6.4.2 Male sex hormones and antagonists

Androgens

Testosterone should not be used for "male menopause" and should only be initiated following investigation by a consultant.

Testosterone oral

(Testosterone undecanoate)

  • Capsules 40mg (£23.94 = 120mg daily)

Indications

  • Androgen deficiency

Dose

  • Initially 120mg–160mg daily for 2–3 weeks; maintenance 40mg–120mg daily

Notes

  1. Oral testosterone is often not sufficient to provide adequate testosterone replacement
Testosterone intramuscular injection (IM)

(Testosterone propionate/ testosterone phenylpropionate/ testosterone isocaproate/ testosterone decanoate)

  • Sustanon® 250 solution for injection 250mg in 1ml (£2.45 = 1ml amp)

Indications

  • Male hypogonadism

Dose

  • Usual therapy is 250mg IM injection every 3-4 weeks.
  • For patients who report large swings in their symptomatic response, an alternative dosing schedule of a lower dose more frequently, may be given

Notes

  1. Contains arachis oil and is contraindicated in patients allergic to peanuts or soya
Testosterone intramuscular injection (IM) (long-acting)

(Testosterone undecanoate)

  • Nebido® oily solution for injection 250mg in 1ml (£87.11 = 4ml vial)

Indications

  • Male hypogonadism

Dose

  • 1g every 10-14 weeks, to be given over 2 minutes by deep intramuscular injection. A second dose may be given after 6 weeks to achieve rapid steady state plasma testosterone levels and then every 10-14 weeks
Testosterone transdermal gel
  • Testogel® gel 16.2mg/g (£31.11 = 88g pump)
    • One pump actuation delivers 1.25g gel containing 20.25mg testosterone
  • Testogel® gel 50mg/5g (£31.11 = 30 x 5g sachets)
    • One 5g sachet contains 50mg testosterone
  • Tostran® gel 2% (£28.67 = 60g pump)
    • One pump actuation delivers 0.5g gel containing 10mg testosterone

Indications

  • Male hypogonadism

Dose

  • Testogel® 16.2mg/g pump:
    • Apply 40.5mg (two actuations) once each morning. Increase dose in steps of 20.25 mg, according to response; maximum 81 mg per day (four actuations).
  • Testogel® 50mg/5g sachet:
    • Apply 50mg (1 x 5g sachet) once each morning. Increase dose in steps of 25mg according to response; max 100mg (2 x 5g sachet) daily
  • Tostran® 2% pump:
    • Apply 60mg (six actuations) once each morning. Adjust dose according to response; max 80mg (eight actuations) daily

Notes

  1. Avoid skin contact with gel application sites to prevent testosterone transfer to other people, especially pregnant women and children—consult product literature.
  2. Refer to individual product literature for specific application directions.
  3. Do not apply to the genital areas
  4. Wash hands with soap and water after applications

Anti-androgens

Cyproterone acetate
  • Tablets 50mg, 100mg (£55.19 = 300mg daily)

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 (£1.01)

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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