Any therapeutic route for delivering a drug or hormone into the systemic circulation that bypasses the gastrointestinal tract and the initial hepatic first-pass metabolism. Common examples include transdermal (gels, patches), injectable (intramuscular, subcutaneous), and transmucosal (sublingual, nasal) methods. In the context of hormonal therapy, this route is often clinically preferred to achieve more stable serum concentrations and potentially reduce specific risks associated with oral delivery.
Origin
The need for non-oral administration stems from the pharmacological challenge of delivering compounds, especially steroids and peptides, that are either poorly absorbed or extensively metabolized by the liver when taken orally. The term reflects a pharmacokinetic strategy to improve bioavailability and optimize the therapeutic index of a drug. This approach is fundamental to modern drug delivery science.
Mechanism
The mechanism of action is based on the anatomical and physiological bypass of the portal circulation. By absorbing the active compound directly into the systemic circulation—for instance, through the skin (transdermal) or muscle (intramuscular)—the drug achieves its therapeutic concentration before reaching the liver for initial processing. This avoids the high peak-and-trough plasma levels often seen with oral dosing and mitigates the potentially detrimental effects of high-concentration metabolites on hepatic protein synthesis, such as coagulation factors.
Physiologic testosterone therapy for women supports metabolic health by improving body composition and insulin sensitivity with a reassuring safety profile.
Physiological female testosterone therapy, while promising for vitality, requires vigilant monitoring for long-term safety, especially cardiovascular and breast health.
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