Chemistry:Testosterone undecanoate

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Short description: Chemical compound

Testosterone undecanoate
Clinical data
Pronunciation/tɛˈstɒstəroʊn ənˈdɛkənoʊeɪt/ teh-STOS-tə-rohn ən-DEK-ə-noh-ayt
Trade namesOral: Kyzatrex, Andriol, Jatenzo, Testoheal, others
IM: Aveed, Nebido, others
Other namesTU; Testosterone undecylate; Testosterone 17β-undecanoate; ORG-538; CLR-610
AHFS/Drugs.comMonograph
MedlinePlusa614041
License data
Pregnancy
category
Dependence
liability		Moderate [2]
Addiction
liability		Moderate [2]
Routes of
administration		By mouth, intramuscular injection
Drug classAndrogen; Anabolic steroid; Androgen ester
ATC code
Legal status
Legal status
Pharmacokinetic data
BioavailabilityOral: 3–7%
Intramuscular: high
Protein bindingHigh (testosterone)
MetabolismLiver
MetabolitesTestosterone, undecanoic acid, metabolites of testosterone
Excretion~90% Urine, 6% feces
Identifiers
CAS Number
PubChem CID
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
Chemical and physical data
FormulaC30H48O3
Molar mass456.711 g·mol−1
3D model (JSmol)
  (verify)

Testosterone undecanoate, sold under the brand name Nebido among others, is an androgen and anabolic steroid (AAS) medication that is used mainly in the treatment of low testosterone levels in men,[6][7][8][9][10][11][12] It is taken by mouth or given by injection into muscle.[9][13]

Side effects of testosterone undecanoate include symptoms of masculinization like acne, increased hair growth, voice changes, hypertension, elevated liver enzymes, hypertriglyceridemia, and increased sexual desire.[9] The drug is a prodrug of testosterone, the biological ligand of the androgen receptor (AR) and hence is an androgen and anabolic steroid.[14][9] It has strong androgenic effects and moderate anabolic effects, which make it useful for producing masculinization and suitable for androgen replacement therapy.[9] Testosterone undecanoate is a testosterone ester and a prodrug of testosterone in the body.[8][6][7] Because of this, it is considered to be a natural and bioidentical form of testosterone.[15]

Testosterone undecanoate was introduced in China for use by injection and in the European Union for use by mouth in the 1970s.[16][17] It became available for use by injection in the European Union in the early to mid 2000s and in the United States in 2014.[18][19] Formulations for use by mouth are approved in the United States.[3][4][20] Along with testosterone enanthate, testosterone cypionate, and testosterone propionate, testosterone undecanoate is one of the most widely used testosterone esters.[14][7][9] 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.[21][6][7][22][9] In addition to its medical use, testosterone undecanoate is used to improve physique and performance.[9] The drug is a controlled substance in many countries.[9]

Oral administration of testosterone undecanoate is an effective method to achieve therapeutic physiological levels of serum testosterone in patients with hypogonadism. In addition, oral therapy has been found to have a positive impact in these patients on quality of life factors such as sexual function, mood, and mental status, as documented in various studies.[23]

Medical uses

Testosterone undecanoate is indicated for testosterone replacement therapy in adult males for conditions associated with a deficiency or absence of endogenous testosterone.[3][4][5]

Side effects

Side effects of testosterone undecanoate include virilization among others.[9]

Anaphylaxis

The Reandron 1000 formulation (Aveed in the United States) contains 1,000 mg of testosterone undecanoate suspended in 4 ml castor oil with benzyl benzoate for solubilization and as a preservative, and is administered by intramuscular injection. As an excipient in Reandron 1000, benzyl benzoate has been reported as a cause of anaphylaxis (a serious life-threatening allergic reaction) in a case in Australia.[24] 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.[25] In Australia, reports to the Adverse Drug Reactions Advisory Committee (ADRAC), which evaluates reports of adverse drug reactions for the Therapeutic Goods Administration (TGA), show several reports of allergic reactions since the anaphylaxis case from 2011.

Pharmacology

Pharmacodynamics

v · d · e Androgenic vs. anabolic activity
of androgens/anabolic steroids
Medication Ratioa
Testosterone ~1:1
Androstanolone (DHT) ~1:1
Methyltestosterone ~1:1
Methandriol ~1:1
Fluoxymesterone 1:1–1:15
Metandienone 1:1–1:8
Drostanolone 1:3–1:4
Metenolone 1:2–1:30
Oxymetholone 1:2–1:9
Oxandrolone 1:3–1:13
Stanozolol 1:1–1:30
Nandrolone 1:3–1:16
Ethylestrenol 1:2–1:19
Norethandrolone 1:1–1:20
Notes: In rodents. Footnotes: a = Ratio of androgenic to anabolic activity. Sources: See template.

