Increased oiliness of skin and acne are common complaints after testosterone treatment, especially if high doses of testosterone are used. These conditions can be treated by topical measures, the testosterone dose can be reduced, or the testosterone preparation can be changed. Because testosterone esters and native testosterone are aromatized to estrogens, changes in the androgen to estrogen balance may occur after testosterone replacement, which may cause gynecomastia. Testosterone replacement also causes fluid retention during the early weeks of treatment and should be used with caution in older patients with congestive heart failure or poor myocardial function.
Sleep-related breathing disorders may be aggravated by testosterone replacement (72). Thus, a detailed history for symptoms of sleep apnea before and during testosterone treatment must be obtained. Patients at high risk for sleep apnea (obese and elderly) should be investigated and treated for sleep apnea before beginning androgen-replacement therapy.
Testosterone administration results in suppression of the gonadotropins and intrates-ticular testosterone production and spermatogenesis. Prolonged testosterone administration will decrease the size of the testes and suppress spermatogenesis. These changes are reversible after stopping testosterone replacement.
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