Chapter 41

Drugs Affecting the Male

Reproductive System

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 Drugs Used to Affect the
Male Reproductive System
• Male steroid hormones or androgens
– Act like testosterone
– Develop male sexual characteristics
• Male sex hormone or anabolic steroids
– Synthetic testosterone preparations have more
anabolic effects than androgenic effects
– Tissue building
• Drugs to improve penile dysfunction
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Sites of Action of Drugs Affecting the
Male Reproductive System

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Signs and Symptoms of Adverse Effects of
Androgens/Anabolic Steroids
• Swelling in fingers or legs
• Continual erection
• Uncontrollable sex drive
• Yellowing skin
• Fever, chills, and rash
• Chest pain and difficulty breathing
• Hoarseness
• Loss of hair or growth of facial hair in women
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 Androgens and Their Indications
• Testosterone (Duratest, Testoderm, others)
– Hypogonadism; breast cancer
• Danazol (Danocrine)
– Blocks the release of FSH and LH in women
• Fluoxymesterone (Halotestin)
– Hypogonadism; breast cancer
• Testolactone (Teslac)
– Breast cancers
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 Androgens
• Actions
– Increase the retention of nitrogen, sodium, potassium
– Decrease the urinary excretion of calcium
– Increase protein anabolism
– Decrease protein catabolism
– Increase the production of red blood cells
• Indications
– Replacement therapy in hypogonadism and delayed
puberty in males
– Inoperable breast cancer
– Prevention of ovulation to treat endometriosis
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 Androgens (cont.)
• Pharmacokinetics
– Well absorbed and widely distributed throughout
the body
– Metabolized in the liver and excreted in the urine
• Contraindications
– Allergy
– Pregnancy and lactation
– Prostate or breast cancer in men
• Cautions
– Liver dysfunction and cardiovascular disease
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 Androgens (cont.)
• Adverse effects
– Acne, edema, and hirsutism
– Deepening of the voice, oily skin and hair, weight
gain, decreased breast size, and testicular atrophy
– Flushing sweating, vaginitis, nervousness, and
emotional lability
– Headache, dizziness, sleep disorders, and altered
electrolytes
• Drug laboratory test
– Thyroid function
– Creatinine
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Alternative Therapies Used to Enhance
Athletic Performance

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Anabolic Steroids and Their Indications
• Oxandrolone (Oxandrin)
– Promotes weight gain in debilitated patients
– Increases protein anabolism
– Treats certain cancers
• Oxymetholone (Anadrol)
– Treats various anemias
• Stanozolol (Winstrol)
– Treats hereditary angioedema
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 Anabolic Steroids
• Actions
– Promote body tissue-building processes
– Reverse catabolic or tissue-destroying processes
– Increase hemoglobin and red blood cell mass
• Indications
– Vary with each drug
– Treatment of anemias, certain cancers, and
angioedema
– Promote weight gain and tissue repair
– Protein anabolism
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 Anabolic Steroids (cont.)
• Pharmacokinetics
– Well absorbed and widely distributed throughout the
body
– Metabolized in the liver and excreted in the urine
• Contraindications
– Allergy and liver dysfunction
– Pregnancy and lactation
– Coronary disease
– Prostate or breast cancer in males
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 Anabolic Steroids (cont.)
• Adverse effects
– Cardiomyopathy
– Hepatic carcinoma
– Personality changes
– Sexual dysfunction
– Virilization
– Inhibition of testicular function, gynecomastia,
testicular atrophy, priapism, baldness, and change
in libido
• Drug-to-drug interactions
– Oral anticoagulants
– Antidiabetic medications
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 Drugs Approved for the Treatment of
Penile Erectile Dysfunction
• Alprostadil (Caverject, MUSE)
– Prostaglandin that relaxes vascular smooth
muscle and allows filling of the corpus
cavernosum when it is injected directly into the
cavernosum
• Sildenafil (Viagra), tadalafil (Cialis), and vardenafil
(Levitra)
– Selectively inhibit phosphodiesterase type 5
receptors (PDE5) and increase nitrous oxide
levels, allowing blood flow into the corpus
cavernosum
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 Drugs for Treatment of
Penile Erectile Dysfunction
• Actions
– Alprostadil: an injectable that acts locally to relax
vascular smooth muscle and promotes blood flow into
the corpus cavernosum causing penile erection
– Inhibits PDE5 receptors, leading to a release of nitrous
oxide, which activates cGMP to cause a prolonged
smooth muscle relaxation, allowing the flow of blood
into the corpus cavernosum and facilitating erection
• Indication
– Treatment of erectile dysfunction in the presence of
sexual stimulation
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 Drugs for Treatment of
Penile Erectile Dysfunction (cont.)
• Pharmacokinetics
– Well absorbed, metabolized in the liver, and excreted
in the urine
• Contraindications
– Conditions that might predispose to priapism
– Penile implants
– Use in women
• Cautions
– Bleeding disorders, coronary artery disease, active
peptic ulcer, retinitis pigmentosa, hypotension or
severe hypertension, congenital prolonged Q-T
interval, and severe hepatic or renal disorders
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 Drugs for Treatment of
Penile Erectile Dysfunction (cont.)
• Adverse effects
– Edema, headache, dizziness, syncope, angina,
and dyspnea
• Drug-to-drug interactions
– PDE5 inhibitors combined with organic nitrates or
alpha blockers
 Can cause dangerous cardiovascular effects,
including death
 Careful patient teaching is essential
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 Use of Drugs Affecting the Male
Reproductive System Across the Lifespan

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Prototype Androgen

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Prototype Anabolic Steroids

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Prototype Drugs for Treatment of
Erectile Dysfunction

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Nursing Considerations for Androgens

• Assessment (history and physical exam)

• Nursing diagnosis

• Implementation

• Evaluation

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 Nursing Considerations for
Anabolic Steroids

• Assessment (history and physical exam)

• Nursing diagnosis

• Implementation

• Evaluation

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Nursing Considerations for Drugs Used in
Treatment of Erectile Dysfunction

• Assessment (history and physical exam)

• Nursing diagnosis

• Implementation

• Evaluation

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