Notes for: Male Sex Hormones And AntagonistsLast edited [11/05/2012 14:07:39]
1. Oral testosterone is often not sufficient to provide adequate testosterone replacement.
2. SustanonR injection may be used for androgen deficiency.
3. Testosterone patches are included for those patients who prefer this method of administration. Some patients are unable to tolerate these due to local irritation and allergic reactions.
4. Testosterone 25 mg implant may be used in gynaecology for proven androgen deficiency after oophorectomy (licensed indication but only available on a named patient basis and cannot be prescribed on FP10).
5. Use of androgens to improve libido in women who retain their ovaries is not currently licensed.
6. Low dose testosterone patches (Intrinsa) have been licensed for women with loss of sexual desire who have had hysterectomy and bilateral oophorectomy. They should be fully oestrogenised but not by the use of conjugated equine oestrogens. Locally we have acknowledged some limited use in specialist menopausal care with prescribing restricted to the small cohort of female patients as defined by the licensed indication, being mindful of the limited clinical response, side effects and safety concerns
7. Testosterone may be used in children to ‘prime’ before endocrine testing and for induction of puberty.
Last edited [11/05/2012 14:09:31]Anti Androgens
1. Finasteride results in shrinkage of prostatic glandular tissue. The evidence suggests that it can reduce the risk of acute urinary retention and need for surgery, although such events are relatively uncommon. It may be useful in men whose prostates are particularly large where TURP / surgery is not indicated or desired. Improvement may take 6 months to be observed. Treatment of BPH is more fully reviewed in chapter 7.
2. Cyproterone acetate is included in this section of the formulary to treat polycystic ovary disease and hirsutism in women. Occasionally a dose lower than 50 mg (eg 25 mg, half a tablet) may be required.
3. In women of child bearing potential cyproterone must be used with cyclical oestrogen or in the form of DianetteR.
HEPATOTOXICITY. Direct hepatic toxicity including jaundice, hepatitis and hepatic failure has been reported (usually after several months) in patients treated with cyproterone acetate 200 - 300 mg daily. Liver function tests should be performed before treatment and whenever symptoms suggestive of hepatotoxicity occur - if confirmed cyproterone