Testosterone therapy dosing

Oettel M (2003) Testosterone metabolism, dose-response relationships and receptor polymorphisms Selected pharmacological/toxicological considerations on benefits versus risks of testosterone therapy in men. Aging Male 6 230-256. 

The goal of testosterone therapy in hypogonadal men is to mimic as closely as possible the normal serum concentration therefore, serum testosterone concentration must be monitored. With transdermal patches, the serum testosterone concentration fluctuates during the 24-hour period, with a peak value 6—9 hours after application and a nadir (about 50% of the peak) just before the next patch is applied (Figure 58-6). With testosterone gels, the mean serum testosterone concentration is relatively constant from one application to the next. Occasional random fluctuations can occur, so measurements should be repeated for any dose. When the enanthate or cypionate esters of testosterone are administered once every 2 weeks (typically in a dose of200 mg), the serum testosterone concentration measured midway between doses should be normal if not, the dose should be adjusted accordingly. 

Teriparatide can be used if bisphosphonates are not tolerated or contraindicated. Testosterone replacement therapy should be considered in men, and high-dose hormonal oral contraceptives can be considered for premenopausal women with documented hypogonadism. 

Measure serum testosterone levels 14 days after initiation of therapy to ensure proper dosing. If the serum testosterone concentration is below the normal range, or if the desired clinical response is not achieved, the dose may be increased from 5 to 7.5 g AndroGel) or 10 g Testim) and from 7.5 to 10 g AndroGel), as instructed by the physician. 

Testosterone is available as oral testosterone undecano-ate, buccal testosterone, intramuscular testosterone esters, testosterone implants, and testosterone transdermal patches and gel. Proponents of transdermal testosterone products, such as gels and scrotal or non-scrotal dermal patches, claim that they have a good safety profile (101). Transdermal testosterone replacement certainly improves bone mass and lean body mass, reduces fat mass, and improves mood and sexual function. There are said to be no harmful effects on the prostate and lipids. Acne, polycythemia, and gynecomastia are stated to be less common with this form of therapy than with the intramuscular esters. To date these claims must be regarded with some reservations it is not at all clear that in equieffective doses the local or topical forms of administration dissociate wanted and unwanted effects. 

Following pretreatment with 5000 IU of hCG three times weekly for up to 12 months to achieve masculinization and a normal serum testosterone level, menotropins is administered as one ampule (75 units) three times weekly in combination with hCG, 2000 IU twice weekly. At least 4 months of combined treatment are usually necessary before spermatozoa appear in the ejaculate. If there is no response, the menotropins dose may be doubled. When adding menotropins to hCG therapy, the dose of hCG must be reduced to keep serum testosterone in the high normal range and avoid hy perandrogeni sm. 

Oleic acid solubilizes 61 mg of testosterone undecanoate in Restandol 40 mg soft gelatin capsules. Testosterone undecanoate is an ester prodrug of testosterone intended for oral administration in hormone replacement therapy. Free testosterone is inactive following oral administration due to virtually complete hepatic first-pass extraction. However, the undecanoate ester prodrug is transported via the intestinal lymphatic system, thereby circumventing the hepatic portal circulation and the associated presystemic first-pass metabolism. The oral dose of testosterone undecanoate is 40-160 mg equivalents of testosterone (one to four capsules) once daily. Restandol 40 mg soft... 

By inducing anovulation with various hormonal therapies, the cyclicity of PMS disappears. Anovulation can be induced by estradiol implants, high doses of progesterones, OCs, GnRH-As, and danazol. For the perimenopausal syndrome, the replacement of hormones such as 17/S-estradiol, progesterone (if the uterus is intact), and testosterone is used to stabilize the deficiency and fluctuations in hormone levels. 

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