Testosterone Replacement Therapy (TRT)
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Posted On :
Mar-30-2010
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Article Word Count :
941
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TRT can be given in the form of injections, pills, pellets and patches. The decision who to treat, with which preparation in what doses, and for how long, must rest with the individual physician, as part of a joint and informed venture with the patient.
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TRT can be given in the form of injections, pills, pellets and patches. The decision who to treat, with which preparation in what doses , and for how long, must rest with the individual physician, as part of a joint and informed venture with the patient. Here I can only give my personal experience, and views derived from that and a review of the extensive literature on the subject.
Though when asked where these testosterone preparations come from, doctors sometimes tell patients that it is extracted from Peruvian Bull's testicles in the mating season, both to explain the cost of the treatment and maximise the placebo effect, that's a lot of "Bull" really. In actual fact it is made synthetically in a large scale drug manufacturing process, from cholesterol the same raw material as the body uses to produce it. The cost of these preparations at present is usually roughly two to three times that of equivalent oestrogen preparations used for female HRT, but hopefully as TRT is used more often, drug companies will be able to reduce this sex hormone discrimination against men.
When testosterone was first produced back in 1935 it was realised that being poorly absorbed and rapidly broken down in the liver, it would not be effective when taken by mouth. The answer was to find different routes of administration so as to bye-pass the liver and chemically modify the molecule to slow its rate of absorption and breakdown. One of the most effective means of doing this was to attach side chains to the testosterone molecule and form compounds called esters, the longer the side chain in general, the slower the rate of breakdown.
Injections
Injections of pure testosterone were tried early on, but were found to work for only two hours, and though the effects were nice while they lasted, some means had to be found of getting a longer period of action if the treatment was to become popular. The first attempt at this was by making an ester called testosterone propionate. Having a short side-chain it only lasted two or three days, but this enabled it to be used clinically even if it meant injections two or three times a week. This was the preparation used in 1944 by Heller and Myers {}to demonstrate for once, if not for all, that the male menopause, or male climacteric as it was called then, is due to testosterone deficiency. They also showed in a controlled trial using placebo injections of sesame oil, how the symptoms of this very real hormonal disorder, including erection problems, could be abolished by TRT.
After the Second World War research on finding newer and more effective preparations got under way, and an ester called testosterone enanthate (Primo-Teston Depot) was produced by the Schering company in Berlin and found to be clinically very effective. Having a longer side chain, it was broken down even more slowly, and injections lasted two or three weeks.
For the last 4 years there have been long-acting injections of testosterone undecanoate in castor oil called Nebido, made by Bayer-Shering. These jast 2-3 months and are very effective, but quite expensive.
Oral Preparations
The stronger of the two preparations is a long chain fatty acid ester called testosterone undecanoate, first used clinically about twenty years ago. It is known under the trade names given to it by the Belgian company Organon that makes it, of Restandol in Europe, and Andriol in the rest of the world, including Canada where it has only recently come onto the market.
It is made in small oval reddish-brown oval capsules containing 40mg of the ester, equivalent to 25 mg of testosterone. It is dissolved in arachis oil so that when taken after a meal it is absorbed by the fat droplets coming from the small intestine, goes into the lymphatic drainage, and bye-passes the liver so that it is not immediately broken down. Peak serum levels are reached after two to four hours, and most is broken down by eight hours, so that this form needs to be taken two or ideally three times a day.
The other safe oral preparation is mesterolone (Pro-Viron), which comes in the form of white 25 mg tablets made by the German firm of Schering. Unlike testosterone itself, and other testosterone derivatives, which are broken down to both an active product called dihyrotestosterone (DHT) and oestrogens, mesterolone only produces raised levels of the former, which makes it a weaker androgen, particularly in relation to improving both libido and potency. However for unknown reasons, it still sometimes seems to work when the undecanoate fails, and so is a useful reserve form, especially when it is wished to maintain or even improve fertility, which the other preparations may suppress. It can for example help young men with the "locker-room syndrome" mentioned earlier, and those who wish to have more facial and body hair to make them feel more "macho". This is little used now.
Creams and Gels.
These have come to the fore in the last ten years, and are probably the most popular form of testosterone treatment. First in the field was Androgel (Testogel in the UK), which is a clear alcoholic solution of pure testosterone, one application to the arms, shoulders or trunk giving good levels of testosterone for 24 hours.
In Australia, Lawley pharmaceuticals in Perth developed an excellent preparation of testosterone in an aqueous base of Macdemia nut oil, either 1% as Androfem for women, 2% for low dosage in men as Andromen, or 5% for stronger dosage in men.
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Article Source :
http://www.articleseen.com/Article_Testosterone Replacement Therapy (TRT)_15073.aspx
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Author Resource :
Dr Malcolm Carruthers is one of the very few UK based physicians who specialise in the diagnosis and treatment of testosterone deficiency. With a broad training in general and laboratory medicine, for the last twenty years he has specialised in Men’s Health, andrology, particularly treating the Andropause aka Male Menopause.
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Keywords :
Andropause, Male Menopause, Mens health, mens, testosterone, prostate, prostate health, man health prostate,
Category :
Health and Fitness
:
Health and Fitness
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