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[85] [62] However, in contrast, the effects of the elevated estrogen levels remain unopposed by bicalutamide, and this is importantly involved in the feminizing side effects (e.g., gynecomastia) of the drug in men. [106] Testosterone levels decline with age in men and younger men have higher testosterone levels on average than older men. [107]
The side effects of bicalutamide, a nonsteroidal antiandrogen (NSAA), including its frequent and rare side effects, have been well-studied and characterized. The most common side effects of bicalutamide monotherapy in men include breast tenderness , breast growth , feminization , demasculinization , and hot flashes .
[139] [140] [141] The combination of a sufficient dosage of a progestogen with very small doses of an estrogen (e.g., as little as 0.5–1.5 mg/day oral estradiol) is synergistic in terms of antigonadotropic effect and is able to fully suppress gonadal testosterone production, reducing testosterone levels to the female/castrate range.
Common side effects of testosterone include acne, swelling, and breast enlargement in men. [9] Serious side effects may include liver toxicity, heart disease, and behavioral changes. [9] Women and children who are exposed may develop masculinization. [9] It is recommended that individuals with prostate cancer should not use the medication. [9]
Hyperandrogenism, especially high levels of testosterone, can cause serious adverse effects if left untreated. High testosterone levels are associated with other health conditions such as obesity, hypertension, amenorrhea (cessation of menstrual cycles), and ovulatory dysfunction, which can lead to infertility.
Some side effects may be ameliorated by using a shorter dosing interval (weekly or every ten days instead of twice monthly with testosterone enanthate or testosterone cypionate). 100 mg weekly gives a much lower peak level of testosterone than does 200 mg every two weeks, while still maintaining the same total dose of androgen.
When used on females, the effects are similar, though there is little research about chemically lowering female's sex drive or female-specific anaphrodisiacs, since most research focuses on the opposite, but anti-androgenic hormone regimens would lower testosterone in females which can impact sex drive or sexual response.
High levels of testosterone are also achieved with a 60 mg dose of oral testosterone in men with liver cirrhosis. [2] These findings are attributed to induction of liver enzymes by testosterone and consequent activation of its own metabolism. [2] [27] Substitution dosages of oral testosterone in men are in the range of 400 to 800 mg/day.