Testosterone therapy adverse effects

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. 

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... 

The use of transdermal patches for administering testosterone to hypogonadal men ( Andropatch ) seems logical and convenient, but a British study in 50 treated patients showed that patient acceptance was surprisingly poor (70). There were adverse effects in 84%, mostly skin problems 72% requested a return to depot injections, and 5% returned to oral therapy. The reservoir patches, 6 cm in diameter, were, to quote the report hteraUy, judged to be too large. 

Another variant on hormone replacement therapy involves using aU three types of sex steroid in parallel, starting from the argument that during the fertile period all three are sjmthesized by the ovary (7). A natural version of this therapy uses estradiol, testosterone (with or without dehydroepiandrosterone), and progesterone in an appropriate pharmaceutical form (for example micro-nized), so that absorption is attained without the need for 17-substitution. This approach naturally avoids some of the undesirable effects of the synthetic steroids, and has been stated to improve menopausal depression and anxiety. However, the adverse effects of all three types of component can be experienced. 

Fernandez-Balsells MM, Murad MH, Lane M, Lampropulos JF, Albuquerque F, Mullan RJ, Agrwal N, Elamin MB, Gallegos-Orozco JF, Wang AT, Erwin PJ, Bhasin S, Montori VM. Adverse effects of testosterone therapy in adult men. A systematic review and meta-analysis. J Clin Endocrinol Metab 2010 95 2560-75. 

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