MEN’S HEALTH DRUGS

Male Reproductive System

The male reproductive system consists of many
structures, of which the testes and seminiferous
tubules are the most important to this
discussion,
✔ they produce primary male hormones

The testes, a pair of oval glands, are the male

gonads. These produce male sex hormones,
mainly from the interstitial or Leydig cells.

The seminiferous tubules, which are channels in

the testes, are the site of spermatogenesis.
✔ the process by which mature sperm cells
are produced
Hormones
Androgens (primarily testosterone) - mediate
the normal development and maintenance of
the primary and secondary male sex • Castration or removal of the testes, before
characteristics. puberty results in lack of development of the
normal male characteristics as well as sterility.
Aside from androgenic activity of testosterone,
it is also involved in:
✔the development of bone and muscle tissue
✔inhibition of protein catabolism (metabolic
breakdown)
✔retention of nitrogen, phosphorus, potassium
and sodium.
✔has erythropoietic effect
 CNS
Hypothalamus
GnRH
Anterior Pituitary

FSH (Interstitial Stimulating Hormones) LH

Seminiferous Tubules Interstitial or Leydig Cells
Sperm Inhibin, Estrogens Testosterone
Drugs Affecting the Male Reproductive
System
• Male Steroid Hormones or Androgens –act
like male sex hormone, testosterone

• Anabolic Steroids – synthetic testosterone

preparations that have more anabolic (tissue-
building) effects than androgenic effects

• Drugs that act to improve penile dysfunction

• Alprostadil, a prostaglandin and sildenafil,

tadalafil and verdanafil – improves erection
Androgens
• Duratest, Testoderm – classic androgen in use
today. Used for replacement therapy in cases
of hypogonadism (underdeveloped testes)
and to treat certain breast cancers.

• danazol (Danocrine) a synthetic androgen

that is used primarily to block the release of
FSH and LH in women.

• testolactone (Teslac) is used for treatment of

specific breast cancers.
 Therapeutic Actions and Indications
Drug Name
danazol (Danocrine)
fluoxymesterone (Halotestin)
testolactone (Teslac)
testosterone (Duratest,
Testoderm)
Usual Dosage
100-600mg/day, depending on
use and response
5-20mg/day PO for replacement
therapy; 10-40mg/day PO for
certain breast cancers
250mg PO q.i.d
50-400mg/dayIM every 2-
4weeks,dose varies with
preparation; some long-acting
depository forms, dematological
patch 4-6mg/day, replace patch
daily
Usual Indications
Blockade of follicle-stimulating
hormone and luteinizing
hormone release in women,
treatment of endometriosis,
prevention of angioma
Replacement therapy in
hypogonadism, certain breast
cancers
Treatment of specific breast
cancers
Replacement therapy in
hypogonadism, certain breast
cancers
Pharmacokinetics Contraindications
The androgens are well absorbed and widely ✔with any known allergies
distributed throughout the body.
✔pregnancy and lactation
They are metabolized in the liver and excreted ✔prostate or breast cancer
in the urine.
✔used cautiously in the presence
It is now known whether androgens enter
of liver dysfunction or
breastmilk, but because of potential adverse cardiovascular disease
effects, another method of feeding the baby
should be used if these drugs are needed during
lactation.
DRUG THERAPY (ANDROGEN) ACROSS THE LIFESPAN

Children
These drugs are used as replacement therapy
and to increase red blood cell production in
renal failure.
✔should be closely monitored with hand and
wrist radiographs pretreatment and every
6months
If precocious puberty occurs, the drug should be
stopped.
Adolescents who are prescribed with androgens
should be alerted for potential increased of
acne.
Adults
Women may experience masculinizing effects
and may need support in coping with these
body changes. Men who uses for replacement
therapy may need to learn self injection
techniques.
✔drugs are not indicated for use in pregnancy
and lactation.
Older Adults
Older adults may have problems with androgen
therapy because of underlying conditions that
are aggravated by the drug effects.

This drug can cause fluid retention and also

hepatotoxic.

