testosterone pellets(tess-toss-te-rone pel-letts) ,
Pregnancy Category: X
Hypogonadism in androgen-deficient men.Delayed puberty in men.
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.
Correction of hormone deficiency in male hypogonadism:
- Initiation of male puberty.
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†)
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)
- edema (most frequent)
- cholestatic jaundice
- drug-induced hepatitis
- liver function test elevation
- change in libido (most frequent)
- erectile dysfunction (most frequent)
- priapism (most frequent)
- prostatic enlargement
- gynecomastia (most frequent)
- hirsutism (most frequent)
- oligospermia (most frequent)
Fluid and Electrolyte
- male pattern baldness
- pain at implantation site
Drug-Drug interactionMay ↑ action of warfarin, oral hypoglycemic agents andinsulin.Concurrent use with corticosteroids may ↑ risk of edema formation.
Route/DosageMale 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.
Pellets: 75 mg
- 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 DiagnosesSexual dysfunction (Indications, Side Effects)
- 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.
- 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.
- 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.