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Pharmacology · chapter 36 · Reproductive Health Drugs

Androgens, Antiandrogens, and Anabolic Steroids

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.

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Key points

  1. What these drugs treat

    They are used to treat hypogonadism, delayed male puberty, and some types of female breast cancer.

  2. Wider effects of testosterone

    It also contributes to bone growth, red blood cell production, decreased excretion of calcium in the urine, and the retention of sodium, potassium, and phosphorous.

  3. Masculinization in female clients

    For females taking testosterone for advanced breast cancer, side effects are generally related to masculinization—voice deepening, clitoral enlargement, and hirsutism.

  4. Androgen contraindications

    Androgens are contraindicated in hypersensitivity to the drug, male breast and prostate cancer, and serious cardiac, hepatic, or renal disease.

  5. Early growth plate closure

    Additionally, testosterone must be used cautiously in prepubescent clients because of the possibility of early bone maturation and early closure of the epiphyseal growth plates. This condition can lead to stunted growth.

  6. X-rays every 6 months

    When young clients are on testosterone therapy, they need radiographs every 6 months to monitor bone maturation.

  7. Prostate risks in older clients

    Older clients may have an increased risk of benign prostatic hyperplasia (BPH) and prostate cancer. Clients with BPH may develop urethral obstruction.

  8. Not in pregnancy

    Testosterone is contraindicated for pregnant clients because it can cause masculinization of the female fetus, and the risks of the drug outweigh the potential benefits for pregnant clients.

  9. Antiandrogens with GnRH analogs

    Antiandrogens are frequently used in combination with gonadotropin-releasing hormone analogs to treat advanced prostate cancer (Freedland Abrahamsson, 2021).

  10. Antiandrogens and the liver

    Adverse Effects and Contraindications Contraindications for the use of antiandrogens are allergy to the drug or its components and liver dysfunction or elevated liver enzymes.

  11. Antiandrogen adverse effects

    The adverse effects of antiandrogens include gynecomastia, breast pain, hot flashes, decreased libido, impotence, diarrhea, anemia, and abnormal liver function. Liver failure can occur.

  12. Anabolic steroid adverse effects

    In general, anabolic steroids can cause electrolyte imbalances, liver damage, insomnia, weight gain, acne, depression, anxiety, aggression, increased cholesterol and low-density lipoprotein levels, hypertension, and changes in the structure of the left ventricle of the heart (DailyMed, Oxandrolone tablet, 2022).

  13. Not approved for bodybuilding

    These drugs are not approved to be used for bodybuilding or enhancing physical performance and, thus, are not prescribed by health care professionals for those purposes, nor are they permitted by athletic competition boards.

  14. Oxandrolone boxed warning

    Oxandrolone can cause serious liver problems, including hepatitis and tumors, and serum lipid changes that could cause coronary heart disease.

Terms to know

Hypogonadism
Hypogonadism is the condition where the testes are undeveloped and fail to produce androgen, sperm, or both.
Delayed puberty
Delayed puberty is when the sex characteristics do not develop at the expected time in puberty.
Antiandrogens
Antiandrogens Antiandrogens are medications that compete with testosterone for androgen-receptor binding sites; in other words, they work against androgens and testosterone.
Anabolic steroids
Anabolic Steroids Anabolic steroids are analogues of testosterone developed for use in tissue building in conditions such as illness or surgery that have caused significant wasting of tissue, weight loss, and depletion of red blood cells.

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

The graded version needs JavaScript. Every question is below anyway, with the answer and why.

Every question here, with the answer

  1. A 13-year-old client with delayed puberty is starting testosterone therapy. Which monitoring should the nurse expect?

    1. Daily blood glucose checks
    2. Radiographs every 6 months to monitor bone maturation
    3. Weekly hearing tests
    4. Monthly pregnancy tests

    Answer: Radiographs every 6 months to monitor bone maturation

    Testosterone can cause early bone maturation and early closure of the growth plates, so young clients need radiographs every 6 months. The other tests are not described for this purpose.

  2. In which clients is testosterone contraindicated? Select all that apply.

    1. A client with prostate cancer
    2. A male client with breast cancer
    3. A pregnant client
    4. A male client with hypogonadism
    5. A client with serious hepatic disease

    Answer: A client with prostate cancer, A male client with breast cancer, A pregnant client, A client with serious hepatic disease

    Androgens are contraindicated in male breast and prostate cancer, serious cardiac, hepatic or renal disease, and pregnancy because of masculinization of the female fetus. Hypogonadism is an indication.

  3. An older male client on testosterone therapy reports difficulty starting his urine stream. What should the nurse consider?

    1. Low red blood cell count
    2. An expected, harmless effect
    3. Urethral obstruction related to benign prostatic hyperplasia
    4. Early closure of growth plates

    Answer: Urethral obstruction related to benign prostatic hyperplasia

    Older clients on testosterone have an increased risk of BPH and prostate cancer, and clients with BPH may develop urethral obstruction. It is not harmless, and growth plate closure applies to young clients.

  4. A client with metastatic prostate cancer is prescribed bicalutamide. Which laboratory results should the nurse review before starting it?

    1. Thyroid hormones
    2. Serum amylase
    3. Liver enzymes
    4. Urine specific gravity

    Answer: Liver enzymes

    Liver dysfunction or elevated liver enzymes are contraindications to antiandrogens, and liver failure can occur. The other tests are not named for this drug.

  5. A client is taking oxandrolone for weight gain after major surgery. Which adverse effects should the nurse monitor for? Select all that apply.

    1. Hypoglycemia unawareness
    2. Aggression or depression
    3. Increased LDL cholesterol
    4. Liver damage
    5. Hypertension

    Answer: Aggression or depression, Increased LDL cholesterol, Liver damage, Hypertension

    Anabolic steroids can cause liver damage, hypertension, increased cholesterol and LDL, depression, anxiety and aggression. Hypoglycemia unawareness is not listed.

  6. A college athlete asks the nurse about using anabolic steroids to build muscle. What is the most accurate response?

    1. "They have no effect on the liver or heart."
    2. "They are approved for athletes if a provider prescribes them."
    3. "They are safe if you take them only in the off-season."
    4. "They are not approved for bodybuilding or performance, and athletic boards do not permit them."

    Answer: "They are not approved for bodybuilding or performance, and athletic boards do not permit them."

    Anabolic steroids are not approved for bodybuilding or enhancing performance, are not prescribed for that, and are not permitted by athletic boards. They can damage the liver and heart.

Where every quote comes from

Section 36.6 Androgens, Antiandrogens, and Anabolic Steroids of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.