✔Should be monitored very carefully and

dosage should be reduced. If signs of liver
failure or hepatitis occur, drug should be
stopped immediately.
While a patient is taking androgens, there may
be a decrease in thyroid function as well as
increased creatinine and creatinine clearance,
results that are not associated with disease
states.

These effects can last up to 2 weeks after the

discontinuation of the therapy.
BENIGN PROSTATIC HYPERTROPHY

It is enlargement of the prostate. This begins as Drugs of Choice:

early as 30 years old and is present in 80% in
1.Finasteride
men by the age of 80 years old.
2.Dutasteride Five-Alpha Reductase
Inhibitor
The most troubling symptoms: obstructed
Finasteride (Proscar, Prospecia) works by inhibiting an
urinary flow
enzyme responsible for prostatic growth which helps
the to ease the passage of urine made difficult by
Surgical treatment: TURP (transurethral enlarged prostate.
resection of the prostate)
Finasteride is also indicated for the treatment of
baldness for men only.
Pharmacokinetics:

Half-Life Onset Peak Duration

4-15hours 3-12hr 8hr Unknown

Usual Dosage:
PO: 1mg daily (Propecia)
PO: 5mg daily (Proscar)

Contraindications (Finasteride):
✔Hypersensitivity
✔Pregnancy
✔Children
Nursing Considerations in Px Receiving Androgens

✔ Reconstitute the drug according to

manufacturer’s directions
✔ Remove old dermal system before applying
new system to clean, dry, intact skin
✔ Monitor response carefully when beginning
therapy
✔ Provide thorough patient teaching, including
measures to avoid adverse effects, warning
signs of problems and the need for regular
evaluation, including blood tests
✔ Instruct a family member or caregiver in
proper preparation and administration
techniques
Anabolic Steroids
The anabolic steroids are analogs of Excessive and non-indicated use
testosterone that have been developed to
produce tissue-building effects of testosterone may lead to:
with less androgenic effects.
✔Cardiomyopathy
These are controlled substances that are known
✔Hepatic carcinoma
to be used illegally for the enhancement of ✔Personality changes
athletic performance through increased muscle
mass, increased hematocrit and increased ✔Sexual dysfunction
strength and endurance.
• Nandrolone – an anabolic steroid indicated Drug Name Usual Dosage Usual Indication

for the treatment of anemia associated with

nandrolone (generic) Males: 100-200mg/wk IM Anemia associated with
chronic renal failure. Females: 50-100mg/wk IM renal dysfunction
Pediatric: 25-50mg/wk IM Breast cancer
every 3-4wk HIV wasting syndrome
• Oxandrolone (Oxandrin) – anabolic steroid
that promotes weight gain in debilitated
patients, increased protein anabolism, treats oxandrolone (Oxandrin) Adult: 2.5mg PO two to four Promotion of weight
certain cancers. times daily gain
Pediatric: <0.1mg/kg/day PO Relief of osteoporosis
Treats cancers

• Oxymetholone (Anadrol-50) – used to treat

various anemias. Oxymetholone (Anadrol-
50)
1-5g/kg/day PO Treatment of anemia in
adults
Therapeutic Actions Contraindications
Anabolic steroids promote body tissue-building ✔Hypersensitivity
processes, reverse catabolic or tissue-destroying
processes, and increase hemoglobin and red ✔Pregnancy
blood cell mass. ✔Lactation
✔Liver dysfunction
Pharmacokinetics ✔Coronary disease
These are well absorbed and widely distributed ✔Prostrate or breast cancer in males
throughout the body.
Metabolized in the liver and excreted in the
urine. Contraindicated for pregnancy. It is not
known to enter breast milk.
Adverse Effects Drug to Drug Interactions
✔Phallic enlargement
✔Hirsutism Oral anticoagulants and
✔Increased skin pigmentation antidiabetic may not be
✔Inhibition of testicular function metabolized normally.
✔Gynecomastia
✔Testicular atrophy
✔Priapism
✔Baldness
✔Change in libido
Nursing Considerations:

✔Administer with food if GI effects are

severe
✔Monitor endocrine function, hepatic
function, and serum electrolytes
before and periodically during therapy
✔Provide thorough patient teaching
including measures to avoid adverse
effects and warning signs of problems,
regular evaluation including blood
tests
Drugs for Penile Dysfunction
Two very different drugs are approved for the
treatment of penile erectile dysfunction, a
condition in which the corpus cavernosum does
not fill with blood to allow for penile erection.

