Table 1416

Populations at Risk for a Hypogonadal State

Elderly

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

Results of Exogenous Use

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

Wound Healing Effect

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.

Complications

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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