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.[26][7][22] 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.[7][22] 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).[26]

Testosterone undecaondate has very low bioavailability when taken orally, only about 3-7% in men and 4-10% in women.[27][28][29] This bioavailability is increased with food, especially foods containing fat, thus it is typically recommended to be taken with a meal.[30][31][32][33] It is absorbed through the lymphatic system (90-100%) and peak serum levels are reached after about 3-5 hours.[28][34][35] From there, plasma levels decline, typically reaching pre-dose levels after 6-12 hours. The elimination half-life via the oral route has been stated to be 1.6 hours, with a mean residence time of 3.7 hours.[7] However, there is a large amount of individual variability in its duration of action.[36] For this reason it is often dosed twice or even three times a day.[36][34]

Testosterone undecanoate is metabolized partially in the intestinal wall into 5-alpha-dihydrotestosterone undecanoate (DHTU).[37] In the blood, non-specific esterases metabolize testosterone undecanoate into testosterone and DHTU into dihydrotestosterone (DHT).[37] Thus, testosterone undecanoate increases plasma levels of both testerone and DHT. The fact the conversion happens in the blood complicates the accurate measurement of blood levels of testosterone induced by the drug, as the conversion continues to occur while blood samples are being prepared for assay. Ideally, enzyme inhibitors should be used to properly assay the blood testosterone levels induced by testosterone undecanoate.[37]

Chemistry

See also: Chemistry:Androgen ester and List of androgen esters

Testosterone undecanoate, or testosterone 17β-undecanoate, is a synthetic androstane steroid and a derivative of testosterone.[38][39] It is an androgen ester; specifically, it is the C17β undecylate (undecanoate) ester of testosterone.[38][39] A related testosterone ester with a similarly very long duration is testosterone buciclate.[6][8]

The first commercialized preparation of oral testosterone undecanoate had it dissolved in oleic acid.[36] This formulation had to be refrigerated in the pharmacy for reasons of stability and would only last about three months at room temperature.[36] A newer more stable pharmaceutical formulation with castor oil and propylene glycol laurate has since been developed.[36] This new formulation can be stored at room temperature for three years.[36] A novel self-emulsifying formulation of oral testosterone undecanoate in 300-mg capsules for use once per day has been under development.<[40]

History

In the late 1970s, testosterone undecanoate was introduced for oral use in Europe,[16] although intramuscular testosterone undecanoate had already been in use in China for several years.[17] Intramuscular testosterone undecanoate was not introduced in Europe and the United States until much later, in the early to mid 2000s and 2014, respectively.[18][19] Testosterone undecanoate was approved in the United States only in 2014 after three previous rejections due to safety concerns.[41]

Society and culture

Generic names

Testosterone undecanoate is the generic name of the drug and its USAN and BAN.[38][39][42][43] It is also referred to as testosterone undecylate.[38][39][42][43]

Brand names

Testosterone undecanoate is or has been marketed under a variety of brand names, including Andriol, Androxon, Aveed, Cernos Depot, Jatenzo, Kyzatrex,[5] Nebido, Nebido-R, Panteston, Reandron 1000, Restandol, Sustanon 250, Undecanoate 250, and Undestor.[38][39][42][44][43]

Availability

Oral testosterone undecanoate is available in Europe, Mexico, Asia, and the United States.[45][46]

Intramuscular testosterone undecanoate has been approved worldwide,[45][9] including the European Union, Russia, and the United States.[9][45][47] Intramuscular testosterone undecanoate is marketed as Nebido in Europe and as Aveed in the United States while oral testosterone undecanoate is marketed as Andriol.[9][45][47]

Testosterone undecanoate, along with other AAS, is a schedule III controlled substance in the United States under the Controlled Substances Act and a schedule IV controlled substance in Canada under the Controlled Drugs and Substances Act.[48][49]

In March 2019, the US Food and Drug Administration approved testosterone undecanoate (Jatenzo), an oral testosterone capsule to treat men with certain forms of hypogonadism. These men have low testosterone levels due to specific medical conditions, such as genetic disorders like Klinefelter syndrome or tumors that have damaged the pituitary gland.[20] The FDA granted the approval of Jatenzo to Clarus Therapeutics.[20][50]

