Table Of ContentE. Nieschlag H. M. Behre (Eds.) Testosterone
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E. Nieschlag H. M. Behre (Eds.)
Testosterone
Action - Deficiency - Substitution
Second Edition
Editorial Assistant: S. Nieschlag
With Contributions by
1. E. Atkinson H. M. Behre S. Bhasin R. Bross
R. Casaburi Y.-L. Chang K. Christiansen
B. Couzinet A. von Eckardstein J. S. Finkelstein
J. Frick L.J. Gooren D. J. Handelsman A. Jungwirth
J.M. Kaufman P. Y. Liu W.A. Meikle E. Nieschlag
C.A. Quigley Y.A. Randall EEG. Rommerts
E. Rovan G. Schaison W. Schanzer P.J. Snyder
T. W. Storer A. Vermeulen G. E Weinbauer
With 95 Figures and 28 Tables
, Springer
Prof. Dr. med. Eberhard Nieschlag
Priv.-Doz. Dr. med. Hermann M. Behre
Institute of Reproductive Medicine, University of Munster
Domagkstrasse 11, D-48129 Munster, Germany
Editorial Assistant: Susan Nieschlag, MA
ISBN -13: 978-3-642-72187-8 e-ISBN -13: 978-3-642-72185-4
DOl: 10.1007/978-3-642-72185-4
Library of Congress Cataloging-in Publication Data
Testosterone: action, deficiency, substitution / E. Nieschlag, H. M. Behre (eds.); editorial
assistant, S. Nieschlag; with contributions by L. E. Atkinson ... [et al.]. - 2nd ed. Includes
bibliographical references and index. ISBN-13:978-3-642-72187-8
1. Testosterone - Therapeutic use. 2. Testosterone - Physiological effect. 1. Nieschlag. E.
II. Behre, H.M. (Hermann M.), 1961- . RM296.5.T47T47 1998 615'.366-dc21
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Preface
The first edition of "Testosterone: Action, Deficiency, Substitu
tion" was published in 1990. Since then our understanding of the
hormone that turns males into men has tremendously increased.
Therefore, the editors felt that a second extended edition of the
book is warranted in order to summarize established and recent
findings in the field and to present the reader with an up-to-date
textbook. The increased mass of knowledge is reflected by the
growth of the volume from 14 to 20 chapters.
In the updated edition the biochemistry and metabolism of
androgens have been complemented by extensive information on
the molecular biology of the androgen receptor and its disorders.
The key role of testosterone in spermatogenesis is now better de
fined. We have a more complete understanding of the psychotro
pic effects of testosterone and know so much about the different
target organs and functions that individual chapters deal with
testosterone and the prostate, lipids and the cardiovascular sys
tem, hair, bones and muscles. The general chapter on pharmacol
ogy and clinical uses of testosterone, in particular in male hypo
gonadism, is extended by pharmacokinetic studies on testoster
one preparations and individual substitution modalities using
testosterone esters as well as implants and advanced trans dermal
applications. The physiologic basis and possible clinical applica
tions of testosterone in non-gonadal diseases, in male senes
cence, in hormonal male contraception and in transsexuals are
discussed. The last chapter describes the role of "investigative"
steroid biochemistry applied to tracking anabolic steroid abuse.
In order to synchronize the writing of the various chapters
the authors met on January 22-25, 1998 at Castle Elmau, Bavaria,
for final editing of their previously submitted chapters. This
guaranteed that all chapters were concluded simultaneously and
reflect precisely the state of current knowledge. The contributors
deserve our appreciation for their prompt and reliable coopera
tion in this venture. We are grateful for a generous grant from
SmithKline Beecham Pharma (Munich) facilitating the meeting
VI Preface
of the authors in combination with a Symposion open to profes
sionals interested in the topic. The splendid isolation of Castle
Elmau high up in the Bavarian Alps provided a congenial atmo
sphere for a productive meeting.
Much of the editorial work was performed by Susan Nieschlag
M. A. whose untiring professional help is gratefully acknowl
edged. Barbel Bahnes, Kerstin Neuhaus and Angelika Schick
helped with the word processing of the manuscripts. Finally we
would like to thank Dr. Carol Bacchus and the Springer-Verlag
for supporting the project and producing the book.
Munster/SchloB Elmau, April 1998 Eberhard Nieschlag
Hermann M. Behre
Table of Contents
1. Testosterone: An overview of biosynthesis,
transport, metabolism and nongenomic actions 1
F. F. G. Rommerts
2. The androgen receptor:
Physiology and pathophysiology 33
C. A. Quigley
3. Behavioural correlates of testosterone • . . . . . . . . . . . . .. 107
K. Christiansen
4. The role of testosterone in spermatogenesis .......... 143
G. F. Weinbauer and E. Nieschlag
5. Androgens and hair ........................... 169
V. A. Randall
6. Androgens and bone metabolism . . . . . . . . . . . . . . . . .. 187
J. S. Finkelstein
7. Androgens and muscles ........................ 209
S. Bhasin, R. Bross, T. W. Storer and R. Casaburi
8. Androgens, cardiovascular risk factors and atherosclerosis 229
A. von Eckardstein
9. Androgens and the prostate ..................... 259
J. Frick, A. Jungwirth and E. Rovan
10. Pharmacology and clinical uses of testosterone ........ 293
E. Nieschlag and H. M. Behre
11. Comparative pharmacokinetics of testosterone esters 329
H. M. Behre and E. Nieschlag
12. Clinical pharmacology
of testosterone pellet implants ................... 349
D. J. Handelsman
VIII Table of Contents
13. Long-term experience with testosterone replacement
through scrotal skin .......................... 365
L.E. Atkinson, Y.-L. Chang and P.J. Snyder
14. A permeation-enhanced non-scrotal
testosterone transdermal system for the treatment
of male hypogonadism ..................•..... 389
W.A. Meikle
15. Percutaneous dihydrotestosterone treatment 423
G. Schaison and B. Couzinet
16. Androgens in male senescence .................. 437
J. M. Kaufman and A. Vermeulen
17. Androgen therapy in non-gonadal disease. . • . . . . . . . . 473
P. Y. Liu and D. J. Handelsman
18. Testosterone in male contraception. . . • . . . . . . . . • . . . 513
E. Nieschlag and H. M. Behre
19. Androgen treatment of female-to-male transsexuals 529
L.J. Gooren
20. Abuse of androgens and detection of illegal use ...... 545
W. Schiinzer
Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 567
List of Contributors
Atkinson, L. E. Christiansen, K.
