Androgens hypogonadism

Androgen replacement in male CF patients with documented hypogonadism may also benefit bone health but should be decided on an individual basis.10,27... 

Androgens are important for general sexual function and libido, but testosterone supplementation is only effective in patients with documented low serum testosterone levels. In patients with hypogonadism, testosterone replacement is the initial treatment of choice, as it corrects decreased libido, fatigue, muscle loss, sleep disturbances, and depressed mood. Improvements in ED may occur, but they should not be expected to occur in all patients.23 The initial trial should be for 3 months. At that time, re-evaluation and the addition of another ED therapy is warranted. Routes of administration include oral, intramuscular, topical patches or gel, and a buccal tablet. 

A 25-year-old male with hypogonadism is treated with a synthetic androgen. Which of the following is activated by a synthetic androgen ... 

In support of a role for androgens in sexual behavior is the finding that sexual interest or motivation is low in prepubertal boys and in men with various forms of hypogonadism (Burris, et al., 1992). Androgen treatments are typically associated with increased interest in sexual activities, as measured by self-report, as well as increases in nocturnal erections. However, increases in sexual behavior as a result of androgen treatments are less reliable, probably in part because men with a history of sexual inactivity may lack social skills or opportunities for sexual behavior. Social and historical variables, possibly also experienced as changes in other hormones, are critical determinants of masculine sexuality. 

Kwan, M., Greenleaf, W. J., Mann, J., Crapo, L., and Davidson, J. M. 1983. The nature of androgen action on male sexuality a combined laboratory self-report study on hypogonadal men. Journal of Clinical Endocrinology and Metabolism 57 557—562. 

Replacement therapy - Replacement therapy in hypogonadism associated with a deficiency or absence of endogenous testosterone. Prior to puberty, androgen replacement therapy is needed for development of secondary sexual characteristics. Prolonged treatment is required to maintain sexual characteristics in these and other males who develop testosterone deficiency after puberty. Appropriate adrenal cortical and thyroid hormone replacement therapy are still necessary, however, and are of primary importance. 

Androgens are used medically as replacement therapy in male hypogonadal disorders (i.e. impaired functioning of the testes). They are administered to adolescent males displaying delayed puberty to promote an increase in the size of the scrotum and other sexual organs. Androgens are also sometimes administered to females, particularly in the management of some... 

Methyltestosterone Synthetic androgen, longer circulatory half-life than testosterone Replacement therapy for male hypogonadal disorders. Breast cancer in females... 

Testosterone Main androgen produced by testes. Esterified forms display longer circulatory half lives Treatment of male hypogonadism. Also sometimes used in treatment of post-menopausal breast carcinoma and osteoporosis... 

Androgens come in oral, injectable, implantable, and topical preparations. Because of the toxicity of the oral preparations and the inconvenience of the injectable forms, the transdermal gels have been a major clinical advance for treatment of hypogonadal males. 

A highly fluorinated androgen agonist, LGD-2941, is in early clinical development for the treatment of several indications related to the beneficial effects of the androgen receptor activation (e.g., hypogonadism). 

Mechanism of Action A synthetic testosterone derivative with androgen activity that promotes growth and development of male sex organs and maintains secondary sex characteristics in androgen-deficient males, TIicrapcuticE/fcct Treats hypogonadism in males. 

S. Bhasin (1993). Androgen treatment of hypogonadal men. J. Clin. Endocrinol. Metab. 81 757. 

Androgens and anabolic agents have been used in the treatment of osteoporosis, either alone or in conjunction with estrogens. With the exception of substitution therapy in hypogonadism, bisphosphonates have largely replaced androgen use for this purpose. 

Schleich F, Legros J-J. Effects of androgen substitution on hpid profile in the adult and aging hypogonadal male. Eur J Endocrinol 2004 151 415-24. 

Because ketoconazole has antiandrogenic properties, it is particularly suitable for women, in whom it has few effects on menstruation and does not cause hirsutism. In men, however, long-term inhibition of androgen production can be disruptive, especially if it leads to gynecomastia and hypogonadism. Combination with ami-noglutethimide and metyrapone has been advocated in order to avoid these effects (SEDA-17, 323). 

Replacement Therapy. Testosterone and other androgens are administered as replacement therapy when the endogenous production of testosterone is impaired. Such conditions include removal of the testes (orchiectomy), various intrinsic forms of testicular failure (cryptorchidism, orchitis), and problems in the endocrine regulation of testosterone production, such as lack of LH production and other forms of hypogonadism.32,144... 

The use of testosterone replacement therapy for the treatment of hypogonadism and ED may assist PDE5 inhibitors if they have failed to be effective (57). Testosterone levels within the normal range have neutral or potentially beneficial effects on the cardiovascular system (58). Androgen replacement therapy should be offered to men with CAD and hypogonadism if symptomatically appropriate. The absence of long-term studies needs to be addressed in terms of possible preventive properties on the vascular wall, reduction in low-density lipoprotein levels, and the reduction of insulin resistance in contrast to the increase in hematocrit and risk of exacerbating prostate cancer. 

Androgenic effects Androgenic steroids are used in males with inadequate androgen secretion. [Note Hypogonadism can be due to Leydig cell dysfunction or, secondarily, to failure of the hypothalamic-pituitary unit. In each instance, androgen is indicated.]... 

By contrast, deficiency of 17-hydroxylase results in impaired ability of the gonads (as well as the adrenals) to synthesize androgens (males) or estrogen (females) patients subsequently manifest with problems typically associated with primary hypogonadism. Deficiency of 17-hydroxylase is similar to that of 11 (3-hydroxylase in that there is adrenal overproduction of min-eralocorticoids, resulting in sodium retention and high blood pressure. Differential diagnosis is usually facilitated by examination of the complete profile of adrenocortical steroid hormones. 

With regard to the development of osteopenia or osteoporosis with hypogonadism in males, lack of androgens is considered as a risk factor from the point of view of the quality of the bone. Anabolic steroids act on the bone probably through the androgen receptors on the osteoblasts, but an inhibitory effect on the osteoclasts is also possible. The condition affects mainly the cortical phase of the bone. When anabolic steroids are applied in females, they are usually combined with estrogens. Their application acts preventively against the loss of bone mass, stimulates osteoformation, and reduces the risk of hip fracture. 

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