Hormone Therapy

Six medicines, six different glands

This is not a category where one medicine stands in for another. Each listing deals with a separate hormone problem, so the easiest way to read it is by the gland involved.

Testosterone and the signal that drives it

For men with low testosterone there are two routes. Androgel and Testosterone Topical are testosterone 1% gel in sachets, replacing the hormone directly. The gel goes on clean, dry skin once a day, usually the shoulders or upper arms, and should be left to dry before dressing. Skin contact with a partner or child can pass the hormone on, so wash your hands and cover the area.

Enclomiphene 50mg tablets, sold as Androxal and plain Enclomiphene, are listed for secondary hypogonadism, where the testicles are healthy but the brain is not sending enough signal. Enclomiphene blocks oestrogen receptors in the pituitary gland, which prompts the body to make more of its own luteinising hormone and, with it, more testosterone. Headache and hot flushes are the effects people report.

Prolactin, thirst and sodium

Three medicines deal with the pituitary and water balance. Cabergoline in 0.25mg and 0.5mg tablets lowers prolactin when the level is too high (hyperprolactinaemia). It is taken once or twice a week, not daily, and nausea or dizziness are most likely after the first doses.

Desmopressin 200mcg is available as DDAVP, also sold as plain desmopressin. It replaces the hormone that tells the kidneys to hold on to water, which is why it is used for diabetes insipidus (constant thirst and large volumes of pale urine) and for bedwetting. Drinking a lot of fluid after a dose can dilute the blood's sodium to a dangerous level, so fluids are kept low in the hours after.

Tolvaptan goes the opposite way. It makes the kidneys pass water, which raises sodium in people whose level has dropped too low (hyponatraemia). Samsca, also sold as plain Tolvaptan, comes in 15mg and 30mg tablets, and under the plain name it is also recorded for autosomal dominant polycystic kidney disease, an inherited condition with cysts in the kidneys. Thirst and frequent urination are expected, and sodium that rises too fast can damage nerves, so blood levels are checked in the early days. For the kidney condition, tolvaptan can also affect the liver.

Adrenal hormone replacement

Fludrocortisone 100mcg, sold as Florinef (also listed as plain fludrocortisone), stands in for aldosterone, the hormone the adrenal glands make to keep salt and water in the body. It is taken for adrenal insufficiency, usually as a daily tablet. Because it holds on to salt, swollen ankles, higher blood pressure and low potassium are the things to look out for.