Testosterone Therapy
Male hypogonadism is the main indication for testosterone. Table 21.1 provides an overview of other possible applications. Some of these applications are dealt with in other chapters of this volume, for example in constitutionally delayed puberty (Chap. 1
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Testosterone Therapy Eberhard Nieschlag and Hermann M. Behre
Contents 21.1
Indications and Preparations: An Overview .......................................................... 437
21.2
Pharmacology of Testosterone Preparations .......................................................... 439 21.2.1 21.2.2 21.2.3 21.2.4 21.2.5
21.3
Oral Testosterone Preparations ............... Buccal Administration ............................ Intramuscular Testosterone Preparations Transdermal Testosterone Preparations .. Testosterone Implants .............................
439 441 442 444 445
Monitoring Testosterone Therapy in Hypogonadism .................................................. 446 21.3.1 21.3.2 21.3.3 21.3.4 21.3.5
Psyche and Sexuality .............................. Somatic Parameters................................. Laboratory Parameters ............................ Prostate and Seminal Vesicles ................. Bone Mass and Muscles .........................
446 447 447 449 450
21.4
Evaluation of Testosterone Substitution Therapy ............................................ 451
21.5
Excessive Height .................................................... 451
21.6
Misuse and Abuse of Anabolic Steroids .............. 452
References ........................................................................... 453
21.1 Indications and Preparations: An Overview All forms of hypogonadism described in the previous chapters associated with Leydig cell insufficiency require testosterone therapy. In secondary hypogonadism long-term testosterone therapy is also indicated. This is only to be interrupted for GnRH or gonadotropin therapy when offspring are desired. Male hypogonadism is the main indication for testosterone. Table 21.1 provides an overview of other possible applications. Some of these applications are dealt with in other chapters of this volume, for example in constitutionally delayed puberty (Chap. 12), in lateonset hypogonadism (LOH) (Chap. 14), in male hormonal contraception (Chap. 29) and in idiopathic male infertility (Chap. 22). In addition, this chapter deals with its use in excessively tall stature (Sect. 21.5) and with its abuse in doping and body building (Sect. 21.6). Because of its erythropoetic effect testosterone is also licensed for the treatment of aplastic and renal anemia, but lost ground to erythropoetin after the Table 21.1 Use of testosterone in men Clinical applications
E. Nieschlag () Centre of Reproductive Medicine and Andrology of the University, Domagkstr. 11, D-48149 Münster/Germany e-mail: [email protected]
Off-label use Application under discussion Experimental use Obsolete application Abuse
E. Nieschlag et al. (eds.), Andrology, DOI: 10.1007/978-3-540-78355-8_21, © Springer-Verlag Berlin Heidelberg 2010
Hypogonadism Primary hypogonadism Secondary hypogonadism LOH Delayed puberty Aplastic and renal anemia Excessive growth Aging male Male contraception Idiopathic infertility High-performance athletics and bodybuilding
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E. Nieschlag and H. M. Behr
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