Populations at Risk for a Hypogonadal State
Those with chronic illness
Those with chronic obstructive pulmonary disease
Those with autoimmune diseases
Those undergoing high-dose corticosteroid therapy
Those with severe acute injury or infection or who are critically ill
Testosterone administration is used mainly to correct a hypogonadal state, because testosterone analogs have much greater anabolic activity100-104 (Table 14.16). Clinical studies have demonstrated a significant increase in net protein synthesis, especially in muscle and skin, with use of high doses of testosterone delivered parenterally.105,106
It is clear that testosterone is needed for the wound healing process, because decreased levels impede healing.107-110 Adequate testosterone levels are required for IGF-1 production (IGF-1 being a wound healing agent). However, there are no reliable data that confirm that an increase in testosterone levels above normal improves wound healing. This is not the case with a number of anabolic steroids that have been shown to increase the rate of wound healing even in the absence of hypogonadism. These agents will be discussed next.
The major complications are the androgenic side effects. Some fluid retention has been reported with high doses. A decrease in high-density lipoproteins has also been reported with the use of large doses.
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