Androgel should be used only if testosterone deficiency is accompanied by such clinical manifestations as: underdevelopment or regression of secondary sexual characteristics, changes in body structure, violation of carbohydrate and lipid metabolism, obesity, asthenia, sexual dysfunction (decreased libido, erectile dysfunction, etc.) decrease in bone mineral density, mood swings, depression, hot flashes, etc.Before starting treatment, other possible causes underlying the above symptoms should be excluded.
At present, there are no clear age standards for testosterone values. However, it should be taken into account that the physiological levels of serum testosterone begin to decline from 30-40 years, and the level of globulin binding sex steroids increases. This, accordingly, leads to a decrease in the level of biologically active testosterone.
Due to variability in laboratory values, testosterone concentrations should be determined in the same laboratory.
Androgel® is not used to treat male infertility or erectile dysfunction, the cause of which is not related to testosterone deficiency.
Prior to the appointment of testosterone, all patients should be screened to rule out the risk of prostate cancer, since androgens can accelerate the progression of subclinical prostate cancer and benign prostatic hyperplasia. A thorough and regular monitoring of the condition of the prostate gland (digital rectal examination,definition of prostate-specific antigen (PSA) in the serum) and mammary glands at least once a year, and in elderly patients and at risk patients (with clinical or family factors) - twice a year.
testosterone drugs should be used with caution in patients with malignancies at risk of hypercalcaemia (and associated hypercalciuria), due to bone metastases. In these patients, it is recommended that the concentration of calcium in the serum be monitored.
In patients with severe cardiac, hepatic or renal insufficiency, treatment with testosterone preparations can cause complications characterized by edema with or without congestive heart failure. In this case, treatment should be stopped immediately. In addition, diuretic therapy may be required.
In patients taking androgens for a long period, in addition to laboratory measurements of testosterone concentrations, it is periodically necessary to check the following laboratory parameters: hemoglobin, hematocrit (for the detection of polycythemia), functional liver and lipid profile.
Data have been published on the increased risk of sleep apnea in patients with hypogonadism receiving treatment with esters of testosterone, especially in those who have risk factors such as obesity and chronic respiratory diseases.
In patients with diabetes, receiving androgens, when the normal concentration of testosterone in the blood plasma can be increased sensitivity to insulin.
Some clinical symptoms: irritability, nervousness, weight gain, prolonged or frequent erections may indicate excessive androgen exposure, requiring dosage adjustment.
If a patient develops a severe local reaction, treatment should be reviewed and, if necessary, discontinued.
When using Androgel in athletes should take into account the fact that this drug contains an active substance (testosterone), which can give a positive reaction in the anti-doping tests.
Potential transfer of testosterone
When appointing Androgel, it is necessary to inform the patient about safety measures.To ensure the safety of the partner, the patient needs, for example, to advise to have sexual intercourse before using the drug or to observe the interval between the application of Androgel and sexual intercourse. If the sexual intercourse is performed in the interval before 6 hours after the application of Androgel®, during the contact period it is recommended to wear a T-shirt covering the place of application of the gel or take a shower before the sexual intercourse.
It is preferable to observe an interval of at least 6 hours between applying the gel and taking a bath or shower. However, occasional showering in the period from 1 to 6 hours after the application of the gel does not have a significant effect on the treatment.
The following precautions are recommended:
- for the patient:
- Wash hands with soap after applying the gel;
- close the area of application of the gel with clothing after the gel has dried;
- Take a shower before before contacting a partner.
- for persons not taking Androgel®:
- in case of contact with the area of application of the gel, previously not washed with water, it is necessary to wash out as soon as possible with soap and water the skin area to which it could fall testosterone;
- it is necessary to inform the doctor about the appearance and development of such signs of hyperandrogenization, as acne or a change in normal hair growth.
In the case of a partner's pregnancy, the patient needs to be more careful about the observance of precautionary measures. Pregnant women should avoid any contact of the drug with the skin. In case of contact with the drug, a woman should wash the contact area with soap and water as soon as possible.
When contacting children, it is recommended to wear a T-shirt covering the place of applying the gel in order to avoid the risk of skin contact of children with the drug.
Androgel® should not be given to patients who can not follow safety instructions (for example, severe chronic alcoholism, substance abuse, severe mental disorders).