Part of “CHAPTER 119 – CLINICAL USE AND ABUSE OF ANDROGENS AND ANTIANDROGENS“

The principal use of androgens is as replacement therapy for androgen-deficient hypogonadal men.2,4 The therapeutic goal of androgen replacement therapy is to restore the normal physiologic effects of testosterone, which depend on the individual’s stage of development.53 In prepubertal androgen deficiency, which delays the onset of pubertal development, the aim of androgen therapy is to induce and maintain normal male secondary sexual characteristics, somatic development, and sexual behavior. Androgens stimulate the normal male pattern of hair growth (face, chest, abdominal, perianal area, and inner thighs); growth of the penis and scrotum; development of accessory sexual organs (prostate and seminal vesicles) with an increase in ejaculatory volume; enlargement of the larynx with consequent deepening of the voice; development of skeletal musculature and an increase in strength, especially in the shoulder and pectoral muscles; decrease and redistribution of body fat; growth of the long bones and eventual closure of epiphyses; erythropoiesis; and libido and potency. An important goal of androgen therapy in prepubertal children is to induce the pubertal growth spurt without compromising adult height by premature closure of the epiphyses. In adult male hypogonadism, the goal of androgen treatment is to restore and maintain secondary male sexual characteristics and sexual behavior.