Endocrine Drugs and Medications Q 29
A relative contraindication to therapy with androgens is:
A. Hepatic failure
B. Pregnancy
C. Prostate cancer
D. Hypogonadism
Correct Answer: A. Hepatic failure
Hepatic failure is considered a relative contraindication because antiandrogens have been known to cause hepatotoxicity. While topical testosterone delivery systems avoid first-pass hepatic metabolism, there remains concern regarding TRT in patients with chronic liver disease. The majority of reports of liver toxicity and jaundice are limited to orally-administered alkylated forms of testosterone.
Option B: Pregnancy is considered an absolute contraindication. Hyperestrogenism can be a side effect of replacement therapy because testosterone undergoes aromatization to estrogen. Aromatase inhibitors may be necessary. Therefore, estradiol levels in men need to be assessed to rule out hyperestrogenism.
Option C: Prostate cancer is an indication for anti androgen administration. Serum PSA levels can increase in response to testosterone treatment, so it is essential to rule out prostate cancer before starting therapy as it can worsen the disease process. Patients on replacement therapy require reevaluation for prostate cancer at three months and one year after beginning treatment.There have been no significant effects of testosterone on lower urinary tract symptoms and BPH. Physicians need to specifically address the risks and benefits of testosterone therapy before initiating treatment.
Option D: Hypogonadism would not be considered a contraindication, but it most certainly is not an indication for therapy. Hypogonadism occurs in 19% of men in their 60s, 28% of men in their 70s, and 49% of men in their 80s. Testosterone is FDA-approved as replacement therapy in men who have low testosterone levels and those with symptoms of hypogonadism. It is essential to distinguish between primary (testicular) and secondary (pituitary-hypothalamic) hypogonadism. Symptoms highly suggestive of hypogonadism include decreased spontaneous erections, decreased nocturnal penile tumescence, decreased libido, decreased beard growth, and shrinking testicles.