ALZA Corporation, Institute for Human Biology
950 Page Mill Road, of the University,
Palo Alto, CA 94394-0802, USA Allende-Platz 2,
20146 Hamburg, Germany
Behre, H.M.
Institute of Reproductive Medicine,
Couzinet, B.
University of Miinster,
Department of Endocrinology
Domagkstr. 11,48129 Miinster,
and Reproductive Medicine,
Germany
Centre Hospitalier de Bicetre,
78, rue du General Leclerc,
Bhasin, s.
Division of Endocrinology, 94275 Kremlin-Bicetre, France
Metabolism and Molecular Medicine,
Charles R. Drew University von Eckardstein, A.
of Medicine and Science, Institute of Clinical Chemistry
1621 E 120th Street, MP-02, and Laboratory Medicine, Central
Los Angeles, CA 90059, USA Laboratory, Albert -Schweitzer-Str. 33,
48129 Miinster, Germany
Bross, R.
Division of Endocrinology, Finkelstein, J. S.
Metabolism and Molecular Medicine, Endocrinology Unit, Massachusetts
Charles R. Drew University General Hospital, Bulfinch 327 -
of Medicine and Science, Fruit Street, Boston, MA 02114, USA
1621 E 120th Street, MP-02,
Los Angeles, CA 90059, USA
Frick, J.
Department of Urology,
Casaburi, R.
Hospital Salzburg, General Hospital,
Division of Respiratory Medicine,
Miillner Hauptstr. 48,
Pulmonary Physiology, and Critical
5020 Salzburg, Austria
Care Medicine,
Harbor-UCLA Medical Center,
Torrance CA 90502, USA
Gooren, L. J.
Dept. of Endocrinology,
Chang, Y.-L. Free University Hospital,
ALZA Corporation, P. O. Box 7057,
950 Page Mill Road, 1007 MB Amsterdam,
Palo Alto, CA 94304-0802, USA The Netherlands
X List of Contributors
Handelsman, D.J. Rommerts, F. F. G.
Andrology Unit, Department of Med Department of Endocrinology
icine and Obstetrics/Gynecology and Reproduction,
(D02), University of Sydney, Erasmus University Rotterdam,
Sydney 2006, NSW, Australia P. O. Box 1738, 3000 DR Rotterdam,
The Netherlands
Jungwirth, A.
Department of Urology, Rovan, E.
Salzburg General Hospital, Department Urology,
Mullner Hauptstr. 48, Salzburg General Hospital,
5020 Salzburg, Austria Miillner Hauptstr. 48,
5020 Salzburg, Austria
Kaufman, J. M.
Department of Endocrinology,
Schaison, G.
Academish Ziekenhuis,
Department of Endocrinology
185 de Pintelaan, and Reproductive Medicine,
9000 Gent, Belgium Centre Hospitalier de Bicetre,
78, rue du General Leclerc,
Liu, P. Y.
94275 Kremlin-Bicetre, France
Andrology Unit, Department of
Medicine and Obstetrics/Gynecology
Schanzer, W.
(D 02), University of Sydney,
Institute of Biochemistry,
Sydney 2006, NSW, Australia
German Sports University Kaln,
Carl-Diem-Weg 6,
Meikle, W. A.
50933 Kaln, Germany
Division of Endocrinology,
University of Utah Medical School,
Snyder, P.J.
50 North Medical Drive,
Department of Medicine,
Salt Lake City, UT 84132-0001, USA
University of Pennsylvania,
520 Stemmler Hall,
Nieschlag, E.
3450 Hamilton Walk,
Institute of Reproductive Medicine,
Philadelphia, PA 19104-6149, USA
University of Munster,
Domagkstr. 11, 48129 Munster,
Germany Storer, T. W.
Laboratory of Exercise Science,
Quigley, C. A. EI Camino College,
Department of Pediatrics, Torrance, CA 90502, USA
Indiana University Medical Center,
702 Barnhill Drive, Vermeulen, A.
Indianapolis, Indiana 46202-5225, Maaltemeers 33,
USA 9052 Ghent-Zwijnaarde, Belgium
Randall, V. A. Weinbauer, G. F.
Department of Biomedical Sciences, Institute of Reproductive Medicine,
Richmond Building, University of University of Munster,
Bradford, Richmond Road, Domagkstr. 11,48129 Munster,
Bradford BD 7 1 DP, United Kingdom Germany
