Testosterone therapy topical

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. 

Liposomal systems also can form an effective drug reservoir in the upper layers of the skin. This is particularly useful for local skin therapy. Ethosomal carriers composed of phospholipid vesicular systems with alcohols are also effective at enhancing tran -dermal delivery of both lipophilic and hydrophilic compounds. The use of these ethosomes has been used in the delivery of minoxidil to the pilo-sebaceous section of the skin with better results than conventional liposomes. Similar results are reported in clinical studies with acyclovir in a topical therapy treatment of recurrent herpes labialis. Other application reports with ethosomes are patches containing testosterone (37). 

The interest in pharmacological therapy for male pattern hair loss started as early as 1965, when a topieal preparation of testosterone was tested for presumed benefits. Topical testosterone failed to show any efficacy (86). The interest then declined until reports about stimulation of hair growth in hypertensive patients being treated with the then experimental drug minoxidil renewed the hopes. 

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... 

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