Berikut adalah hasil dari Pertemuan Ilmiah Tahunan Persandi V-Pandi XIX, dengan judul Current Hopes in Sexual Dysfunction and Infertility Solution, yang bertempat di Grand Sahid Jaya Hotel Jakarta, 27-29 April 2011
Testosteron Treatment Options: Choices and Non Choices in The World. By: Prof Ronald S. Swerdloff, MD (UCLA)
Testosterone is the principal male hormone produced in the testes. It is an anabolic steroid that acts directly as a hormone on the nuclear androgen receptor or on the cell surface rapid acting signaling pathways; it also can create its biological effects acting as a pre-hormone substrate for its metabolites such as estradiol and dehydrotestosterone (DHT). Testosterone acts on many target organs with different level of tissue responsiveness and different characteristics of the dose response curve.
Testosterone medications are usually reserved in men as a treatment for hypogonadism (low testosterone).
There are many treatment formulations and delivery routes available.
Routes of administration include:
1. Oral–> medications include testosterone esters such as testosterone undecanoate (TU) or 17 alkylated testosterone such as methyl testosterone. The oral TU available in many countries is short acting, requires administration with food, two or three times a day;
One example of this kind of medication is: Andriol®, Restandol®
They’re usually taken three or four times a day for the first two or three weeks. Once the testosterone level has built up, the dose is gradually reduced to one to three capsules everyday. Capsules should be swallowed whole with a fatty meal to help with absorption. The dose needed may vary from individual to individual.
2. Trans-buccal –> is given twice daily and gives reasonably constant levels at equilibrium;
This picture shows how to apply the transbuccal testosterone. The usage of this may lead to some “annoying” feeling just like something stuck on your teeth which is actually true. Sometimes gingivitis or gum irritation may happen. But transcuccal testosterone is one of preferred method of using testosterone replacement therapy that can maintain a stable and constant level of testosterone in the blood for day long.
One example of this kind of medication is: Striant®
3. Trans-dermal –> trans dermal testosterone are very popular and can be given as gels, patches and roll ons. They are usually once a day preparations with acceptable pharmacokinetics. The gels are relatively free of the skin irritation seen with closed system patches. The disadvantage of gelsis the possibility of transfer by skin to skin partners or children.
Examples of testoterone gels are: Androgel®, Tostrex®, Testogel®, Tostran™ and Testim™
Each gel should be applied to a specific area of the body, such as the arms or the abdomen, so be sure to read the patient information leaflet supplied with the therapy. Occasionally testosterone gel can cause skin irritation in some people.
Care should be taken to avoid skin-to-skin contact with other people as the testosterone could rub off on them. However, the gel is absorbed into the skin quite quickly and once it is absorbed clothing can be worn without affecting its release in the body. Alternatively, to minimise the chance of transfer, the application site can be washed after about six hours.
Andropatch®, Androderm® is a sticky patch, which releases testosterone slowly and may be applied to your back, stomach, upper arms or thighs. It is recommended that it is changed at about 10 o’clock each night and left on for 24 hours, so that the testosterone level mimics your natural testosterone cycle.
The majority of people may at some stage experience some redness and itching or rashes on their skin where the patch has been. These effects usually disappear within ten days of removing the patch.
4. Injectable –> Injectables can be intermediate lasting such as testosterone enanthate and sypionate giving peak values at days 1-2 after injection and nadirs at about 10 days. There are peaks and valleys when given as a q2week (once every teo week) regimen so some clinicians favor smaller dose weekly injections.
Short-acting injections (every two to three weeks)
Short-acting injections need to be given every two to three weeks by your GP or nurse. These include Sustanon® 250 (blend of : testosterone isocaproate, testosterone decanoate, testosterone phenylpropionate), Virormone® (testosterone propionate). They don’t require daily administration and last for weeks at a time. Short-acting injections have been used in the UK for 30 years, but they may be associated with mood fluctuations.
Longer acting testosterone (every 10-14 weeks) injectables are available in many countries (but not the USA) with injections required only once every three months. Injectables have the disadvantage of requiring somewhat uncomfortable delivery.
Nebido® is one example of long acting testosterone injectable (Testosterone Undecanoate). Six weeks after the initial injection, your GP or nurse may administer the next injection (‘loading dose’). Once the testosterone level is stabilised, injections are only needed once every quarter (between 10 to 14 weeks) minimising visits to the doctor. This type of injection does have quite a large volume. However, once administered it maintains the testosterone level within the physiological range, minimising the mood fluctuations which may be seen in short acting injections.
5. Subcutaneous pellets –> Long term pellets are even longer lasting but may require some skill in administering and may extrude from side.
Testopel® is one example of testosterone pellet
Testosterone pellets are implanted under the skin in the lower abdomen or buttock. This does require minor surgery, usually under a local anaesthetic in a hospital. The pellets (usually three to six pellets are implanted at a time) dissolve gradually and last between three and six months. After this time new ones are added to maintain the testosterone level. In some cases, implants can cause slight bleeding, scarring or infection where they’ve been inserted. It is also possible that the implants cause a bump (extrusion) or that they are pushed out of the body (expulsion).
Warning: before you decide to give yourself a Testosterone Replacement Therapy (TST), you should first contact your physician.
Do not use any testosterone if you:
- have breast cancer (rare in men).
- have prostate cancer.
- are a woman (especially if you are pregnant or breast-feeding). TST may harm the babies of pregnant and breast-feeding women.
- are allergic to testosterone.
Tell your doctor if you have or had:
- problems urinating due to an enlarged prostate.
- liver problems.
- kidney problems.
- heart problems.
- lung problems.
- Tell your doctor about all the medicines you take, including prescription and non- prescription medicines, vitamins, and herbal supplements.
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- From left to right
- 1. Prof. Dr. Nukman Moeloek, dr, SpAnd (Indonesia Senior Andrology Specialist)
- dr Yuan Ade Sukma (myself)
- Prof. Christina Wang, dr, PhD (President of ISA WHO, 2011)
- Prof. Ronald S. Swerdloff, MD (UCLA)
- Prof. Dr. KM Arsyad, DABK, SpAnd ( Chief of PERSANDI, 2011)