Q:

5/28/2013
I am caring for a 26 year-old gentleman who has been diagnosed with a testosterone deficiency by a local endocrinologist. He has benefitted from the use of topically applied testosterone agents though has severe contact sensitivity to all that he has tried making their use problematic. He tested positive when patched to all 3 agents (Androgel, Testim and Fortesta). His endocrinologist does not want to use oral agents due to side effects and injectibles are difficult and painful to administer. Is there any value to skin testing or desensitization if he skin tested positive? Could I even desensitize to a topically applied product? So far my literature search has not yielded any information on testosterone allergy other than topical sensitization presumably with adhesive materials, which does not pertain to his situation. Thank You.

A:

Thank you for your inquiry.

1. Yes, there might be value to skin testing with a new agent. You could consider trying Axiron, which is a non-gel formulation. You could patch test to Axiron, and if the test was negative, proceed with treatment using this agent.

2. You also asked if desensitization could be attempted. The answer to that is" theoretically" it can be done (1). Unfortunately, in terms of desensitization, it is more theoretically possible than practically accomplished.I am not aware of any published protocol describing a desensitization regimen to testosterone, and could not find any inthe literature.

Parenthetically, I mentioned that another practical solution could be pretreatment with topical corticosteroids prior to application of the testosterone (2).

Finally, if the patient is not actually sensitive to the testosterone molecule itself, he could consider testosterone implants which would obviously eliminate the repeated pain of injection therapy.

In terms of the future, there is a Depo-Testosterone preparation which is available in Europe, and is being considered for approval in the United States, which might be helpful because the number of injections would be markedly reduced. I am also aware of an attempt to develop a testosterone spray (Luramist), but do not know how far along the spray is in the development process.

In summary, if indeed your patient is allergic to the molecule itself, none of the forms of administration will get by the issue of a potential allergic reaction. If this is the case, then the only available treatment would be a desensitization procedure or the use of corticosteroids (pre-application). Unfortunately, I know of no specific protocol available to guide you in the desensitization process, and you would simply have to work out an empiric dosage regimen.

If, however, since all the preparations you mentioned were gels, it is the gel itself, you have other options available as mentioned above.

Thank you again for your inquiry and we hope this response is helpful to you.

References:
1. Frey JR. Contact Sensitivity: Induction, Tolerance, Desensitization. Int Arch Allergy 1974; 46:806–814 (DOI:10.1159/000231182).
2. Shouls J, Shum KW, Gadour M, Gawkrodger DJ. Contact allergy to testosterone in an androgen patch: control of symptoms by pre-application of topical corticosteroid. Contact Dermatitis 2001 (August); Volume 45, Issue 2, pages 124–125.

Sincerely,
Phil Lieberman, M.D.


AAAAI - American Academy of Allergy Asthma & Immunology