Testosterone

What is Testosterone

Testosterone is the primary androgen found in the body.

Endogenous testosterone is synthesized by cells in the testes, ovaries, and the adrenal cortex.

Therapeutically, testosterone is used in the management of primary or acquired hypogonadism in males (adolescent or adult), and use is also appropriate for selected adolescent males with constitutional delay of growth and puberty (CDGP).

In prepubertal males with hypogonadism, testosterone treatment is directed at initiating pubertal development at the appropriate age, then maintaining virilization.

Per guidelines, adult men with low testosterone concentrations due to medical conditions, and not exclusively due to aging, are appropriate candidates for testosterone replacement therapy (TRT) if certain criteria are met.

Historical uses of testosterone have included the palliation of advanced breast cancer in postmenopausal women.

Testosterone is commonly used off-label in transgender males (female to male) to support virilization.

In postmenopausal women, testosterone has been used off-label in selected patients with low libido, but this use is not sufficiently studied and is not recommended due to the potential for virilizing effects that may be irreversible.

The FDA has alerted of a possible increased risk of cardiovascular events or stroke associated with approved and unapproved uses of testosterone products in men; however, no clinical studies have been of sufficient size or duration to definitively establish the effects of testosterone therapy on cardiovascular health in men.

Testosterone injections have been commercially marketed for medical use since the mid-twentieth century.

In 1995, the FDA initially approved testosterone transdermal dosage forms; many unique dosage delivery forms, including buccal and subcutaneous implants and injections, have been FDA approved since that time.

Indications

  • delayed puberty
  • hypogonadism
  • palliative treatment of breast cancer

For androgen replacement therapy in males with hypogonadism (primary and hypogonadotropic types)

for the treatment of hypogonadism (primary and hypogonadotropic types)

Side Effects

  1. abdominal pain
  2. abnormal dreams
  3. acne vulgaris
  4. alopecia
  5. amenorrhea
  6. amnesia
  7. anaphylactoid reactions
  8. anxiety
  9. apnea
  10. appetite stimulation
  11. arthralgia
  12. asthenia
  13. azoospermia
  14. back pain
  15. breast cancer
  16. bronchospasm
  17. bullous rash
  18. chills
  19. confusion
  20. contact dermatitis
  21. cough
  22. dental pain
  23. depression
  24. diarrhea
  25. dysgeusia
  26. dyspepsia
  27. dyspnea
  28. dysuria
  29. edema
  30. elevated hepatic enzymes
  31. emotional lability
  32. epiphyseal closure
  33. epistaxis
  34. eructation
  35. erythema
  36. erythrocytosis
  37. fatigue
  38. feminization
  39. fluid retention
  40. folliculitis
  41. furunculosis
  42. gastroesophageal reflux
  43. gingivitis
  44. gynecomastia
  45. hair discoloration
  46. headache
  47. hearing loss
  48. hematuria
  49. hirsutism
  50. hostility
  51. hot flashes
  52. hypercalcemia
  53. hypercholesterolemia
  54. hyperglycemia
  55. hyperhidrosis
  56. hypertension
  57. hypertriglyceridemia
  58. hypoglycemia
  59. impotence (erectile dysfunction)
  60. infection
  61. infertility
  62. injection site reaction
  63. insomnia
  64. irritability
  65. jaundice
  66. lacrimation
  67. libido decrease
  68. libido increase
  69. maculopapular rash
  70. malaise
  71. mastalgia
  72. memory impairment
  73. musculoskeletal pain
  74. myalgia
  75. myocardial infarction
  76. nasal congestion
  77. nasal dryness
  78. nasal irritation
  79. nausea
  80. new primary malignancy
  81. nocturia
  82. oligomenorrhea
  83. oligospermia
  84. osteopenia
  85. osteoporosis
  86. paresthesias
  87. parosmia
  88. peliosis hepatis
  89. pelvic pain
  90. peripheral edema
  91. pharyngitis
  92. physiological dependence
  93. polycythemia
  94. polyuria
  95. priapism
  96. prostatic hypertrophy
  97. prostatitis
  98. pruritus
  99. psychological dependence
  100. pulmonary embolism
  101. pulmonary oil microembolism
  102. rash
  103. rhinorrhea
  104. seborrhea
  105. sinusitis
  106. skin irritation
  107. skin necrosis
  108. skin ulcer
  109. spermatogenesis inhibition
  110. stomatitis
  111. stroke
  112. suicidal ideation
  113. syncope
  114. teratogenesis
  115. testicular atrophy
  116. thromboembolism
  117. tinnitus
  118. urticaria
  119. vesicular rash
  120. virilization
  121. vomiting
  122. weight gain
  123. wheezing
  124. xerosis
  125. xerostomia

Monitoring Parameters

  • blood pressure
  • hemoglobin/hematocrit
  • LFTs
  • serum cholesterol profile
  • serum gonadotropin concentrations
  • serum testosterone concentrations

