Androgen side effects

Question 1

what is the major side effect of androgen therapy? what are its clinical signs? when do they appear? what is the pathogenesis? what other problems might occur?

Answer 1

heptatotoxicity; 2-5 months following use the pt will develop jaundice; bile plugging in the capillaries (cholestasis); other problems: tumors

Question 2

what is the cause of weight gain in the short term use of T?

Answer 2

edema

Question 3

side effects for prepubertal males and females?

Answer 3

virilization

Question 4

what are the feminizing effects? why do they occur and when is it the worst? what is an option with less of this problem?

Answer 4

gynecomastia; occurs due to the conversion of T to E2 by aromatase, this is the worst in men with liver disease, since they cannot remove the T by any other mechanism than a T -> E shunt; fluoxymestrone is a poor aromatase substrate

Question 5

what is an effect on RBC’s?

Answer 5

polycythemia, especially in men with COPD; worst with depot injections (testosterone esters)

Question 6

what organ is exquistely sensitive to T therapy?

Answer 6

prostate; check PSA levels before and during T therapy

Question 7

what are some other side effects (the commonly known ones)

Answer 7

deranged lipid metabolism (incr. LDL-c, decreased HDL-c), hair loss, increased aggression, decreased sperm, acne

Question 8

what are the contraindications for androgen therapy?

Answer 8

BPH, prostate cancer, polycythemia (baseline Hct above 52%)

Question 9

how is the therapy monitored?

Answer 9

again, monitor PSA, Hct
for TM depot forms, check the levels before the next injection, they should be at the lower limit of normal
for TD/TB forms, they should be a constant normal level