Testosterone Pharmacology - Real Life Pharmacology Podcast

Summary

In this episode of the Real Life Pharmacology Podcast, host Air Christensen explores testosterone as a treatment for hypogonadism. He discusses its physiological role, various delivery methods (e.g., topical gels, injections), and potential risks, such as cardiovascular issues, mood changes, and the possibility of abuse in athletes. The podcast also highlights key drug interactions, including with warfarin, corticosteroids, and diabetes medications, and emphasizes the importance of patient education, especially for those using topical testosterone. Christensen wraps up by encouraging listeners to explore educational resources available at Med Ed 101.

Takeaways

• 😀 Testosterone is primarily used to treat **hypogonadism**, a condition where patients have low testosterone levels.
• 😀 Testosterone plays a key role in the development and maintenance of **male characteristics** and **male sex organs**.
• 😀 **Anabolic steroids**, like testosterone, are often abused in sports for their muscle-building properties, leading to concerns of performance enhancement misuse.
• 😀 Testosterone is available in various forms, including **intramuscular injections**, **topical gels/patches**, **oral**, and **subcutaneous pellets**.
• 😀 **Topical testosterone** can have significant **systemic absorption**, raising the risk of **incidental exposure** to others, especially through skin-to-skin contact.
• 😀 Exposure to testosterone in **pregnant women** can cause **virilization** (development of male characteristics) in the fetus, making patient education crucial.
• 😀 Common **adverse drug reactions (ADRs)** of testosterone include **acne**, **aggression**, **insomnia**, and **roid rage**.
• 😀 Testosterone can increase **blood pressure**, elevate **lipid levels**, and raise the risk of **cardiovascular events** like heart attack and stroke.
• 😀 There is an increased risk of **DVT** (deep vein thrombosis) and **pulmonary embolism** (PE) with testosterone use.
• 😀 Drug interactions include **warfarin**, which can increase **INR levels**, raising the risk of bleeding, and **corticosteroids**, which can lead to **fluid retention** and **edema**.
• 😀 In diabetic patients, testosterone can influence **glucose metabolism**, potentially increasing the risk of **hypoglycemia**, especially in those on insulin or oral hypoglycemic agents.

Q & A

What is the primary use of testosterone in medical practice?

Testosterone is primarily used in the treatment of hypogonadism, a condition where patients have a deficiency in testosterone. It is used as replacement therapy to address this deficiency.

How does testosterone impact male characteristics and sex organs?

Testosterone is classified as an androgen, which is responsible for the development and maintenance of male characteristics, such as muscle mass and body hair, as well as the formation of male sex organs.

What is the connection between testosterone and anabolic steroids?

Testosterone, and its synthetic derivatives, are considered anabolic steroids. These steroids promote muscle building, which is why they are often abused by athletes and bodybuilders to enhance performance.

What are the different forms of testosterone available for clinical use?

Testosterone is available in various forms, including intramuscular injections, topical gels and patches, oral tablets, and subcutaneous pellets that provide timed or delayed release.

What is a key patient education point for those using topical testosterone products?

Patients using topical testosterone products, such as gels or patches, should be educated on the risk of incidental exposure. Skin-to-skin contact with others, especially pregnant women, can lead to unintentional absorption of the hormone, which can cause serious birth defects.

What are some common adverse drug reactions associated with testosterone use?

Common adverse reactions include acne, emotional changes such as aggression ('roid rage'), anxiety, insomnia, and cardiovascular issues like elevated blood pressure, heart attack, and stroke. There is also an increased risk of deep vein thrombosis (DVT) and pulmonary embolism (PE).

How can testosterone affect cardiovascular health?

Testosterone can raise blood pressure and increase lipid levels, which can elevate the risk of cardiovascular events like heart attacks and strokes. These effects make it important to monitor cardiovascular health in patients receiving testosterone therapy.

What are the potential drug interactions with testosterone that clinicians should be aware of?

Testosterone may interact with warfarin, increasing its concentration and raising the risk of bleeding. It can also interact with corticosteroids, leading to fluid retention and edema. Additionally, in patients with diabetes, testosterone can affect glucose metabolism, potentially causing hypoglycemia when used with insulin or other diabetes medications.

Why should the use of testosterone be monitored in patients taking warfarin?

Testosterone can increase the concentration of warfarin, which may lead to an elevated INR and increased bleeding risk. Clinicians should monitor the patient's INR, particularly after initiating testosterone therapy, to prevent adverse effects.

What precautions should be taken when combining testosterone with corticosteroids?

When testosterone is used alongside corticosteroids, there may be an additive risk for fluid retention and edema. Patients should be closely monitored for signs of these effects, especially when both medications are used simultaneously.