Use of Androgens

Androgens and their synthetic derivatives are approved for administration in several clinical situations, which are presented below. 

Replacement Therapy. Testosterone and other androgens are administered as replacement therapy when the endogenous production of testosterone is impaired. Such conditions include removal of the testes (orchiectomy), various intrinsic forms of testicular failure (cryptorchidism, orchitis), and problems in the endocrine regulation of testosterone production, such as lack of LH production and other forms of hypogonadism.32,144 

Catabolic States. Androgens can be administered for their anabolic properties in conditions where there is substantial muscle catabolism and protein loss.101 Such conditions include chronic infections, severe traumas, severe burns, and recovery from extensive surgeries.35,115 However, the use of androgens in these situations is somewhat controversial. These agents are not typically used as a primary treatment, but as adjuncts to more conventional treatments such as dietary supplementation and exercise. 

Delayed Puberty. In males, androgens may be administered on a limited basis to accelerate the normal onset of puberty.124,125 These drugs are typically used when puberty is anticipated to occur spontaneously but at a relatively late date—that is, when puberty is not delayed because of some pathologic condition. 

Breast Cancer. Androgens have been used to treat a limited number of hormone-sensitive tumors, such as certain cases of breast cancer in women. Other drugs such as the antiestrogens, however, have largely replaced the use of androgens in such cancers. The 

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The primary therapeutic use of androgens is as replacement therapy in testicular deficiency (Table 63.2), a condition in which induction and maintenance of male secondary sex characteristics are desired. Although re-... 

The use of androgenic steroids is contraindicated in pregnant women or women who may become pregnant during the course of therapy. 

Use of androgenic steroids is likely to produce a sensation of energy and euphoria, but also with a tendency to sleeplessness and irritability (1). More extreme changes in mental state can result in extreme swings in mood, ranging from depression to aggressive elation. An unusual complication in one case was a toxic confusional state and choreiform movements caused by an anabolic steroid (SED-12, 1038) (29), but it may have been due to the non-specific results of endocrine stress in a susceptible individual. 

Interest in the use of androgens in elderly men continues, with on the one hand the long-standing hope that potency and libido may be restored, and, on the other hand, the belief that cardiovascular prospects might be improved. The uncertainties that exist in this latter respect have been well reviewed in a paper that merits reading in full it is best summarized in the author s own conclusion that overall, the androgens are as likely to prevent arterial disease as they are to cause it (93). 

The incidence of liver tumors following the use of androgens and anabolic steroids still cannot be calculated. What is clear is that if these products are used in high doses or over long periods of time (and there is now much doubt about whether they are more than marginally effective in such conditions as osteoporosis and aplastic anemia), techniques such as CT scanning and ultrasonography should be used routinely to ensure early detection of liver lesions. 

The main reason for caution with the use of androgens is the susceptibility of menopausal women to their virilizing effects, which can sometimes prove irreversible. Deepening of the voice, hirsutism, and acne can occur in many patients at an early stage of treatment and can prove distressing. There may be enlargement of the clitoris, although not consistently. 

With prolonged treatment, as in long-term use of androgens in mammary carcinoma, male pattern baldness, excessive body hair, prominent musculature, and hypertrophy of the clitoris may develop and may be irreversible. Patients receiving the 17a-alkyl substituted androgens may develop hepatic adenocarcinoma, the complications may be more common in people with Fanconi s anemia. 

WHO (1992). Guidelines for the Use of Androgens in Men (WHO/HPR/MALE/92), Geneva, Special Programme of Research, Development and Research Training in Human Reproduction. 

Johnson CA. Use of androgens in patients with renal failure. Semin Dial 2000 13 36-39. 

Tanaka, A., Kyokuwa, M., Mori, T., and Kawashima, S. (1995). Acceleration of renal dysfunction with ageing by the use of androgen in Wistar/Tw rats. In Vivo 9, 495-502. 

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