From the FDA Drug Label
In the majority of patients, testosterone levels increased above baseline during the first week, declining thereafter to baseline levels or below by the end of the second week of treatment. Castrate levels were reached within two to four weeks and once attained were maintained for as long as drug administration continued. The use of GnRH agonists may cause a reduction in bone mineral density. Patients should be informed that diabetes, or loss of glycemic control in patients with pre-existing diabetes, has been reported during treatment with GnRH agonists, including ZOLADEX.
Treatment for Hyperandrogenism (Elevated Testosterone Levels):
- The treatment involves the use of GnRH agonists such as leuprolide or goserelin, which can reduce testosterone levels to castrate levels.
- Flutamide, an antiandrogen, can also be used in combination with GnRH agonists to treat hyperandrogenism.
- It is essential to monitor patients for symptoms and signs suggestive of development of cardiovascular disease and manage them according to current clinical practice.
- Patients should be informed about the potential risks of treatment, including reduction in bone mineral density and increased risk of diabetes.
- Regular assessment of serum Prostate Specific Antigen (PSA) may be helpful in monitoring the patient's response to treatment. 1 2 3
From the Research
Treatment for hyperandrogenism should focus on addressing the underlying cause and managing symptoms through medication and lifestyle changes, with first-line pharmacological treatments including combined oral contraceptives and anti-androgens such as spironolactone. The goal of treatment is to reduce androgen levels, alleviate symptoms, and improve quality of life. Key considerations in treatment include:
- The patient's desire for pregnancy
- Symptom severity
- Underlying conditions, such as polycystic ovary syndrome (PCOS) Regular monitoring of liver function, electrolytes, and metabolic parameters is necessary during pharmacological treatment, and most medications require several months to show full benefit in reducing symptoms like hirsutism, acne, and irregular menstruation 4, 5. It is essential to tailor treatment to the specific needs of the patient, taking into account their individual circumstances and health status. For women with PCOS, weight loss of even 5-10% can significantly improve symptoms by decreasing insulin resistance and androgen production 5. In cases where insulin resistance is present, metformin (1500-2000 mg daily) can be a useful addition to treatment, as it improves insulin sensitivity and indirectly reduces androgen levels 5. Ultimately, the most effective treatment approach will depend on the individual patient's needs and circumstances, and may involve a combination of medication, lifestyle changes, and ongoing monitoring and support.