Androgens, circulating

The adult male prostate contains abundant acid phosphatase which it secretes into the semen. The production of this enzyme is governed by the circulating levels of androgenic hormones. Castration or estrogen administration markedly reduces the prostatic urinary acid phosphatase of males. Other organs such as the liver, kidney, spleen, red cells and platelets also contain significant amounts of acid phosphatase. 

Specifically, for women with PCOS, the use of depot and intermittent oral medroxyprogesterone acetate suppresses pituitary gonadotropins and circulating androgens.15 Further, the use of cyclic progesterone may benefit women over age 40 and in whom anovulatory bleeding occurs.11... 

Bilateral orchiectomy, or removal of the testes, rapidly reduces circulating androgens to castrate levels (andro-stenedione less than 50 ng/mL, 1.7 nmol/L).15 However, many patients are not surgical candidates owing to their advanced age, and other patients find this procedure psychologically unacceptable.15 Orchiectomy is the preferred initial treatment in patients with impending spinal cord compression or ureteral obstruction. 

Testosterone (T.) derivatives for clinical use. T. esters for im. depot injection are T. propionate and T. heptanoate (or enanthate). These are given in oily solution by deep intramuscular injection. Upon diffusion of the ester from the depot, esterases quickly split off the acyl residue, to yield free T. With increasing lipophilicity, esters will tend to remain in the depot, and the duration of action therefore lengthens. A T. ester for oral use is the undecanoate. Owing to the fatty acid nature of undecanoic acid, this ester is absorbed into the lymph, enabling it to bypass the liver and enter, via the thoracic duct, the general circulation. 17-0 Methyltestosterone is effective by the oral route due to its increased metabolic stability, but because of the hepatotoxicity of Cl 7-alkylated androgens (cholestasis, tumors) its use should be avoided. Orally active mesterolone is 1 a-methyl-dihydrotestosterone. Trans-dermal delivery systems for T. are also available. 

In the human female, IGF-1 is expressed by follicular theca cells, while IGF-2 is synthesized by granulosa cells (Chapter 8). The IGF-1 and -2 receptors are widely expressed in ovarian tissue, and synthesis of both growth factors and their receptors are influenced by circulating gonadotrophin levels. IGF-1 exerts a direct mitogenic effect on human granulosa cells, and promotes increased androgen and oestradiol synthesis by these cells. IGF-1 also promotes increased expression of FSH and LH receptors in ovarian tissue. 

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