cyproterone and Sexual-Dysfunction--Physiological

Cyproterone acetate (CPA) has been discovered more than 25 years ago and it was the first antiandrogen suitable for clinical use. CPA inhibits the action of endogenous and exogenous androgens at all androgen target organs; these include the prostate, seminal vesicles, testes, and the vas deferens. However, this antiandrogen also antagonizes less sex-specific effects of androgens, for example ossification of the epiphyseal cartilage, sebaceous gland function and skin thickness. Indications for CPA: Prostate cancer, androgen induced disorders of the skin (acne, seborrhoea, hirsutism, alopecia), precocious puberty and sexual disorders in men. Concerning sexual deviations clinical trials started in 1966. CPA leads to loss of libido and the ability to achieve erection, followed by the inability to achieve orgasm, after about 14 days of treatment (100-200 mg daily orally or 300 mg weekly i.m.). These effects are reversed in the same order as the onset. About 75 to 80% of patients respond to this therapy. CPA is generally well tolerated. Tiredness, lack of drive, listlessness and depressive moods have been reported as non-specific side-effects. Slight gynecomastia occurs in about 20% of patients. There are no good alternatives in this indication. Pure antiandrogens are unsuitable, because these are unable to inhibit libido sufficiently. Tranquilizers are not very effective, high doses of estrogens are associated with severe (cardiovascular) side effects. Orchidectomy is an irreversible intervention, LHRH analogues are associated with hot flushes and the initial increase in testosterone (flare phenomenon).

Topics: Androgen Antagonists; Cyproterone; Cyproterone Acetate; Humans; Male; Sexual Dysfunction, Physiological

Topics: Aggression; Androgen Antagonists; Crime; Cyproterone; Female; Gender Identity; Humans; Male; Sexual Behavior; Sexual Dysfunction, Physiological

Many antiandrogens, mainly steroidal and some nonsteroidal agents, have been synthesized and tested in several available biological assays. Unfortunately, many of these compounds have other biological activities which make it difficult to ascertain the precise mechanism of antiandrogenic action. The blocking of androgen action can be accomplished by a number of ways: (1) the inhibition of gonadotropin release and/or synthesis, (2) the interference with testosterone and/or dihydrotestosterone biosynthesis, (3) the blocking of protein synthesis, and (4) the competition with androgens at receptor sites. Although the major reason for the development of antiandrogens is to utilize them in certain clinical situations, some have become important tools in studying androgen action, particularly on the molecular level. The clinical effectiveness of some antiandrogens in prostatic hyperplasias, hirsutism, and acne represents an important advance in therapeutics, but the search for more potent antiandrogens with minimal side effects should continue.

Topics: Acne Vulgaris; Androgen Antagonists; Animals; Biological Assay; Comb and Wattles; Cyproterone; Female; Fertility; Flutamide; Genitalia, Male; Hirsutism; Male; Phthalimides; Progesterone; Prostatic Hyperplasia; Prostatic Neoplasms; Sebaceous Glands; Sebum; Sex Differentiation; Sexual Behavior, Animal; Sexual Dysfunction, Physiological; Steroids

Topics: Age Factors; Anxiety, Castration; Behavior Therapy; Compulsive Personality Disorder; Cyproterone; Dependent Personality Disorder; Exhibitionism; Fantasy; Female; Humans; Male; Marital Therapy; Mother-Child Relations; Object Attachment; Paraphilic Disorders; Prognosis; Psychotherapy; Sexual Dysfunction, Physiological; Stress, Psychological; United Kingdom

Topics: Acne Vulgaris; Alopecia; Androgen Antagonists; Bone Development; Cyproterone; Female; Growth; Hirsutism; Humans; Hypertrichosis; Libido; Male; Prostate; Prostatic Neoplasms; Puberty, Precocious; Seminal Vesicles; Sexual Dysfunction, Physiological; Skin

Topics: Androgen Antagonists; Animals; Body Height; Bone Development; Cell Differentiation; Contraceptives, Oral; Cyproterone; Epididymis; Female; Gonads; Hirsutism; Humans; Libido; Male; Pregnadienes; Pregnancy; Prostate; Prostatic Neoplasms; Puberty, Precocious; Sebaceous Glands; Seminal Vesicles; Sexual Dysfunction, Physiological; Testosterone

Topics: Clinical Trials as Topic; Cyproterone; Female; Humans; Male; Sexual Dysfunction, Physiological

Topics: Aged, 80 and over; Androgen Antagonists; Cyproterone; Humans; Huntington Disease; Male; Sexual Dysfunction, Physiological

A 58-year-old man with previous dorsal vertebral fractures was referred for continuing management of osteoporosis. He was treated in the past with cyproterone acetate for hypersexuality. There were no other risk factors for osteoporosis. A dual energy radiographic absorptiometry scan confirmed osteoporosis. Treatment with alendronate 10 mg/day improved bone density and back pain. Patients receiving longterm treatment with cyproterone might be at risk for developing osteoporosis and would benefit from regular bone density monitoring.

Topics: Alendronate; Androgen Antagonists; Bone Density; Cyproterone; Humans; Male; Middle Aged; Osteoporosis; Sexual Dysfunction, Physiological

Topics: AIDS Dementia Complex; Cyproterone; Cyproterone Acetate; Humans; Male; Middle Aged; Sexual Dysfunction, Physiological

Topics: Adult; Androgen Antagonists; Cyproterone; Ejaculation; Female; Humans; Male; Sexual Dysfunction, Physiological

Topics: Adrenocorticotropic Hormone; Adult; Child; Cyproterone; Female; Humans; Hydrocortisone; Male; Puberty, Precocious; Sexual Dysfunction, Physiological

The author in his present paper gives an outline of the indications, contraindications, and legal problems of Androcur treatment. Androcur (cyproterone acetate) is an antiandrogen that is capable of competitively inhibiting androgens in the organism. Accordingly, the effects obtained by drug therapy, of which the purpose is to reduce the sexual desire or libido, are similar to those produced by operative castration. The use of such drugs makes it possible to control abnormal sex drives and desires and prevent sexual offenders from becoming recidivous. Since treatment with Androcur is an intervention in the deeply personal sphere and there is not yet availability any reliable data on the full reversibility of the phenomena involved (for example, alterations to the testicles) especially in the case of long-time treatment, such therapy should be carried out on the principle of absolute voluntariness and after suitable suggestions have been furnished as to the proper treatment of the respective subject.

Topics: Adolescent; Adult; Cyproterone; Ethics, Medical; Female; Humans; Informed Consent; Male; Sexual Dysfunction, Physiological; Testis; Time Factors

Topics: Androstenedione; Animals; Cricetinae; Cyproterone; Disease Models, Animal; Disorders of Sex Development; Dogs; Erectile Dysfunction; Estradiol; Female; Guinea Pigs; Haplorhini; Homosexuality; Humans; Male; Posture; Rats; Sexual Abstinence; Sexual Behavior; Sexual Behavior, Animal; Sexual Dysfunction, Physiological; Species Specificity; Testosterone

Topics: Androgen Antagonists; Cyproterone; Female; Humans; Male; Sexual Dysfunction, Physiological

Topics: Adolescent; Adult; Cyproterone; Female; Humans; Male; Puberty, Precocious; Sex Offenses; Sexual Dysfunction, Physiological