Contraindications

  • accidental exposure
  • benzoic acid hypersensitivity
  • benzyl alcohol hypersensitivity
  • breast cancer
  • breast-feeding
  • cardiac disease
  • children
  • contraception requirements
  • coronary artery disease
  • depression
  • diabetes mellitus
  • females
  • geriatric
  • heart failure
  • hepatic disease
  • hypercalcemia
  • hypertension
  • infants
  • infertility
  • intravenous administration
  • labor
  • magnetic resonance imaging (MRI)
  • myocardial infarction
  • nasal polyps
  • nasal septal perforation
  • nasal surgery
  • nasal trauma
  • neonates
  • obesity
  • obstetric delivery
  • polycythemia
  • polyoxyethylated castor oil hypersensitivity
  • pregnancy
  • prostate cancer
  • prostatic hypertrophy
  • pulmonary disease
  • pulmonary oil microembolism
  • renal disease
  • reproductive risk
  • rhinorrhea
  • serious hypersensitivity reactions or anaphylaxis
  • sesame oil hypersensitivity
  • Sjogren’s syndrome
  • sleep apnea
  • soya lecithin hypersensitivity
  • stroke
  • substance abuse
  • suicidal ideation
  • thromboembolism

Interactions

  • Abarelix
  • Acarbose
  • Alogliptin
  • Alogliptin; Metformin
  • Alogliptin; Pioglitazone
  • Alpha-glucosidase Inhibitors
  • Ambrisentan
  • Aprepitant, Fosaprepitant
  • Atazanavir
  • Atazanavir; Cobicistat
  • Boceprevir
  • Cabozantinib
  • Canagliflozin
  • Canagliflozin; Metformin
  • Carvedilol
  • Cobicistat
  • Cobimetinib
  • Conivaptan
  • Corticosteroids
  • Cyclosporine
  • Dabigatran
  • Daclatasvir
  • Dapagliflozin
  • Dapagliflozin; Metformin
  • Dapagliflozin; Saxagliptin
  • Darbepoetin Alfa
  • Darunavir
  • Darunavir; Cobicistat
  • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
  • Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
  • Degarelix
  • Dipeptidyl Peptidase-4 Inhibitors
  • Doravirine; Lamivudine; Tenofovir disoproxil fumarate
  • Dronedarone
  • Edoxaban
  • Efavirenz; Emtricitabine; Tenofovir
  • Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
  • Elbasvir; Grazoprevir
  • Eliglustat
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Empagliflozin
  • Empagliflozin; Linagliptin
  • Empagliflozin; Linagliptin; Metformin
  • Empagliflozin; Metformin
  • Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
  • Emtricitabine; Tenofovir disoproxil fumarate
  • Epoetin Alfa
  • Ertugliflozin
  • Ertugliflozin; Metformin
  • Ertugliflozin; Sitagliptin
  • Everolimus
  • Fluconazole
  • Fosamprenavir
  • Glipizide; Metformin
  • Glyburide; Metformin
  • Goserelin
  • Histrelin
  • Hydrochlorothiazide, HCTZ; Propranolol
  • Idelalisib
  • Incretin Mimetics
  • Insulins
  • Isavuconazonium
  • Ixabepilone
  • Lamivudine; Tenofovir Disoproxil Fumarate
  • Leuprolide
  • Leuprolide; Norethindrone
  • Linagliptin
  • Linagliptin; Metformin
  • Loperamide
  • Loperamide; Simethicone
  • Lopinavir; Ritonavir
  • Lumacaftor; Ivacaftor
  • Maraviroc
  • Meglitinides
  • Metformin
  • Metformin; Pioglitazone
  • Metformin; Repaglinide
  • Metformin; Rosiglitazone
  • Metformin; Saxagliptin
  • Metformin; Sitagliptin
  • Methoxy polyethylene glycol-epoetin beta
  • Miglitol
  • Mitotane
  • Nafarelin
  • Ombitasvir; Paritaprevir; Ritonavir
  • Oritavancin
  • Oxymetazoline
  • Pazopanib
  • Pexidartinib
  • Posaconazole
  • Pramlintide
  • Propranolol
  • Ranolazine
  • Rifaximin
  • Riluzole
  • Ritonavir
  • Rivaroxaban
  • Romidepsin
  • Sapropterin
  • Saw Palmetto, Serenoa repens
  • Saxagliptin
  • SGLT2 Inhibitors
  • Simvastatin; Sitagliptin
  • Sitagliptin
  • Sofosbuvir; Velpatasvir
  • Sofosbuvir; Velpatasvir; Voxilaprevir
  • Somatropin, rh-GH
  • St. John’s Wort, Hypericum perforatum
  • Sulfonylureas
  • Telaprevir
  • Telotristat Ethyl
  • Tenofovir Alafenamide
  • Tenofovir, PMPA
  • Thiazolidinediones
  • Ticagrelor
  • Tolvaptan
  • Triptorelin
  • Vemurafenib
  • Vinblastine
  • Vincristine
  • Vincristine Liposomal
  • Voriconazole
  • Warfarin
  • Zonisamide
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