Risks of Androgens (Nursing)

00:01 So the wrists of androgens include like these male physical characteristics we call that Virilization.

00:06 Most females don't want those male characteristics.

00:10 That's one of the risks.

00:12 You can also prematurely close their growth plate or the epiphyseal plate.

00:17 They liver toxicity, hepatotoxicity, remember H-E-P-A-T we're thinking of liver and then toxicity tells us it is bad for the liver.

00:28 And also messes with your salt and water retention you end up with extra edema and it can make prostate cancer worse.

00:36 Now, that's just a checklist. Right? And those are really hard to remember.

00:40 So let's walk through each one of these to help them stick in your brain better.

00:44 Okay, when we talk about virilization, that's the first one.

00:47 With women there isn't anything on that list that I want.

00:50 Look acne, increased facial and body hair and increased interest in sex.

00:56 Well, I don't want any more facial hair than I have, right? So that's usually not something women are interested in.

01:04 It might be irreversible and you might also develop male pattern baldness.

01:08 Okay, so stop and picture this for a minute.

01:10 If you're a girl you're growing hair here and you're losing hair here.

01:16 Again not something we're usually looking for.

01:19 It also affects other sex organs.

01:21 They have clitoral enlargement and they go deeper voice.

01:25 Okay.

01:26 This would be really hard to write, a like in online dating service for right.

01:32 Here I've got acne, I have a low voice, I'm balding and I have a beard these are not be things I'll be looking for to make me more attractive.

01:40 Now girls you're going to see growth of pubic hair and they're also going to see the clitoral enlargement.

01:45 And if you see any of these signs you need to discontinue the treatment immediately because these are likely irreversible just like they would be with women.

01:54 So be very careful with this if you know so girls having these experiences you're seeing these changes in their bodies.

02:00 The treatment needs to absolutely stop.

02:03 Remember if a little girl is accidentally exposed to these maybe they have a brother who's receiving the treatment and you notice these things happening.

02:10 You need to figure out how they're getting that androgen transferred to them.

02:14 Now with boys, they're going to see their regular changes that they would see in puberty they have an increase in pubic hair their penile enlargement, they'll have increased directions and possibly even persistent erections.

02:26 That's what you're going to see in a boy's body.

02:29 So testosterone is a hormone that can cause significant changes in the bodies of women, girls, and boys.

02:37 Now, let's go back to that premature growth plate closure.

02:40 Now look at the graphic we made for you here.

02:42 You see the blue points on the top and the bottom, that's the epiphyseal plate.

02:47 It's also known as the growth plate.

02:49 So go ahead and write growth plate, right on top of that epiphyseal plate.

02:54 That just the same name that we use for that.

02:56 It's located at each end of the long bones and it plays a role in how tall you grow.

03:02 It's an area of growing tissue and children and adolescents.

03:05 So that's part of your bones where it gets longer and longer and longer now, that's where we determine the link and the shape of a mature bone.

03:13 So it tells how tall I'm going to be.

03:17 Now androgens put you at risk for a premature.

03:19 That means it's too early.

03:21 That growth plate closes off early.

03:24 So why is that a problem? Well, because remember it's the growth plate the determines the length and shape of a mature bone.

03:32 So normally what happens in puberty is that cartilage growth slows down and it stops at the end of adolescence.

03:38 Normally when those remember the testosterone level is peeking.

03:43 So then it calcifies after a calcifies usually around age 16 to 21.

03:50 There's no further growth.

03:51 So the bone will not get longer and the child will not get taller.

03:55 That's it game over when the growth plate closes you are done.

04:00 So things that can happen to that growth plate.

04:02 Maybe they have a break in the growth plate.

04:04 They have an injury or premature closure will end up in the child being shorter.

04:10 Okay.

04:11 So what puts a kid at risk for this could be androgens.

04:14 Injury and both of these could cause a premature closing of that bone, which means they won't be as tall as there are normally intended to be.

04:23 So look at the difference in those bones there.

04:25 See how they look at adolescents see how the blue area it's all calcified.

04:28 It's not changeable now, the epiphyseal plate when it's still growing that growth plate is still moving and getting bigger is where you see the larger blue shaded areas.

