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Physical Treatments for Sexual Problems
Published in Philipa A Brough, Margaret Denman, Introduction to Psychosexual Medicine, 2019
There are four approaches to testosterone replacement therapy (TRT). The transdermal approach is currently the most commonly used: Oral: Testosterone undecanoate is absorbed via the hepatic lymphatic system and then to the systemic circulation. Since this is dependent on lipid content of ingested food, it results in a very variable testosterone level over 24 hours.Transbuccal: This is delivered via a sustained release muco-adhesive buccal testosterone tablet that needs to be applied and removed every 12 hours since it is not fully dissolvable.Transdermal: These are used daily and give more uniform testosterone levels throughout a 24-hour period. They are available as patches and gels, and the latter give less skin reaction and normalized testosterone levels although caution must be taken with regard to partner transfer within the first 12 hours after application.Injectable: These vary in half-life from weekly to 12 weekly preparations, the latter being safer, more acceptable and better able to produce levels within a normal range.
The practical management of hormonal treatment in adults with gender dysphoria
Published in James Barrett, Transsexual and Other Disorders of Gender Identity, 2017
Oral testosterone undecanoate is directly converted to dihydrotestosterone by 5α-reductase 1 in the lacteals of the gut. Plasma testosterone levels are usually undectable if measured. Treatment is monitored by measuring plasma dihydrotestosterone levels 4 h after a dose; it should be in the normal male range of 1–3 nmol/l.
Hypogonadism, erectile dysfunction, and infertility in men
Published in Philip E. Harris, Pierre-Marc G. Bouloux, Endocrinology in Clinical Practice, 2014
Pierre-Marc G. Bouloux, Shalender Bhasin
The recent introduction of intramuscular testosterone undecanoate (Nebido, Bayer, Leverkusen, Germany; 1 g) provides a convenient preparation with a long duration of action103,104 The first two injections are given at an interval of 6 weeks, and thereafter at 3-month intervals. Nebido is made up in a 4 cc preparation that must be administered as a deep intramuscular injection. Occasional patients have reported coughing following injection, possibly the consequence of circulating oily droplets.
Testosterone treatment and change of categories of the International prostate symptom score (IPSS) in hypogonadal patients: 12 years prospective controlled registry study
Published in The Aging Male, 2023
Aksam Yassin, Daniel Kelly, Joanne Nettleship, Raidh Talib, Raed M. Al-Zoubi, Omar M. Aboumarzouk, Bassam Albaba
A perceived barrier to TTh in elderly men is often an increase in prostate volume and the subsequent deterioration of urinary function parameters. As the prostate is an androgen-dependent organ, an increase in testosterone levels may induce prostate growth and development and increase prostate volume [15]. This, therefore, raises concerns regarding LUTS and prostate cancer in men receiving TTh [15]. In order to address this issue, data were collected from two German population-based single-centre, prospective, cumulative registry studies, to give a combined population of men with symptoms of hypogonadism. The effects of testosterone undecanoate (TU) was investigated in this population, with up to 12 years follow-up, by measuring IPSS at baseline and a final recorded visit to determine if long-term TTh showed improvement in LUTS and related symptoms in hypogonadal men.
What are the pharmacological considerations for male congenital hypogonadotropic hypogonadism?
Published in Expert Opinion on Pharmacotherapy, 2022
Giulia Rastrelli, Mario Maggi, Giovanni Corona
Testosterone therapy (TTh) is the most widely used approach for the induction and progression of pubertal development [5]. TTh is started with one-fifth of the adult dose or less. Injectable short-acting esters of testosterone (testosterone enanthate or cypionate) are the most used medications. The usual initial dose is 50 mg monthly, which is gradually increased to the adult dose over two or 3 years (Table 1). TTh allows the development of secondary sexual characteristics to be coordinated with psychological and sexual behavior development. Possible alternative formulations deal with the use of oral testosterone undecanoate (TU) and transdermal gels. TU is easy to take and the dose of 40 mg per capsule allows a stepwise slow increase in the dose up to the adult dose (Table 1). Testosterone gel preparations are easy to titrate, and this represents an advantage (Table 1); however, experience with testosterone gel in adolescents is still limited and treatment protocols are still not well defined.
International Society for the Study of Women's Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women
Published in Climacteric, 2021
Sharon J. Parish, James A. Simon, Susan R. Davis, Annamaria Giraldi, Irwin Goldstein, Sue W. Goldstein, Noel N. Kim, Sheryl A. Kingsberg, Abraham Morgentaler, Rossella E. Nappi, Kwangsung Park, Cynthia A. Stuenkel, Abdulmaged M. Traish, Linda Vignozzi
Testosterone preparations, specifically intramuscular (IM), subcutaneous implants, and oral formulations (methyltestosterone 1.25–2.5 mg or testosterone undecanoate 40 mg), often in combination with estrogen therapies, have been evaluated in RCTs with relatively few participants and followed for relatively short periods of time. The longest duration placebo-controlled trial (24 months) included 331 subjects [110,111]. These preparations are not commonly used currently. IM administration is associated with wide excursions of serum testosterone concentrations well beyond physiological levels; subcutaneous implants occasionally yield markedly elevated testosterone levels with erratic release over time and difficulty locating for removal if necessary. Oral testosterone undecanoate was associated with unpredictable absorption and blood levels in the male range, even at the lowest dose studied [103].