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Testosterone undecanoate,  is an androgen and anabolic steroid (AAS) medication which is used mainly in the treatment of low testosterone levels in men.[3][1][4][5] It is also used in hormone therapy for transgender men.[6][7][8] It is taken by mouth two to three times per day with food or given by injection into muscle once every 12 weeks or so.[5][9]

Side effects of testosterone undecanoate include symptoms of masculinization like acne, increased hair growth, voice changes, and increased sexual desire.[5] The drug is a synthetic androgen and anabolic steroid and hence is an agonist of the androgen receptor (AR), the biological target of androgens like testosterone and dihydrotestosterone (DHT).[10][5] It has strong androgenic effects and moderate anabolic effects, which make it useful for producing masculinization and suitable for androgen replacement therapy.[5] Testosterone undecanoate is a testosterone ester and a prodrug of testosterone in the body.[4][3][1] Because of this, it is considered to be a natural and bioidentical form of testosterone.[11]

Testosterone undecanoate was introduced in China for use by injection and in Europe for use by mouth in the 1970s.[12][13] It became available for use by injection in Europe in the early to mid 2000s and in the United States in 2014.[14][15] A formulation for use by mouth is not currently available in the United States but is pending approval as of 2018.[16] Along with testosterone enanthate, testosterone cypionate, and testosterone propionate, testosterone undecanoate is one of the most widely used testosterone esters.[10][1][5] However, it has advantages over other testosterone esters in that it can be taken by mouth and in that it has a far longer duration when given by injection.[17][3][1][2][5] In addition to its medical use, testosterone undecanoate is used to improve physique and performance.[5] The drug is a controlled substance in many countries and so non-medical use is generally illicit.[5]

Contents

Medical uses

Testosterone undecanoate is used in androgen replacement therapy. It is specifically approved only for the treatment of hypogonadism.[18][19][20] As an intramuscular injection, it is administered at a dosage of 1,000 mg once every 12 weeks.[9] Conversely, oral testosterone undecanoate must be taken two or three times a day with food.[9][21]

Side effects

Side effects of testosterone undecanoate include virilization among others.[5]

Anaphylaxis

The Reandron 1000 formulation (Nebido in the United States) contains 1,000 mg of testosterone undecanoate suspended in castor oil with benzyl benzoate for solubilization and as a preservative, and is administered by intramuscular injection. As an excipient, benzyl benzoate has been reported as a cause of anaphylaxis in a case in Australia.[22] Bayer includes this report in information for health professionals and recommends that physicians “should be aware of the potential for serious allergic reactions” to preparations of this type.[23] In Australia, reports to ADRAC, which evaluates reports of adverse drug reactions for the Therapeutic Goods Administration, show several reports of allergic issues since the anaphylaxis case from 2011.[citation needed]

Pharmacology

Pharmacodynamics

Testosterone undecanoate is a prodrug of testosterone and is an androgen and anabolic–androgenic steroid (AAS). That is, it is an agonist of the androgen receptor (AR).

Pharmacokinetics

Testosterone undecanoate has a very long elimination half-life and mean residence time when given as a depot intramuscular injection.[24][1][2] Its elimination half-life is 20.9 days and its mean residence time is 34.9 days in tea seed oil, while its elimination half-life is 33.9 days and its mean residence time is 36.0 days in castor oil.[1][2] These values are substantially longer than those of testosterone enanthate (which, in castor oil, has values of 4.5 days and 8.5 days, respectively).[24] Testosterone undecanoate is administered via intramuscular injection once every three months or so.[9][25]

Chemistry

Testosterone undecanoate, or testosterone 17β-undecanoate, is a synthetic androstane steroid and a derivative of testosterone.[26][27] It is an androgen ester; specifically, it is the C17β undecylate (undecanoate) ester of testosterone.[26][27] A related testosterone ester with a similarly very long duration is testosterone buciclate.[3][4]

History

In the late 1970s, testosterone undecanoate was introduced for oral use in Europe,[12] although intramuscular testosterone undecanoate had already been in use in China for several years.[13] Intramuscular testosterone undecanoate was not introduced in Europe and the United States until much later, in the early to mid 2000s and 2014, respectively.[14][15] Testosterone undecanoate was approved in the United States after three previous rejections due to safety concerns.[28]

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