Testosteron Treatment Options: Choices and Non Choices in The World. By: Prof Ronald S. Swerdloff, MD (UCLA)

Berikut adalah hasil dari Pertemuan Ilmiah Tahunan Persandi V-Pandi XIX, dengan judul Current Hopes in Sexual Dysfunction and Infertility Solution, yang bertempat di Grand Sahid Jaya Hotel Jakarta, 27-29 April 2011

Testosteron Treatment Options: Choices and Non Choices in The World. By: Prof Ronald S. Swerdloff, MD (UCLA)

Testosterone is the principal male hormone produced in the testes. It is an anabolic steroid that acts directly as a hormone on the nuclear androgen receptor or on the cell surface rapid acting signaling pathways; it also can create its biological effects acting as a pre-hormone substrate for its metabolites such as estradiol and dehydrotestosterone (DHT). Testosterone acts on many target organs with different level of tissue responsiveness and different characteristics of the dose response curve.

Testosterone medications are usually reserved in men as a treatment for hypogonadism (low testosterone).

There are many treatment formulations and delivery routes available.

Routes of administration include:

1. Oral--> medications include testosterone esters such as testosterone undecanoate (TU) or 17 alkylated testosterone such as methyl testosterone. The oral TU available in many countries is short acting, requires administration with food, two or three times a day;

One example of this kind of medication is: Andriol®

2. Trans-buccal --> is given twice daily and gives reasonably constant levels at equilibrium;

This picture shows how to apply the transbuccal testosterone

One example of this kind of medication is: Striant®

3. Trans-dermal --> trans dermal testosterone are very popular and can be given as gels, patches and roll ons. They are usually once a day preparations with acceptable pharmacokinetics. The gels are relatively free of the skin irritation seen with closed system patches. The disadvantage of gelsis the possibility of transfer by skin to skin partners or children.

Examples of this kind of medication is: Androderm ®, Androgel®,  Tostrex®,

4. Injectable --> Injectables can be intermediate lasting such as testosterone enanthate and sypionate giving peak values at days 1-2 after injection and nadirs at about 10 days. There are peaks and valleys when given as a q2week (once every teo week) regimen so some clinicians favor smaller dose weekly injections.

Testosterone Enanthate

Longer acting testosterone injectables are available in many countries (but not the USA) with injections required only once every three months. Injectables have the disadvantage of requiring somewhat uncomfortable delivery.

Nebido® is one example of long acting testosterone injectable (Testosterone Undecanoate)

5. Subcutaneous pellets --> Long term pellets are even longer lasting but may require some skill in administering and may extrude from side.

Testopel® is one example of testosterone pellet

Warning: before you decide to give yourself a Testosterone Replacement Therapy (TST), you should first contact your physician.

Do not use any testosterone if you:

• have breast cancer (rare in men).


• have prostate cancer.


• are a woman (especially if you are pregnant or breast-feeding). TST  may harm the babies of pregnant and breast-feeding women.


• are allergic to testosterone.

Tell your doctor if you have or had:

• problems urinating due to an enlarged prostate.


• liver problems.


• kidney problems.


• heart problems.


• lung problems.


• diabetes.

Tell your doctor about all the medicines you take, including prescription and non- prescription medicines, vitamins, and herbal supplements.

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From left to right

1. Prof. Dr. Nukman Moeloek, dr, SpAnd (Indonesia Senior Andrology Specialist)

2. dr Yuan Ade Sukma (myself)

3. Prof. Christina Wang, dr, PhD (President of ISA WHO, 2011)

4. Prof. Ronald S. Swerdloff, MD (UCLA)

5. Prof. Dr. KM Arsyad, DABK, SpAnd ( Chief of PERSANDI, 2011)