WASHINGTONTesticular cancer is a highly curable disease, but many of the
young men who survive it are left with fatigue, loss of libido, depression,
and weight loss due to low testosterone levels. This has usually been treated
with painful, deep intramuscular injections of an oil-based testosterone
preparation every 2 to 3 weeks. Testosterone patches were developed as an
alternative but cause skin rashes in some patients.
A testosterone-containing gel circumvents most of these problems. In a
poster at the Oncology Nursing Society’s 27th Annual Congress (abstract 116),
Teresa Sinopoli, RN, MS, AOCN, stressed the importance of teaching patients
how to handle the gel preparation safely. "The testosterone gel is a simple,
easy-to-apply formulation for testosterone replacement therapy, but some
special care must be used to get the maximum benefit from the gel and to
prevent the exposure of others," Ms. Sinopoli told ONI.
AndroGel (Unimed Pharmaceuticals, Inc., Deerfield, Illinois) is a clear,
hydro-alcoholic gel containing 1% testosterone. It is applied daily to the
shoulders, upper arms, and abdomen. Patients typically use one 5-g packet of
the gel per day.
Ms. Sinopoli said that the gel should be applied only to clean, dry,
unbroken skin. "Showering and swimming both decrease absorption of the
testosterone from the gel into the systemic circulation, so we advise
patients not to bathe until 6 hours after applying the gel."
She said that patients should be told to wash their hands very carefully
with soap and water immediately after applying the gel, and to put on a
T-shirt after the gel has dried to decrease the chance that the gel will rub
off on anyone else.
Since testosterone is teratogenic, it is important to prevent skin-to-skin
testosterone transfer between treated men and their partners. She said that
it is especially important that pregnant women and children be protected from
contact with the gel, and that patients should be reminded to dispose of
empty packets in such a way that they will not be accidentally handled by
other adults, children, or pets in the household.