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.