Table 1417

Clinical Effects of Testosterone Administration

Correction of the androgenic/anabolic deficiency of a hypogonadal state

Increased anabolism and muscle synthesis in the elderly

Increased lean mass synthesis in healthy humans

Decreases bone loss

Androgenic side effects

Summary

Testosterone is a necessary androgen for maintaining lean mass and wound healing. A deficiency leads to catabolism and impaired healing. The use of large doses exogenously has increased net protein synthesis, but a direct effect on wound healing has not yet been demonstrated.

anabolic steroids

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Anabolic steroids refer to the class of drugs produced by modification of testosterone.2224108-110 These drugs were developed in order to take clinical advantage of the anabolic effects of testosterone while decreasing androgenic side effects of the naturally occurring molecule. Modifications in the steroid ring were made because of the short half-life of testosterone and its masculinizing properties. Modifications included a 17-a-methyl derivative for oral use and a 17-P-ester configuration for parenteral use. These changes markedly increased half-life and decreased androgenic properties (Table 14.18).

The mechanisms of action of testosterone analogs are also through activation of the androgenic receptors found in highest concentration in myocytes and skin fibro-blasts. Some populations of epithelial cells also contain these receptors. Androgenic receptors were first isolated in the 1960s.93-95,108-110

Stimulation leads to a decrease in efflux of amino acids and an increase in influx into the cell. Activation of intracellular DNA and DNA polymerase also occurs with androgenic receptor stimulation. A decrease in fat mass is also seen due to the preferential use of fat for fuel. There are no metabolic effects on glucose production.

All anabolic steroids increase overall protein synthesis and new tissue formation, as evidenced by an increase in skin thickness and muscle formation.110-114 All these agents also have anticatabolic activity, decreasing the protein degradation caused by cortisol and other catabolic stimuli.114 In addition, all anabolic steroids have andro-genic or masculinizing effects.

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