29 July 2002
Better Male Hormone Replacement Methods Needed
by George Atkinson

Better methods of delivering hormone replacement therapy to men are needed to make it more acceptable to patients. In an editorial overview in this month's Current Opinion in Oncologic, Endocrine & Metabolic Investigational Drugs Dr Paul Gard, Senior Lecturer, School of Pharmacy and Biomolecular Sciences, University of Brighton, UK, points out that the development of male hormone replacement therapy delivery methods is lagging a long way behind those for female HRT. 'There is good evidence that testosterone secretion decreases with age and that many men over the age of 60 have lower levels than normal,' said Dr Gard. 'This can lead to a number of symptoms including osteoporosis, loss of weight and strength, plus mood disorders, loss of memory and cognitive ability. It is generally recognized that testosterone replacement therapy may be of value in the alleviation of some of the symptoms associated with aging males.

'Most testosterone in the blood is inactive as it is bound by a protein called sex hormone binding globulin (SHBG). However, studies show older men have a significant increase in SHBG concentration, which means that they have even less testosterone that is biologically active. Commented Dr Gard: 'There are many ways of delivering female steroids - either for contraception or menopausal HRT - including locally acting creams, oral formulations, injections, implants, vaginal rings and skin patches.

Unfortunately, we don't have the same array of choices for giving men hormone treatments, although we do have oral formulations, injections and skin patches. It is clear, however, that the assessment of such methods is still in its relative infancy.'There are problems associated with most of the currently available androgen delivery methods. Oral formulations carry a risk of liver damage; injections require the man to see a healthcare provider every two weeks and are linked to increases in body weight, some types of injection also raised prostate volume and prostate-specific antigen (PSA) which is linked to prostate cancer; solid implants require the insertion of up to six implants in the upper arm - although researchers think this is a promising method of long-term androgen administration in hypogonadism (a condition where the testes don't work properly); and transdermal patches cause skin irritation, are unsightly and rustle.

Said Dr Gard: 'If the use of testosterone replacement is to become more common in an aging population, there is a need to improve upon the methods of drug delivery that are currently available.'

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