04:38 Now, let's look at the third possible adverse effect of androgens or testosterone specifically, so it's hepatotoxicity.

04:46 Now, we always try to break words down and help you remember those.

04:49 Toxicities definitely bad right? And hepatic refers to your liver.

04:54 So this is hepatotoxic.

04:56 Now, it's certain form of androgens are testosterone.

04:59 Now I've got it there 17-alpha-alkylated, right? That's just to let you know It's only specific androgen testosterone hormones that cause this effect.

05:07 It's a cholestatic hepatitis.

05:10 Now itis means inflammation just underline I-T-I-S and right inflammation under that.

05:15 We can help you learn some medical terminology as we go through this.

05:19 But this means cholestatic hepatitis because that isn't flowing anymore.

05:24 The bile isn't flowing.

05:25 It's just like if you had a gallstone in the bile duct, the bile doesn't flow well, and that's why you end up with inflammation of the liver.

05:33 See the liver makes the bile and it's meant to flow down that common bile duct into the small intestine.

05:39 If it can't flow down through there.

05:42 It's going to start irritating that liver because it backs up.

05:45 That's what cholestatic meaning still hepatitis is.

05:50 So you want to make sure that you're kind of monitoring liver function text on a periodically on a pretty regular basis.

05:57 So watch how their livers doing because we know that especially with this 17-alpha-alkylated androgen or testosterone they can have some hepatotoxicity.

06:07 Also another risk It might increase LDL and decrease HDL.

06:11 That's a bad deal because remember LDL is the bad cholesterol and HDL is the good cholesterol, so he'd wanted the opposite but people on androgens or testosterone have an increased risk of their LDL levels shooting up and their HDL levels going down.

06:29 Another possible adverse effect for taking an androgen like testosterone is that androgens promote sodium and water retention.

06:38 Well that kind of goes without saying, if you promote anything that causes your body to hang onto sodium, water is going to follow.

06:45 So once you hang on a sodium, you're going to have an increased water retention, so I'm going to have lots of extra fluid on board.

06:51 So you want to watch closely if the patient is any cardiovascular problems.

06:55 If there are any kind of walking that balance of fluid volume overload.

06:59 This could be something that cause further fluid volume overload.

07:03 So remember, androgens like testosterone promote sodium retention.

07:08 They're going to have more water and more volume.

07:11 So watch your patients closely for signs of overload.

07:15 Now prostate cancer isn't caused by testosterone, but it can make it worse.

07:22 So it's really important that you educate your patients about this risk.

07:26 Also you want to make sure that they might have undiagnosed prostate cancer so you'll want to screen them before you start this therapy.

07:34 So just to be clear testosterone and androgen like testosterone does not cause prostate cancer but if they have prostate cancer that may not even be aware of it, It will make it worse.

07:46 So you definitely want to make sure that they have screening before they start this therapy.

07:50 Now androgen should not be used with pregnant women with obvious with men with prostate cancer that we just talked about or breast cancer because remember that men can also have cancer.

08:01 And you shouldn't use androgens like testosterone for athletic performance enhancement.

08:06 Let's go back over those categories.

08:09 Not for pregnant women because it's going to cause some significant changes to the fetus particularly of female fetus, men with prostate or breast cancer or for athletic performance enhancement.

08:20 The risk far outweigh the benefits of the improvement in performance enhancement.

08:25 Okay.

08:26 I really want to go back and emphasize the risk of accidental exposure.

08:30 Now, you know that we can use transdermal methods of getting androgens or testosterone gel.

08:35 You put it on your skin, but if it brushes up against clothing or another individual you could accidentally expose them to testosterone.

08:43 So be very careful about handling the close of patients who use androgen gels and also touching patients who have this gel you don't want to accidentally expose them to virillization and all the other things that could happen from testosterone.

08:58 Now hypogonadism is the only FDA approved therapeutic use of androgen therapy.

09:05 So I want you to underline that hypogonadism is the only FDA approved.

09:11 We talked about some off-label uses.

09:13 But this is the only one approved by the FDA.

09:16 So that means I have lower absence secretion of testosterone from the testes.

09:21 So for now this is only approved by the FDA in males who have low or absent secretion of testosterone from the gonads.