Selecting a Treatment Regimen
Table 5. Conditions associated with alterations in SHBG concentrations
Conditions associated with decreased SHBG concentrations Moderate obesity* Nephrotic syndrome* Hypothyroidism Use of glucocorticoids, progestins, and androgenic steroids* Acromegaly
Diabetes mellitus* Conditions associated with increased SHBG concentrations Aging* Hepatic cirrhosis and hepatitis* Hyperthyroidism Use of anticonvulsants* Use of estrogens
HIV disease *Particularly common conditions associated with alterations in SHBG concentrations. Table 6. Clinical pharmacology of some testosterone formulations
Formulation†
T enanthate or cypionate
Regimen
75–100 mg/ wk IM or 150–200 mg every 2 wk IM
Pharmacokinetic Profile
Aſter a single IM injection, serum T levels rise into the supraphysiological range, then decline gradually into the hypogonadal range by the end of the dosing interval.
Nongenital T patch
1 or 2 patches, designed to nominally deliver 5–10 mg T over 24 h ap- plied daily on nonpressure areas.
Restores serum T, DHT, and E2 levels into the physiological male range.
DHT and E2
DHT and E2 levels rise in proportion to the increase in T levels. T:DHT and T:E2 ratios do not change.
Advantages
Corrects symptoms of androgen deficiency. Relatively inexpensive, if self- administered. Flexibility of dosing.
T:DHT and T:E2 levels are in the physiological male range.
Ease of application, corrects symptoms of androgen deficiency and mimics the normal diurnal rhythm of T secretion. Lesser increase in hemoglobin than injectable esters.
4 Disadvantages
Requires IM injection. Peaks and valleys in serum T levels.
Serum T levels in some androgen- deficient men may be in the low normal range; these men may need application of 2 patches daily. Skin irritation at the application site may be a problem for some patients.
