testosterone pellets

Responsible for the normal growth and development of male sex organs.
Maintenance of male secondary sex characteristics:
- Growth and maturation of the prostate, seminal vesicles, penis, scrotum,
- Development of male hair distribution,
- Vocal cord thickening,
- Alterations in body musculature and fat distribution.

Therapeutic effects:

Correction of hormone deficiency in male hypogonadism:
- Initiation of male puberty.

Pharmacokinetics ⬆ ⬇

Absorption: Pellets slowly release testosterone.

Distribution: Unknown.

Protein Binding: 98%.

Metabolism/Excretion: Metabolized by the liver; 90% eliminated in urine as metabolites.

Half-Life: 10–100 min.

Time/Action Profile ⬆ ⬇

(androgenic effects‡)

ROUTE	ONSET	PEAK	DURATION
SUBQ	unknown	unknown	3–6 mo

‡Response is highly variable among individuals; may take mo.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Male patients with breast or prostate cancer;
OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

Renal impairment;
Hepatic impairment;
Cardiac disease;
Benign prostatic hypertrophy;
Hypercalcemia;
Pedi: Males 12 yr (safety and effectiveness not established);
Geri: Appears on Beers list. risk of prostatic hyperplasia/carcinoma in older adults. Avoid use in older adults, except for confirmed hypogonadism with clinical symptoms.

Adv. Reactions/Side Effects ⬆ ⬇

CV: edema, DEEP VEIN THROMBOSIS, MI

Derm: male pattern baldness

EENT: deepening of voice

Endo: gynecomastia, hirsutism, oligospermia

F and E: hypercalcemia, hyperkalemia, hyperphosphatemia

GI: cholestatic jaundice, drug-induced hepatitis, ↑liver enzymes, nausea, vomiting

GU: change in libido, erectile dysfunction, priapism, prostatic enlargement

Local: pain at implantation site

Metab: hypercholesterolemia

Neuro: STROKE

Interactions ⬆ ⬇

Drug-drug:

May ↑ effects of warfarin, oral hypoglycemic agents, andinsulin.
Concurrent use with corticosteroids may ↑ risk of edema formation.

Route/Dosage ⬆ ⬇

Male Hypogonadism (Replacement Therapy)

SC
(for SUBQ implantation)
(Adults ): 150–450 mg every 3–6 mo.

Delayed Male Puberty

SC
(for SUBQ implantation)
(Children ): 150–450 mg every 3–6 mo for up to 6 mo.

Availability ⬆ ⬇

Assessment ⬆ ⬇

Monitor intake and output ratios, weigh patient twice weekly, and assess patient for edema. Report significant changes indicative of fluid retention.
Assess for abuse using higher doses than prescribed and usually in conjunction with other anabolic androgenic steroids. May result in MI, stroke, depression, hostility, aggression, liver toxicity, and infertility. Measure serum testosterone levels if abuse is suspected.
Men: Monitor for precocious puberty in boys (acne, darkening of skin, development of male secondary sex characteristics—increase in penis size, frequent erections, growth of body hair). Bone age determinations should be measured every 6 mo to determine rate of bone maturation and effects on epiphyseal closure.
- Monitor for breast enlargement, persistent erections, and increased urge to urinate in men. Monitor for difficulty urinating in elderly men, because prostate enlargement may occur.

Lab Test Considerations:

Prior to therapy, confirm diagnosis of hypogonadism by measuring serum testosterone levels in the morning on at least 2 separate days; these serum testosterone concentrations should be below the normal range (300–1050 ng/dL). Monitor serum testosterone levels 4–12 wk after starting therapy. Discontinue therapy if concentrations are consistently outside of normal range.
- Monitor hemoglobin and hematocrit periodically during therapy; may cause polycythemia.
- Monitor hepatic function tests and serum cholesterol levels periodically during therapy. May ↑ serum AST, ALT, bilirubin, and cholesterol levels and suppress clotting factors II, V, VII, and X.
- Monitor blood glucose closely in patients with diabetes who are receiving oral hypoglycemic agents or insulin.
- Monitor serum sodium, chloride, potassium, and phosphate concentrations (may be ↑).

Implementation ⬆ ⬇

Range-of-motion exercises should be done with all bedridden patients to prevent mobilization of calcium from the bone.
Pellets are to be implanted SUBQ by a health care professional.

Patient/Family Teaching ⬆ ⬇

Advise patient to report the following signs and symptoms promptly: priapism (sustained and often painful erections), difficulty urinating, gynecomastia, edema (unexpected weight gain, swelling of feet), hepatitis (yellowing of skin or eyes and abdominal pain), or unusual bleeding or bruising.
- Instruct patient to use testosterone as directed. Do not use higher than prescribed doses. Explain rationale for prohibiting use of testosterone for increasing athletic performance. Testosterone is neither safe nor effective for this use and has a potential risk of serious side effects.
- Advise patients with diabetes to monitor blood closely for alterations in blood glucose concentrations.
- Emphasize the importance of regular follow-up physical exams, lab tests, and x-ray exams to monitor progress.
- Radiologic bone age determinations should be evaluated every 6 mo in prepubertal children to determine rate of bone maturation and effects on epiphyseal centers.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