In March 2022, testosterone undecanoate (Tlando) was approved for medical use in the United States.[4]

In July 2022, Kyzatrex, an oral testosterone undecanoate capsule, was approved for medical use in the United States.[5][51] The FDA granted the approval of Kyzatrex to Marius Pharmaceuticals.[51][52]

Research

Non-alcoholic steatohepatitis

In 2013, a phase II clinical trial testing intramuscular testosterone undecanoate for the treatment of non-alcoholic steatohepatitis (NASH) was initiated in the United Kingdom.[53] In the United States in 2018, Lipocine Inc. began investigating the potential of using an oral testosterone undecanoate formulation, known as LPCN-1144, in patients with NASH.[54]

Osteoporosis

In 2013, a study aimed to evaluate the efficacy of testosterone undecanoate therapy on bone mineral density (BMD) and biochemical markers of bone turnover in elderly males with osteoporosis and low serum testosterone levels.

They study found that administering low-dose testosterone undecanoate (TU) at a rate of 20 mg per day to elderly men with low serum testosterone and osteoporosis effectively increases bone mineral density in the lumbar spine and femoral neck, and improves bone turnover, similar to the standard-dose TU (40 mg, per day) treatment. The treatment did not exhibit any adverse side effects on the prostate gland, including prostate-specific antigen. Therefore, low-dose TU appears to be a safe and cost-effective protocol for treating elderly male osteoporosis.[55] However, further clinical trials with larger sample sizes, multiple centers, and long-term follow-ups are required to determine the efficacy and safety of low-dose testosterone undecanoate treatment in elderly male osteoporosis with low serum testosterone.

Health implications

Risks associated with treatment of late-onset hypogonadism

There is a potential concern in the medical community that the administration of testosterone therapy for the treatment of late-onset hypogonadism may escalate the risks associated with benign prostatic hyperplasia, prostate cancer and heart diseases.[56]

Body composition

In 2020, a study that evaluated the effects of testosterone therapy in men with testosterone deficiency and varying degrees of weight (normal weight, overweight, and obesity) on anthropometric and metabolic parameters found that long-term testosterone undecanoate therapy in hypogonadal men, regardless of their weight at the start of the study, led to improvements in several body composition parameters, including body weight, waist circumference, and body mass index. Additionally, testosterone undecanoate therapy was found to lower fasting blood glucose and HbA1c levels and improve lipid profiles in this population.[57]

Bone density

There have been several studies that evaluate the effect of testosterone therapy on bone density or bone mineral density (BMD). One study concluded that long-term testosterone replacement therapy (TRT) in middle-aged men with late-onset hypogonadism (LOH) and metabolic syndrome (MS) led to a significant increase in both vertebral and femoral bone mineral density (BMD) after 36 months of treatment, as measured by dual-energy x-ray absorptiometry. The TRT treatment was shown to induce a 5% per year increase in BMD without changes in body mass index (BMI). The study suggests that long-term TRT could be beneficial for improving bone health in middle-aged men with LOH and MS, even in the absence of osteoporosis.[58]