Penile erection can be compromised by:

✔the aging process
✔vascular and neurological conditions

DRUGS OF CHOICE:
1.alprostadil (Caverject, MUSE)
2.sildenafil, tadalafil, vardenafil
1. alprostadil (Caverject, MUSE) – is a
prostaglandin that relaxes vascular smooth
muscle and allows filling of the corpus
cavernosum when it is injected directly into
the cavernosum.

2. sildenafil (Viagra), taladafil (Cialis) and

vardenafil (Levitra) – phosphodieterase
type 5 receptors (PDE5), allowing blood
flow into the corpus cavernosum. These
drugs have the advantage of being oral
drugs that can be timed in coordination
with sexual acitivity.
Therapeutic Actions and Indications
The prostaglandin alprostadil is injected and
acts locally to relax vascular smooth muscle and
promote blood flow into the corpus
cavernosum. It is metabolized to inactive
compounds in the lungs and excreted in the
urine.
✔Not indicated for use in women and not
classified for use in pregnancy and lactation
If alprostadil is being used during coitus,
condoms should be used in pregnant woman.
The PDE5 Inhibitors are taken orally and act to
increase nitrous oxide levels in the corpus
cavernosum. Nitrous oxide activates the enzyme
cGMP, which causes smooth muscle relaxation,
allowing the flow of blood in the corpus
cavernosum.
Sildenafil is approved for treatment of
pulmonary arterial hypertension.
These drugs are well absorbed in the GI tract,
undergo metabolism and excreted in the urine.
 DRUGS ONSET DURATION ACTION
Sildenafil 27 minutes 4 hours Taken drug 1hour before
sexual stimulation
Vardenafil 26 minutes 4 hours Taken 1 hour before
sexual stimulation
Tadalafil 45 minutes 36 hours Select this drug if the
timing of sexual
stimulation is not known
and may be several hours
away
Contraindications and Cautions
✔ Presence of anatomical obstruction that
might predispose priapism
✔ Penile implants
✔ Not for women
✔ Bleeding disorders
✔ Coronary artery disease, pepticulcers
✔ Retinits pigmentosa
✔ Optic neuropathy
✔ Severe hypertension
✔ Severe hepatic or renal disorders
Adverse Effects
Alprostadil:
Drug to Drug Interactions:
✔pain at the injection site
PDE5 Inhibitors:
✔Infection
✔Priapism
▪Cannot be taken with organic nitrates or alpha-
adrenergic blockers; serious cardiovascular
✔Fibrosis
disease may occur even death
✔Rash
▪Ketoconazole, erythromycin, itraconazole can
PDE5 Inhibitors: cause increase level of PDE5 Inhibitor drugs in
✔Headache the system
✔Flushing ▪Indinavir, ritonavir can increase Vardenafil and
✔Dyspepsia taladafil serum levels in the system
✔Urinary Tract Infection
✔Diarrhea
✔Dizziness
✔Possible optic neuropathy
✔Rash
Nursing Considerations:
✔ Assess the cause of dysfunction before
beginning therapy
✔ Monitor patients with vascular disease
✔ Instruct the patient in the injection of
alprostadil, storage of the drug, filling of the
syringe, sterile technique and proper disposal
of needles
✔ Monior patients who are taking PDE5
inhibitors for use of nitrates or alpha-blockers
✔ Provide thorough patient teaching, including
measures to avoid adverse effects and
warning signs of problems as well as the need
for regular evaluation
Thank you! ☺