testosterone pellets

testosterone pellets

(tess-toss-te-rone pel-letts) ,

Testopel

(trade name)

Classification

Therapeutic: hormones
Pharmacologic: androgens
Pregnancy Category: X

Indications

Hypogonadism in androgen-deficient men.Delayed puberty in men.

Action

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: Crosses the placenta.
Protein Binding: 98%.
Metabolism and Excretion: Metabolized by the liver; 90% eliminated in urine as metabolites.
Half-life: 10–100 min.

Time/action profile (androgenic effects†)

ROUTEONSETPEAKDURATION
SCunknownunknown3–6 mo
†Response is highly variable among individuals; may take months

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Obstetric: Pregnancy and lactation; Male patients with breast or prostate cancer; Women.
Use Cautiously in: Pre-existing cardiac, renal, or liver disease; Geriatric patients (↑ risk of prostatic hyperplasia/carcinoma); Benign prostatic hypertrophy; Hypercalcemia; Prepubertal males.

Adverse Reactions/Side Effects

Ear, Eye, Nose, Throat

  • deepening of voice (most frequent)

Cardiovascular

  • edema (most frequent)

Gastrointestinal

  • cholestatic jaundice
  • drug-induced hepatitis
  • liver function test elevation
  • nausea
  • vomiting

Genitourinary

  • change in libido (most frequent)
  • erectile dysfunction (most frequent)
  • priapism (most frequent)
  • prostatic enlargement

Endocrinologic

  • gynecomastia (most frequent)
  • hirsutism (most frequent)
  • oligospermia (most frequent)
  • hypercholesterolemia

Fluid and Electrolyte

  • hypercalcemia
  • hyperkalemia
  • hyperphosphatemia

Dermatologic

  • male pattern baldness

Local

  • pain at implantation site

Interactions

Drug-Drug interaction

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

Route/Dosage

Male Hypogonadism (replacement therapy)
Subcutaneous (for subcutaneous implantation): (Adults) 150–450 mg every 3–6 mo.
Delayed Male Puberty
Subcutaneous (for subcutaneous implantation): (Children) 150–450 mg every 3–6 mo for up to 6 mo.

Availability

Pellets: 75 mg

Nursing implications

Nursing assessment

  • Monitor intake and output ratios, weigh patient twice weekly, and assess patient for edema. Report significant changes indicative of fluid retention.
  • 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: 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, and bilirubin, ↑ 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 ↑).

Potential Nursing Diagnoses

Sexual dysfunction (Indications,  Side Effects)

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 subcutaneously 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.
    • 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 diabetic patients 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.

Evaluation/Desired Outcomes

  • Resolution of the signs of androgen deficiency without side effects. Therapy is usually limited to 3–6 mo followed by bone growth or maturation determinations.
References in periodicals archive ?
Testosterone pellets provide satisfying beneficial effects and are also an alternative for those patients who do not want to bother too much with treatment.
The American boxing star then admitted he had testosterone pellets implanted under his skin for the first fight.
Peterson had testosterone pellets inserted into his hip before he claimed a controversial split-decision win over Khan in December but is adamant they did not affect his performance.
Peterson, 28, has admitted to taking testosterone pellets but the fighter's camp insist he only acted on medical advice after suffering from low levels of the hormone.
Implanted testosterone pellets are not recommended because they do not provide consistent testosterone levels and are not reversible if side effects develop or if PSA increases.
28) Oral desogestrel with testosterone pellets was recently found to lead to azoospermia, but requires daily administration of the progestin and a minor procedure for insertion of pellets.
One such strategy involves giving male rats testosterone pellets to replace testosterone; other methods involve blocking the degradation of testosterone with aromatase inhibitors (aromatase is a key enzyme involved in converting testosterone to estrogen) such as Fadrozol.
If this doesn't work, testosterone pellets can be implanted under the skin of the buttocks.
Trough serum testosterone predicts the development of polycythemia in hypogonadal men treated for up to 21 years with subcutaneous testosterone pellets.
A month of testosterone for replacement therapy costs approximately $50 for the Depo-Testosterone injections or $100-$150 for transdermal patches, topical gels, oral testosterone, or testosterone pellets, said Dr.
A month of testosterone for replacement therapy costs about $50 for the Depo-Testosterone injections or $100-$150 for transdermal patches, topical gels, oral testosterone, or testosterone pellets, said Dr.
Implantable testosterone pellets are highly popular in the United Kingdom and Australia, where they have been used for more than 30 years.