References

  1. ↑ "Testosterone Use During Pregnancy". 20 August 2019. https://www.drugs.com/pregnancy/testosterone.html. 
  2. ↑ 2.0 2.1 "Anabolic steroid misuse". 2022-11-04. https://www.nhs.uk/conditions/anabolic-steroid-misuse/. 
  3. ↑ 3.0 3.1 3.2 "Jatenzo- testosterone undecanoate capsule, liquid filled". 11 January 2021. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ed7b5d41-7475-4c10-99b9-b62b3434ae60. 
  4. ↑ 4.0 4.1 4.2 4.3 "Tlando- testosterone undecanoate capsule, liquid filled". 28 March 2022. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=479b55bd-2023-486a-8922-3b1de48b935c. 
  5. ↑ 5.0 5.1 5.2 5.3 "Kyzatrex- testosterone undecanoate capsule, liquid filled". 18 October 2022. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7f7167a7-2a25-47e2-acf5-33f499fce971. 
  6. ↑ 6.0 6.1 6.2 6.3 Testosterone: Action, Deficiency, Substitution. Cambridge University Press. 26 July 2012. pp. 313–315, 321–322. ISBN 978-1-107-01290-5. https://books.google.com/books?id=MkrAPaQ4wJkC&pg=PA315. Retrieved 3 January 2018. 
  7. ↑ 7.0 7.1 7.2 7.3 7.4 7.5 7.6 Cite error: Invalid <ref> tag; no text was provided for refs named NieschlagBehre2010
  8. ↑ 8.0 8.1 8.2 Principles and Practice of Endocrinology and Metabolism. Lippincott Williams & Wilkins. 2001. pp. 1185–. ISBN 978-0-7817-1750-2. https://books.google.com/books?id=FVfzRvaucq8C&pg=PA1185. Retrieved 3 January 2018. 
  9. ↑ 9.00 9.01 9.02 9.03 9.04 9.05 9.06 9.07 9.08 9.09 9.10 9.11 9.12 Anabolics. Molecular Nutrition LLC. 2011. pp. 180–182, 331–334. ISBN 978-0-9828280-1-4. https://books.google.com/books?id=afKLA-6wW0oC&pg=PT180. Retrieved 3 January 2018. 
  10. ↑ "Testosterone therapy for transgender men". The Lancet. Diabetes & Endocrinology 5 (4): 301–311. April 2017. doi:10.1016/S2213-8587(16)00036-X. PMID 27084565. 
  11. ↑ "Long-acting intramuscular testosterone undecanoate for treatment of female-to-male transgender individuals". The Journal of Sexual Medicine 4 (5): 1479–1484. September 2007. doi:10.1111/j.1743-6109.2007.00556.x. PMID 17635694. 
  12. ↑ "Safety aspects of 36 months of administration of long-acting intramuscular testosterone undecanoate for treatment of female-to-male transgender individuals". European Journal of Endocrinology 161 (5): 795–798. November 2009. doi:10.1530/EJE-09-0412. PMID 19749027. 
  13. ↑ New Concepts for Human Disorders of Sexual Development. S. Karger AG. 28 September 2010. pp. 256–. ISBN 978-3-8055-9569-8. https://books.google.com/books?id=CQhaAgAAQBAJ&pg=PA256. Retrieved 3 November 2016. 
  14. ↑ 14.0 14.1 "Pharmacology of anabolic steroids". British Journal of Pharmacology 154 (3): 502–521. June 2008. doi:10.1038/bjp.2008.165. PMID 18500378. 
  15. ↑ "Compounded Bioidentical Hormones in Endocrinology Practice: An Endocrine Society Scientific Statement". The Journal of Clinical Endocrinology and Metabolism 101 (4): 1318–1343. April 2016. doi:10.1210/jc.2016-1271. PMID 27032319. 
  16. ↑ 16.0 16.1 Testosterone Dreams: Rejuvenation, Aphrodisia, Doping. University of California Press. 21 February 2005. pp. 134–. ISBN 978-0-520-93978-3. https://archive.org/details/testosteronedrea00hobe. 
  17. ↑ 17.0 17.1 The Scientific Basis of Urology. CRC Press. 26 July 2010. pp. 294–. ISBN 978-1-84184-749-8. https://books.google.com/books?id=h6HSBQAAQBAJ&pg=PA294. Retrieved 27 October 2017. 
  18. ↑ 18.0 18.1 Williams Textbook of Endocrinology. Elsevier Health Sciences. 11 November 2015. pp. 709, 711, 765. ISBN 978-0-323-34157-8. https://books.google.com/books?id=iPIACwAAQBAJ&pg=PA709. Retrieved 27 October 2017. 
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  20. ↑ 20.0 20.1 20.2 Meyer L (27 March 2019). "FDA approves new oral testosterone capsule for treatment of men with certain forms of hypogonadism" (Press release). U.S. Food and Drug Administration (FDA). Archived from the original on 7 September 2020. Retrieved 27 August 2020.
