Content Reviewers:Yifan Xiao, MD
Contributors:Salma Ladhani, MD, Jake Ryan, Maria Emfietzoglou, MD, Elizabeth Nixon-Shapiro, MSMI, CMI
They prevent the biological effects of androgens like testosterone in the body and are used in the treatment of prostate cancer, benign prostatic hyperplasia, hair loss in males, and hirsutism in females.
Two important intermediate molecules in that process are dehydroepiandrosterone, also called DHEA, and the molecule that it gets converted into - androstenedione.
Testosterone also helps with secondary sexual characteristics which aren’t required for reproduction but are associated with masculinity, like a male pattern of hair growth on the face, chest, axillary, and genital areas.
The hair itself changes from thin soft hair of childhood to thick and coarse hair of adulthood, and the voice eventually deepens.
Testosterone also has tissue-building effects, sometimes called anabolic effects.
Other anabolic effects include development of broad shoulders and muscular arms and legs.
Last but not least, testosterone stimulates erythropoiesis, giving men a higher red blood cell count than women.
Now, in some pathological conditions, testosterone levels in the body drop lower than normal which can lead to a variety of problems ranging from delayed puberty in children to decreased libido in adults.
Low testosterone levels can also suspend normal growth, and affect secondary sexual characteristics during puberty, while it may cause anemia and decreased muscle mass in adults ultimately leading to limited physical ability.
Testosterone derivatives include fluoxymesterone and methyltestosterone, which are given orally, and testosterone esters like testosterone cypionate which are long-acting androgens given by intramuscular depot injection.
Now, testosterone and testosterone derivatives are mainly used for testosterone replacement therapy in hypogonadism in biological males, where low levels of testosterone in the body result in delayed puberty, or delayed sexual maturation.
They are used both in primary hypogonadism meaning testicular disease, and in secondary hypogonadism or hypopituitarism meaning pituitary disease, in order to stimulate the development of secondary sexual characteristics and accelerate growth.
They are also used in order to stimulate anabolism as a means of promoting recovery after a burn or injury, and in order to promote weight gain in patients with wasting syndromes, like those with cancer or AIDS.
Now, both testosterone and testosterone derivatives can cause masculinization in females, which includes enlargement of the clitoris, acne, and hirsutism, which is the growth of facial and chest hair, as well as menstrual irregularity.
In males, excessive doses inhibit LH release via a negative feedback mechanism which leads to a decrease in intratesticular testosterone and gonadal atrophy.
Finally, they cause an increase of low density lipoprotein, or LDL, and a decrease of high density lipoprotein, or HDL, which leads to obesity.
They include medications like nandrolone and oxandrolone.
They tend to increase muscle size and strength, and promote erythropoiesis, meaning they increase red blood cell production.
However, their clinical use is limited.
They have also been abused illegally by athletes to increase athletic performance.
Now, side effects are similar to those caused by testosterone derivatives, however high doses of anabolic steroids can also cause cholestatic jaundice, a reduction in bile flow from the liver into the small intestine that eventually leads to bile salts depositing in the skin, giving it a yellowish color, increasing liver enzyme levels, and hepatocellular carcinoma, which is a liver tumor.
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