The aim of treatment is to restore gonadal function. This is accomplished by replacing gonadal steroids and, when indicated, restoring fertility potential by the administration of gonadotropins or gonadotropin-releasing hormone. The latter is not a priority in critical care conditions. In contrast, the catabolic effects of testosterone deficiency in men may contribute to the loss of protein from vital organs and tissues, and, in particular, aggravate muscle wasting. The critical condition in itself is associated with profound hypoandrogenemia, and treatment with testosterone or anabolic testosterone analogs has been shown to improve nitrogen balance without having the potential to normalize it.
Administration of testosterone is preferred in the parenteral form (testosterone enanthate or cypionate 100-300 mg intramuscularly every 2-4 weeks). The effectiveness can be monitored by the patient's clinical condition and by measuring serum levels. Overdosage may lead to salt and fluid retention, edema, excessive sexual stimulation, priapism, gynecomastia, aggressive behavior, polycythemia, and worsening of benign prostatic hypertrophy in middle-aged and elderly males. Synthetic testosterone analogs have been designed to weaken the androgen properties while selecting the anabolic effect on protein synthesis.
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