Testosterone therapy intramuscular

Siddique H, Smith JC, Corrall RJM. Reversal of poly-cythaemia induced by intramuscular androgen replacement using transdermal testosterone therapy. Clin Endocrinol 2004 60 143-5. 

Patients with testicular dysfunction require androgen replacement for somatic development and maintenance. Conventional treatment for testicular dysfunction consists of periodic intramuscular injections of chemically modified testosterone or, more recently, skin patch apphcations. However, long-term pulsatile testosterone therapy is not optimal and can cause multiple problems, including disregulated erythropoiesis and bone density changes. 

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. 

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. 

Hormonal therapy with testosterone should be reserved primarily for patients with hypogonadal disorders. There are two important warnings about the indiscriminate use of intramuscular testosterone in patients with serum testosterone levels in the normal range. First, many impotent patients are older and may have adenocarcinoma of the prostate, thus exogenous testosterone may accelerate the growth of the neoplasm. Second, although testosterone may induce a marked increase in libido, patients may still be unable to achieve adequate erection. 

For the man with symptomatic hypogonadism (decreased libido, energy loss, and erectile dysfunction), a normal prostate examination, and a normal serum prostate-specific antigen, testosterone can be considered as adjunctive therapy. Testosterone patches (2.5-5 mg daily), intramuscular injections (10 to 400 mg every 2 to 4 weeks), 1% topical gel, pellet implants (150 50 mg every 3-6 months), and a buccal formulation are available (see Table 88-6). Testosterone replacement increases bone density in men. The benefits of therapy need to be... 

Hormonal therapy with testosterone should be reserved primarily for patients with hypogonadal disorders. There are two important warnings about the indiscriminate use of intramuscular testosterone in patients with serum testosterone... 

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