It is recommendable to discontinue sex steroid administration 3-4 weeks before any elective surgical intervention. Immobilization is a trombogenic risk factor and sex steroids may aggravate the risk of thromboembolism. Once subjects are fully mobilized again, hormone therapy may be reinstated. To attain both an almost complete reduction of the effects of androgens is required. Administration of estrogens alone will suppress gonadotropin output and therewith androgen production, but dual therapy with one compound suppressing androgen action and an other with estrogen effect is probably more effective.
Several agents are available to inhibit androgen action.
In Europe the most widely used drug is cyproterone acetate, a progestational compound with antiandrogenic properties. The usual starting dose is 100 mg per day. Later when testosterone levels are effectively suppressed the dose may be reduced to 50 mg per day. If not available medroxyprogesterone acetate, 5-10 mg per day, probably somewhat less effective, is an alternative. Spironolactone, a diuretic with antiandrogenic properties, has similar effects.