after several months) in patients treated with cyproterone acetate 200-300mg daily. Liver function tests should be performed before treatment and whenever symptoms suggestive of hepatotoxicity occur-if confirmed cyproterone should normally be withdrawn.
  • In women of child bearing potential cyproterone must be used with cyclical oestrogen or in the form of co-cyprindiol. Please refer to chapter 13.
  • Cyproterone is contra-indicated in patients with a history of thrombo-embolic disorders

5 alpha-reductase inhibitors

Finasteride
  • Tablets 5mg (£1.12)

Indications

  • benign prostatic hyperplasia

Dose

  • 5mg daily, review treatment at 3–6 months and then every 6–12 months (may require several months' treatment before benefit is obtained)

Notes

  • Finasteride results in shrinkage of prostatic glandular tissue. The evidence suggests that it can reduce the risk of acute urinary retention and need for surgery, although such events are relatively uncommon. It may be useful in men whose prostates are particularly large where TURP/surgery is not indicated or desired. Improvement may take 6 months to be observed.
  • Finasteride is also used for hirsuitism (unlicensed).

 

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