Androgel should be used only for testosterone deficiency, accompanied by such clinical manifestations as: underdevelopment or regression of secondary sexual characteristics, changes in body structure, impaired carbohydrate and lipid metabolism, obesity, asthenia, impaired sexual function (decreased libido, erectile dysfunction, etc.), decreased bone mineral density, mood swings, depression, hot flashes, etc. Before starting treatment, other possible causes underlying the above symptoms should be ruled out.
There are currently no clear age standards for testosterone levels. However, it should be taken into account that physiological levels of serum testosterone begin to decline from 30-40 years, and the level of sex steroid-binding globulin rises. This, accordingly, leads to a decrease in the level of biologically active testosterone.
Due to the variability of laboratory values, the determination of testosterone concentration should be carried out in the same laboratory.
Androgel is not used to treat male infertility or erectile dysfunction, the cause of which is not associated with testosterone deficiency.
Before prescribing testosterone, all patients should be screened to exclude the risk of prostate cancer, since androgens can accelerate the progression of subclinical prostate cancer and benign prostatic hyperplasia. Careful and regular monitoring of the state of the prostate gland (digital rectal examination, determination of prostate-specific antigen (PSA) in the serum) and breast glands should be carried out at least once a year, and in elderly patients and patients at risk (with clinical or family factors) – twice a year.
Testosterone preparations should be used with caution in patients with malignant neoplasms because of the danger of hypercalcemia (and concomitant hypercalciuria) due to bone metastases. In these patients, it is recommended that serum calcium concentration be monitored.
In patients suffering from severe heart, liver or kidney failure, treatment with testosterone preparations can cause complications, characterized by edema with congestive heart failure or without it. 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 concentration, the following laboratory parameters should be periodically checked: hemoglobin, hematocrit (to detect polycythemia), liver function tests, and lipid profile.
Evidence has been published of an increased risk of developing sleep apnea in patients with hypogonadism who are being treated with testosterone esters, especially those with risk factors such as obesity and chronic respiratory diseases.
In patients with diabetes mellitus receiving androgens, when a normal concentration of testosterone in the blood plasma is reached, an increase in insulin sensitivity may be observed.
Some clinical symptoms: irritability, nervousness, weight gain, prolonged or frequent erections may indicate excessive exposure to androgen, requiring dosage adjustment.
If the patient develops a severe local reaction, treatment should be reviewed and, if necessary, discontinued.
When using Androgel in athletes, it is necessary to take into account the fact that this drug contains an active substance (testosterone), which can give a positive reaction in anti-doping tests.
Potential testosterone transmission
When prescribing Androgel, it is necessary to inform the patient about safety measures.
To guarantee the safety of the partner, the patient should, for example, be advised to have sexual intercourse before using the drug or to observe the interval between the use of Androgel and sexual intercourse. If sexual intercourse is carried out in the interval up to 6 hours after applying the Androgel preparation, it is recommended to wear a T-shirt covering the place of application of the gel during the period of contact or take a shower before 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, accidental showering in the period from 1 to 6 hours after applying the gel does not have a significant effect on treatment.
The following precautions are recommended:
for the patient:
wash hands with soap after applying the gel;
to cover the area of application of the gel with clothing after the gel has dried;
take a shower before contacting a partner.
for people not taking Androgel:
in case of contact with the gel application area not previously washed with water, it is necessary to wash as soon as possible with soap and water a skin area on which testosterone could get;
it is necessary to inform the doctor about the appearance and development of such signs