NCLEX Review Guide: Endocrine Pharmacology - Androgens

Primary Androgen Medications

• Testosterone is the primary natural androgen hormone responsible for male sexual development and maintenance of secondary sexual characteristics.
• Synthetic androgens include methyltestosterone, fluoxymesterone, and testosterone cypionate used for hormone replacement therapy.
• Androgens are administered via oral, intramuscular, transdermal, or topical gel routes depending on the specific medication.

Primary Indications

• Hypogonadism in males is the most common indication for androgen replacement therapy to restore normal testosterone levels.
• Treatment of delayed puberty in adolescent males when constitutional delay is confirmed by endocrine evaluation.
• Certain types of breast cancer in postmenopausal women as palliative treatment for hormone-sensitive tumors.
• Severe osteoporosis in postmenopausal women when other treatments have failed or are contraindicated.

Assessment and Monitoring

1. Obtain baseline liver function tests, lipid profile, and complete blood count before initiating therapy.
2. Monitor prostate-specific antigen (PSA) levels in male patients over 40 years old before and during treatment.
3. Assess for signs of fluid retention, edema, or heart failure especially in elderly patients.
4. Evaluate blood pressure and cardiovascular status regularly as androgens can increase blood pressure.

Common Adverse Effects

• Hepatotoxicity is a serious concern, especially with oral androgens requiring regular liver function monitoring.
• Virilization in females includes deepening voice, increased body hair, clitoral enlargement, and menstrual irregularities.
• Cardiovascular effects include increased blood pressure, fluid retention, and potential for thrombotic events.
• Mood changes such as increased aggression, irritability, or mood swings may occur with high doses.

Essential Teaching Points

• Instruct patients using topical testosterone to apply to clean, dry skin and wash hands thoroughly after application.
• Educate about transfer risk - topical testosterone can transfer to others through skin contact, especially dangerous for pregnant women and children.
• Advise patients to report signs of liver problems including jaundice, dark urine, light-colored stools, or abdominal pain.
• Emphasize importance of regular follow-up appointments for monitoring blood work and assessing treatment effectiveness.