Women can take testosterone as a cream, through a patch or in the form of pellet implants, which have the highest consistency of delivery. Synthesized from yams or soybeans, and compounded of pure, bioidentical testosterone, the pellets, each slightly larger than a grain of rice, are inserted just beneath the skin in the hip in a one-minute outpatient procedure. They dissolve slowly over three to four months, releasing small amounts of testosterone into the blood stream, but speeding up when needed by the body -- during strenuous activities, for example -- and slowing down during quiet times, a feature no other form of hormone therapy can provide.
The effects of testosterone administration on the GH axis in androgen-deficient HIV-infected women are unknown. In this study, we determined the effects of transdermal testosterone administration on GH secretory dynamics and pulse characteristics in this population. GH-IGF-I parameters were determined in response to testosterone ( mg/patch, twice a week; estimated delivery rate, 150 microg/d) vs. placebo over 6 months in 31 HIV-infected women. IGF-I increased significantly in the testosterone-treated compared with the placebo-treated patients [37 (-4, 73) vs. -30 (-98, 39) ng/ml, P = ; (-, ) vs. - (-, ) nmol/liter]. GH pulse frequency increased significantly in the testosterone-treated compared with the placebo-treated subjects [ (, ) vs. (-, ) peaks per 12 h, respectively; P = ]. Before testosterone administration, overnight GH pulse amplitude was significantly related to IGF-I in univariate (r = , P = ) and multivariate regression analysis; however, free testosterone, estradiol, and body mass index were not significantly correlated with baseline IGF-I. In contrast, after 6 months of treatment with testosterone, the change in IGF-I was significantly correlated to the change in free testosterone in univariate (r = , P = ) and multivariate regression analysis. For each pg/ml ( pmol/liter) increase in free testosterone, IGF-I increased 19 ng/ml ( nmol/liter), controlling for estradiol, body mass index, and GH pulse parameters (r(2) = ). We demonstrate that IGF-I increases in response to physiologic, transdermal testosterone in HIV-infected women. The mechanism of this effect is unknown, but may involve a direct effect of testosterone on IGF-I, independent of changes in GH pulse dynamics.
The manufacturers of certain testosterone products (., AndroGel and Striant) state that their products are contraindicated in patients with soybean, soy, or soya lecithin hypersensitivity because they are derived partially from soy plants. There is a risk of serious hypersensitivity reactions or anaphylaxis with the use of testosterone undecanoate (Aveed) oil for injection. These allergic reactions can occur after any injection of testosterone undecanoate during the course of therapy, including after the first dose. Observe patients in the healthcare setting for 30 minutes after an Aveed injection in order to provide appropriate medical treatment in the event of serious hypersensitivity reactions or anaphylaxis. The Aveed injection contains benzyl benzoate, the ester of benzyl alcohol and benzoic acid, and refined castor oil. Therefore, testosterone undecanoate use is contraindicated in patients with polyoxyethylated castor oil hypersensitivity, benzoic acid hypersensitivity, or benzyl alcohol hypersensitivity. Patients with suspected hypersensitivity reactions should not be re-treated with testosterone undecanoate injection.