  21. ↑ "A new oral testosterone undecanoate formulation". World Journal of Urology 21 (5): 311–315. November 2003. doi:10.1007/s00345-003-0372-x. PMID 14579074. 
  22. ↑ 22.0 22.1 22.2 "Intramuscular injection of testosterone undecanoate for the treatment of male hypogonadism: phase I studies". European Journal of Endocrinology 140 (5): 414–419. May 1999. doi:10.1530/eje.0.1400414. PMID 10229906. 
  23. ↑ "Is Oral Testosterone the New Frontier of Testosterone Replacement Therapy?". Cureus 14 (8). August 2022. doi:10.7759/cureus.27796. PMID 36106278. 
  24. ↑ "Anaphylaxis triggered by benzyl benzoate in a preparation of depot testosterone undecanoate". Case Reports in Medicine 2012. 2012. doi:10.1155/2012/384054. 384054. PMID 22272209. 
  25. ↑ "Nebido Monograph – Information for Health Care Professionals". Bayer. 2016. http://www.nebido.com/en/hcp/product-information/nebido-monograph/index.php. 
  26. ↑ 26.0 26.1 The Leydig Cell in Health and Disease. Springer Science & Business Media. 28 October 2007. pp. 423–. ISBN 978-1-59745-453-7. https://books.google.com/books?id=x4ttqKIAOg0C&pg=PA423. Retrieved 6 October 2016. 
  27. ↑ "Absolute bioavailability of testosterone after oral administration of testosterone-undecanoate and testosterone". European Journal of Drug Metabolism and Pharmacokinetics 11 (2): 145–149. 1986. doi:10.1007/BF03189840. PMID 3770015. 
  28. ↑ 28.0 28.1 Foye's Principles of Medicinal Chemistry. Lippincott Williams & Wilkins. 24 January 2012. pp. 1360–. ISBN 978-1-60913-345-0. https://books.google.com/books?id=Sd6ot9ul-bUC&pg=PA1360. 
  29. ↑ "Absolute bioavailability of testosterone after oral administration of testosterone-undecanoate and testosterone". European Journal of Drug Metabolism and Pharmacokinetics 11 (2): 145–149. April 1986. doi:10.1007/BF03189840. PMID 3770015. 
  30. ↑ "Testosterone preparations for clinical use in males". Testosterone: Action, Deficiency, Substitution. Cambridge University Press. 26 July 2012. pp. 309–335. doi:10.1017/CBO9781139003353.016. ISBN 978-1-107-01290-5. 
  31. ↑ Testosterone: From Basic to Clinical Aspects. Springer. 30 March 2017. pp. 13–. ISBN 978-3-319-46086-4. https://books.google.com/books?id=Et6TDgAAQBAJ&pg=PA13. 
  32. ↑ "Important effect of food on the bioavailability of oral testosterone undecanoate". Pharmacotherapy 23 (3): 319–325. March 2003. doi:10.1592/phco.23.3.319.32104. PMID 12627930. 
  33. ↑ "The effect of food composition on serum testosterone levels after oral administration of Andriol Testocaps". Clinical Endocrinology 66 (4): 579–585. April 2007. doi:10.1111/j.1365-2265.2007.02781.x. PMID 17371478. 
  34. ↑ 34.0 34.1 "Steady-state pharmacokinetics of oral testosterone undecanoate with concomitant inhibition of 5α-reductase by finasteride". International Journal of Andrology 34 (6 Pt 1): 541–547. December 2011. doi:10.1111/j.1365-2605.2010.01120.x. PMID 20969601. 
  35. ↑ "Reexamination of pharmacokinetics of oral testosterone undecanoate in hypogonadal men with a new self-emulsifying formulation". Journal of Andrology 33 (2): 190–201. 4 March 2012. doi:10.2164/jandrol.111.013169. PMID 21474786. 
  36. ↑ 36.0 36.1 36.2 36.3 36.4 36.5 "Pharmacology of testosterone preparations". Testosterone: 405–444. 1 January 2001. doi:10.1017/CBO9780511545221.015. 
  37. ↑ 37.0 37.1 37.2 "Importance of measuring testosterone in enzyme-inhibited plasma for oral testosterone undecanoate androgen replacement therapy clinical trials". Future Science OA 1 (4): FSO55. November 2015. doi:10.4155/fso.15.55. PMID 28031910. 
  38. ↑ 38.0 38.1 38.2 38.3 38.4 The Dictionary of Drugs: Chemical Data: Chemical Data, Structures and Bibliographies. Springer. 14 November 2014. pp. 641–642. ISBN 978-1-4757-2085-3. https://books.google.com/books?id=0vXTBwAAQBAJ&pg=PA641. Retrieved 6 October 2016. 
  39. ↑ 39.0 39.1 39.2 39.3 39.4 Index Nominum 2000: International Drug Directory. Taylor & Francis. January 2000. pp. 1002–1004. ISBN 978-3-88763-075-1. https://books.google.com/books?id=5GpcTQD_L2oC&pg=PA1002. Retrieved 13 December 2017. 
