Physical Treatments for Sexual Problems
Philipa A Brough, Margaret Denman in 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.
Scientific Basis of Male Hypogonadism
Anthony R. Mundy, John M. Fitzpatrick, David E. Neal, Nicholas J. R. George in The Scientific Basis of Urology, 2010
Nebido® is a testosterone undecanoate preparation suspended in castor oil for intramuscular injection. This testosterone ester had been used in oral capsules since the 1970s, but had obviously already been applied as intramuscular injections in China for several years, with a long halflife (62). The vehicle was changed from Chinese teaseed oil to castor oil in Europe (61,63,64). When compared with testosterone enanthate, serum testosterone levels remain in the normal range for long periods of time (64). Some patients have now been followed for up to eight years, with good substitution and no serious side effects (65). Treatment necessitates 1000 mg injections every 10 to 14 weeks, following a loading dose at 6 weeks (32,66). Adjustments of injection intervals may be scheduled according to serum testosterone levels determined from serum samples taken just before the next injection. In addition to its use in hypogonadism, testosterone undecanoate has become a valuable asset in male contraception trials and, as such, has outlived testosterone enanthate and buciclate. Testosterone undecanoate has the potential to be combined with norethisterone enanthate (NETE) into one contraceptive regimen, and in combination with subcutaneous etonorgestrel implants, it is currently being tested in Europe by Schering and Organon in multicenter trials for male contraception (67). Since this preparation in teaseed oil has a shorter half-life than its European variant in castor oil, it needs to be injected more frequently than Nebido. However, a trial involving 308 couples in China, using monthly injections of 500 mg testosterone undecanoate, resulted in 97% of men showing azoospermia with complete contraceptive protection.
The benefits and risks of androgen therapy in the aging male: prostate disease, lipids and vascular factors
Barry G. Wren in Progress in the Management of the Menopause, 2020
Very convincing evidence that testosterone is involved in this sex difference comes from experiments wherein androgen levels were severely lowered with a luteinizing hormone-releasing hormone agonist, whereupon HDL cholesterol levels increased. When serum androgen levels subsequently were returned to normal, serum levels of HDL cholesterol decreased to normal male levels43. Most, but not all studies in adult men find a positive correlation between plasma testosterone and plasma HDL cholesterol concentrations. Administration of aromatizable androgens to hypogonadal men caused an increase in HDL cholesterol, while non-aromatizable androgens did the opposite. The role of estrogens was corroborated in another study44. In our own study the oral (aromatizable) androgen testosterone undecanoate was administered to hypogonadal men and to previously non-treated female-to-male transsexuals. While serum estradiol levels in the females remained three to four times higher during testosterone administration than in men, in both sexes levels of HDL cholesterol and HDL2 cholesterol declined and were eventually of the same magnitude. This led us to conclude that testosterone is indeed the major determinant of the sex difference in HDL cholesterol levels45. An alternative explanation is that the oral administration of testosterone may have been a significant variable since the effects of androgens on lipoproteins are, at least in part, mediated by hepatic lipase, which enhances catabolism of HDL particles. Hepatic lipase may be more stimulated by oral than by parenteral administration of androgens. However, in line with our finding is that women with hyperandrogenism, with endogenous androgen overproduction, show ‘male-like’ plasma lipoprotein profiles.
Dietary fluted pumpkin seeds induce reversible oligospermia and androgen insufficiency in adult rats
Published in Systems Biology in Reproductive Medicine, 2019
Rex-Clovis C. Njoku, Sunny O. Abarikwu, Augustine A. Uwakwe, Chidimma J. Mgbudom-Okah, Chioma Yvonne Ezirim
Potent and innocuous forms of contraception suitable for different couples and diverse cultures are crucial for family planning (Chauhan and Agarwal 2010; Plana 2017; Ain et al. 2018). Obviously, numerous fertility control efforts are aimed at women, and men have been asked to share in this responsibility (Amory 2016; Plana 2017). The call for men to be equal partners with women in fertility regulation has been slow due to limited acceptable contraceptive options (Plana 2017). More so, complications associated with existing male contraceptive options such as hormonal imbalance, epididymitis and semen leakage prompted the search for other methods of male contraception (Anawalt and Amory 2001; Kanakis and Goulis 2015; Ain et al. 2018). This led to considerable efforts in the formulations of hormone and non-hormonal dependent male contraceptives. Hormone dependent male contraceptives tend to influence the spermatogenic process via the suppression of hypothalamic-pituitary-testicular axis leading to infertility and reduced sperm count (Meriggiola and Pelusi 2006; Xie et al. 2017). Of these, testosterone enanthate and testosterone undecanoate suppresses the endogenous synthesis of testosterone and reduces spermatogenesis (Kanakis and Goulis 2015). This method was observed to promote undesired side effects such as lowering of high-density lipoprotein, hypertension, weight gain, and cancer (Anawalt and Amory 2001; Nieschlag et al. 2003; Kumar et al. 2012).
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].
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.
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