Testosterone adverse effects

In some animals, consumption of a phytoestrogen-rich diet can cause temporary infertility and reproductive system disorders (Irvine, 1999). In humans, lower testosterone levels and a decline in human semen quality over the past century have been luiked to increased exposure to environmental endocrine disrupters (EDCs) (Sharpe and Skakkebaek, 1993). Furthermore, cases of sexual impotence have been reported in males exposed to synthetic estrogens in the pharmaceutical industry (Mattison et al., 1990). If this might be the case, the fetal-prepubertal period and Sertoli cell development would be of critical importance (Sharpe and Skakkebaek, 1993). However, an adverse effect of phytoestrogens on male fertility has yet to be proven. Recent work (Mitchell et al., 2001) addressing this point led to the conclusion that up to 40 mg/day of isoflavones over a two-month period had no effects on gonadotrophin and... 

Oral testosterone products are also available for supplementation. Unfortunately, testosterone has poor oral bioavailability and undergoes extensive first-pass metabolism. Alkylated derivatives such as methyltestosterone and fluoxymesterone have been formulated to compensate for these problems, but this modification makes them considerably more hepatotoxic. This adverse effect makes oral replacement undesirable and this route of administration should not be used. 

Ketoconazole inhibits a variety of cytochrome P450 enzymes, including 11-hydroxylase and 17-hydroxylase. It is highly effective in lowering cortisol in Cushing s disease, and patients can be maintained successfully on therapy for months to years. The most common adverse effects are reversible elevation of hepatic transaminases and GI upset. It can cause gynecomastia and lower plasma testosterone values. 

Prenatal and postnatal exposures to fenvalerate reduced prostate and seminal vesicle weights and plasma testosterone levels in male rats [55], A chronic study showed no adverse effects on reproductive tissues at a high dose level of 1,000 ppm [142]. In vivo and in vitro studies with rats and mice suggested that fenvalerate may affect male and female reproduction, possibly due to calcium transport alteration [143-146], One paper reported that fenvalerate affected human sperm count and sperm motility of male workers who were exposed to fenvalerate in a pesticide factory [147]. 

Adverse effects include changes in libido and the occurrence of oedema, weight gain and gynecomastia, may occur. Androgens are potentially hepato-toxic, testosterone less than methyltestosterone and fluoxymesterone. Androgens can potentiate anticoagulant action. 

Testolactone is a synthetic drug related to testosterone. It is used for palliative treatment of advanced breast cancer in postmenopausal women and in women who have had their ovaries removed. The principal action of testolactone is reported to be inhibition of steroid aromatase activity and the reduction in estrone synthesis. The most common adverse effects are nausea, vomiting, and anorexia. An advantage is that it does not cause women to develop male characteristics such as a deep voice or facial hair. 

B. The only time testosterone is indicated for the treatment of erectile dysfunction is if the cause is clearly related to hypogonadism. In other situations, the adverse effects related to testosterone and its limited effectiveness preclude its use. 

Anabolic-androgenic steroids (AAS), which are analogs of the male hormone testosterone, are used among athletes and bodybuilders. AAS alter the hormonal systems of males and females, and induce many adverse effects. In addition to the sex-related changes, violent behavior and psychological dependence can also occur. The use of AAS in professional sports as well as in high school sports has aroused considerable attention. 

Other reported adverse effects of gonadotropin treatment are headache, depression, edema, precocious puberty, and (rarely) production of antibodies to hCG. In men treated with gonadotropins, the risk of gynecomastia is directly correlated with the level of testosterone produced in response to treatment. An association between ovarian cancer, infertility, and fertility drugs has been reported. However, it is not known which, if any, fertility drugs are causally related to cancer. 

The adverse effects of long-term testosterone therapy in HIV-positive men are irritability, weight gain, fatigue, hair loss, reduced volume of ejaculate, testicular atrophy, truncal acne, breast tenderness, and increased aggression... 

Buccal testosterone tablets provide sustained release of testosterone and also bypass first-pass metabolism in the liver. Small-scale work with a bioadhesive buccal tablet of testosterone has shown that adequate serum concentrations can be obtained and that the buccal tablet (administered twice daily) is well tolerated (102). Other work has confirmed that twice-daily buccal application is optimal to maintain therapeutic serum concentrations of testosterone and its metabolites (103-105) however, it appears that about one patient in six initially has a degree of oral discomfort from the presence of the mucoadhesive tablet, although this fades after a few days and does not seriously affect compliance. Common adverse effects of buccal testosterone include gum irritation, pain, and tenderness, and edema (106) and headache (107). 

In an open comparative study of androgenetic alopecia in 90 men oral finasteride (1 mg/day for 12 months n = 65) was compared with 5% topical minoxidil solution twice daily (n = 25) (22). The cure rates were 80% for oral finasteride and 52% for topical minoxidil. The adverse effects were all mild, and did not lead to withdrawal of treatment. Of the 65 men given oral finasteride, six had loss of libido, and one had an increase in body hair at other sites irritation of the scalp was seen in one of those who used minoxidil. These adverse events disappeared as soon as the treatment was withdrawn. The laboratory data did not show any statistically or clinically significant changes from baseline values to the endpoint, except for the serum total testosterone concentration, which was increased, and free testosterone and serum prostate-specific antigen in the finasteride group which were reduced from baseline values. 

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