C H A P T E R 4 1
Drugs affecting the male reproductive system
631
■■
Androgens are the male sex hormones that are
responsible for the development and maintenance
of male sex characteristics and secondary sex
characteristics or androgenic effects.
■■
Androgens are used for replacement therapy or to
block other hormonal effects.
ANABOLIC STEROIDS
The
anabolic steroids
are analogues of testosterone
that have been developed to produce the tissue-building
effects of testosterone with less androgenic effect. Nan-
drolone is an available form for the management of
acute and chronic renal failure and associated anaemia.
KEY POINTS
Therapeutic actions and indications
Anabolic steroids promote body tissue-building pro-
cesses, reverse catabolic or tissue-destroying processes
and increase haemoglobin and red blood cell mass. Indic
ations for particular anabolic steroids vary with the drug
(see Table 41.2). They can be used to treat anaemias,
certain cancers and angio-oedema, to promote weight
gain and tissue repair in debilitated people, and protein
anabolism in individuals who are receiving long-term
corticosteroid therapy.
Anabolic steroids are also known to be used illegally
for the enhancement of athletic performance by promot-
ing increased muscle mass, increased haematocrit and,
theoretically, an increase in strength and endurance. The
adverse effects of these drugs can be deadly when they
are used in the amounts needed for enhanced athletic
performance (see Adverse effects).
Pharmacokinetics
Like the androgens, the anabolic steroids are well
absorbed and widely distributed throughout the body.
They are metabolised in the liver and excreted in the
urine. Anabolic steroids are contraindicated for use in
pregnancy because of adverse effects on the male fetus.
It is not known whether anabolic steroids enter breast
milk, but because of the potential for adverse effects,
another method of feeding the baby should be used if
these drugs are needed during breastfeeding.
Contraindications and cautions
These drugs are contraindicated in the presence of any
known allergy to anabolic steroids; during pregnancy
and breastfeeding
because of potential masculinisation
in the neonate
; and in the presence of liver dysfunction
because these drugs are metabolised in the liver and are
known to cause liver toxicity
, coronary disease
because
of cholesterol-raising effects through effects on the liver
or prostate or breast cancer in males.
Adverse effects
In prepubertal males, adverse effects include virili-
sation (e.g. phallic enlargement, hirsutism, increased
skin pigmentation). Postpubertal males may experience
■
■
Monitor liver function periodically with long-term
therapy, and
arrange to discontinue the drug at any
sign of hepatic dysfunction.
■
■
Provide thorough teaching, including measures to
avoid adverse effects, warning signs of problems
and the need for regular evaluation, including
blood tests. Instruct a family member or caregiver
in proper preparation and administration
techniques as appropriate
to enhance knowledge
about drug therapy and to promote compliance
with the drug regimen.
Evaluation
■
■
Monitor response to the drug.
■
■
Monitor for adverse effects (androgenic effects,
cardiac effects, serum electrolyte imbalance,
headache, sleep disturbances, rash, hepatocellular
carcinoma).
■
■
Evaluate the effectiveness of the teaching
plan (person can name drug, dosage, adverse
effects to watch for and specific measures to
avoid them; family member or caregiver can
demonstrate proper technique for preparation and
administration of the drug as appropriate).
■
■
Monitor the effectiveness of comfort measures and
compliance with the regimen.
TABLE 41.2
DRUGS IN FOCUS Anabolic steroids
Drug name
Dosage/route
Usual indications
Nitrates
nandrolone
(Deca-Decabolin)
25–150 mg/week by deep IM injection
Treatment of acute renal failure, chronic
renal insufficiency or associated anaemia,
management of inoperative breast
cancer, osteoporosis, aplastic anaemia;
promotion of catabolism with prolonged
corticosteroid use
