Androgens

Question 1

What medications are a part of the androgens class:

Answer 1

1. Testosterone cypionate (Depo-testosterone)
2. Testosterone gel (Andro-gel)

Question 2

Indications for testosterone:

Answer 2

1. testosterone deficiency
2. masculinizing hormone therapy in transgenders
3. treatment of endometriosis and some post-menopausal symptoms in women

Question 3

How is testosterone cypionate (Depo-testosterone) administered?

Answer 3

IM

Question 4

Which method of administration is preferred (IM vs Gel)

Answer 4

Gel. IM absorption varies and can cause fluctuation in serum testosterone levels

Question 5

Major ADR’s for androgens:

Answer 5

1.potentially life-threatening hepatitis
2.worsening of cardiovascular comorbidities
3.cerebrovascular disease
4.prostatic hypertrophy
5.breast or uterine cancer in transgender men
6.female virilization

Question 6

Important monitoring for androgens:

Answer 6

1. Serum testosterone levels
2. PSA and digital prostate exam before initiation and throughout the duration of treatment d/t increased risk of prostate hypertrophy & cancer

Question 7

Prolongued use of androgens can cause these effects in men:

Answer 7

1. Gynecomastia, decreased sperm levels & libido
2. Priapism (sustained erection: emergency)
3. Changes in urination (due to changes in prostate gland)
4. scrotal/groin pain

Question 8

Prolongued use of androgens can cause these effects in women:

Answer 8

1. Menstrual irregularities
2. Hypercalcemia
3. Virilization: hoarseness, hair thinning, and menstrual disruption

Question 9

Prolongued use of androgens can cause these effects in both men and women:

Answer 9

• Suppression of clotting factors, and increased RBC production: can contribute to hemorrhage and thrombus formation simultaneously
• Change in liver function, edema and cholestatic jaundice

Question 10

Contraindications for the use of androgens:

Answer 10

• Male breast cancer
• prostate cancer
• prostate nodule/induration,
• PSA greater than 4ng/mL or greater than 3ng/mL in men at high risk of prostate cancer,
• hematocrit greater than 50%,
• severe sleep apnea,
• severe urinary symptoms,
• HF
• pregnancy/lactation

Question 11

Androgens should be used cautiously in which types of patients?

Answer 11

Preexisting renal, cardiac or hepatic disease

Question 12

The risk for cardiovascular events associated with androgens is due to its action/changes on:

Answer 12

lipoproteins

Question 13

True or False

Use or abuse of androgens does not affect the normal feedback mechanisms of the male reproductive system

Answer 13

False - patients taking androgens may be at risk for withdrawal, and suppression of normal androgen production may last even after discontinuation

Question 14

Androgens most commonly interact with the following drug classes:

Answer 14

1. anticoagulants
2. diabetic agents
3. corticosteroids

Question 15

_______ is a potentially life threatening adverse effect of androgen therapy

Answer 15

severe hepatic disease

Question 16

Endogenous androgens are responsible for effects related to _____

Answer 16

• primary/secondary male sex characteristics
  (genitalia maturation, increase metabolic rate, increased red blood cell production, skeletal growth, etc.)

Question 17

How are androgens metabolized?

Answer 17

CYP450 3A4

Question 18

Patient education when using androgens:

Answer 18

• Cholestatic hepatitis and jaundice may occur with low doses of androgens
• report signs of abdominal pain, jaundice, anorexia, muscle pain and weakness as they may be symptoms of hepatic injury

Question 19

How often should serum testosterone levels should be drawn?

Answer 19

2 to 3 months after initiating treatment, then annually while on therapy

Question 20

The FDA warns that androgens may cause:

Answer 20

Peliosis hepatis

Question 21

Lab monitoring for patients on long-term androgens include:

Answer 21

Calcium, testosterone, PSA, liver function, glucose, and
lipids

Question 22

Androgens are indicated for:

Answer 22

• Symptomatic treatment for male deficiency
• Female libido, endometriosis, and postmenopausal symptoms
• Symptomatic treatment in both sexes for cancer and HIV