  40. ↑ "Androgens: Pharmacological Use and Abuse ☆". Reference Module in Neuroscience and Biobehavioral Psychology. Elsevier. 2017. doi:10.1016/B978-0-12-809324-5.03356-3. ISBN 978-0-12-809324-5. 
  41. ↑ "FDA Approves Aveed Testosterone Jab, with Restrictions". 7 March 2014. http://www.medscape.com/viewarticle/821632. 
  42. ↑ 42.0 42.1 42.2 Concise Dictionary of Pharmacological Agents: Properties and Synonyms. Springer Science & Business Media. 6 December 2012. ISBN 978-94-011-4439-1. https://books.google.com/books?id=tsjrCAAAQBAJ&pg=PA270. Retrieved 6 October 2016. 
  43. ↑ 43.0 43.1 43.2 "Testosterone". https://www.drugs.com/international/testosterone.html. 
  44. ↑ "Testosterone undecanoate profile and most popular brands in USA". http://downsizefitness.com/rankings/testosterone-undecanoate/. 
  45. ↑ 45.0 45.1 45.2 45.3 "The History of Testosterone and the Testes: From Antiquity to Modern Times". Testosterone. Springer. 2017. pp. 1–19. doi:10.1007/978-3-319-46086-4_1. ISBN 978-3-319-46084-0. 
  46. ↑ Hormones, Brain and Behavior, Five-Volume Set. Academic Press. 10 June 2002. pp. 20–. ISBN 978-0-12-532104-4. https://books.google.com/books?id=cGbE2nC__Q0C&pg=PA20. Retrieved 27 October 2017. 
  47. ↑ 47.0 47.1 "Drug Product Database". Health Canada. 18 March 2010. http://www.hc-sc.gc.ca/dhp-mps/prodpharma/databasdon/index-eng.php. 
  48. ↑ Drug Abuse Handbook, Second Edition. CRC Press. 21 December 2006. pp. 30–. ISBN 978-1-4200-0346-8. https://books.google.com/books?id=ZjrMBQAAQBAJ&pg=PA30. Retrieved 11 November 2017. 
  49. ↑ Pharmacology for Canadian Health Care Practice. Elsevier Health Sciences. 5 August 2016. p. 50. ISBN 978-1-77172-066-3. https://books.google.com/books?id=dNgoDwAAQBAJ&pg=PA50. Retrieved 11 November 2017. 
  50. ↑ "Clarus Therapeutics Receives U.S. FDA Approval of Jatenzo (Testosterone Undecanoate Capsules for Oral Use) (CIII) for Testosterone Replacement Therapy in Certain Adult Men". http://clarustherapeutics.com/content/investors-and-media/releases/clarus-receives-fda-approval-of-jatenzo.htm. 
  51. ↑ 51.0 51.1 "Drug Approval Package: Kyzatrex Capsules". 21 December 2022. https://www.accessdata.fda.gov/drugsatfda_docs/nda/2022/213953Orig1s000TOC.cfm. 
  52. ↑ "Kyzatrex (testosterone undecanoate) FDA Approval History". https://www.drugs.com/history/kyzatrex.html. 
  53. ↑ Pilot Open Study of Testosterone Replacement in Non-alcoholic Steatohepatitis. 25 April 2017. https://clinicaltrials.gov/ct2/show/NCT01919294. Retrieved 14 March 2022. 
  54. ↑ "Lipocine Inc. - Clinical Trials". https://www.lipocine.com/pipeline/lpcn-1144/clinical-trials.htm. 
  55. ↑ "Effects of low-dose testosterone undecanoate treatment on bone mineral density and bone turnover markers in elderly male osteoporosis with low serum testosterone". International Journal of Endocrinology 2013. 2013. doi:10.1155/2013/570413. PMID 23533404. 
  56. ↑ "Testosterone treatment of late-onset hypogonadism - benefits and risks". Rev Endocr Metab Disord 23 (6): 1151–1157. December 2022. doi:10.1007/s11154-022-09712-1. PMID 35266057. 
  57. ↑ "Differential effects of 11 years of long-term injectable testosterone undecanoate therapy on anthropometric and metabolic parameters in hypogonadal men with normal weight, overweight and obesity in comparison with untreated controls: real-world data from a controlled registry study". International Journal of Obesity 44 (6): 1264–1278. June 2020. doi:10.1038/s41366-019-0517-7. PMID 32060355. 
  58. ↑ "Effects of long-acting testosterone undecanoate on bone mineral density in middle-aged men with late-onset hypogonadism and metabolic syndrome: results from a 36 months controlled study". The Aging Male 15 (2): 96–102. June 2012. doi:10.3109/13685538.2011.631230. PMID 22439807. 

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