title: Critical appraisal of androgen use in hereditary angioedema: a systematic review.
abstract: OBJECTIVE
  To provide an objective basis for evaluating the risk-benefit ratio of long-term androgen use in patients with hereditary angioedema (HAE).
  
  
  METHODS
  PubMed was searched with no time limitations using the keywords hereditary angioedema or angio-oedema combined with danazol, stanozolol, and androgen.
  
  
  METHODS
  Qualifying articles were English-language reports of androgen use in patients with HAE, with relevant safety and/or efficacy information. Reports were categorized according to level of evidence (LOE).
  
  
  RESULTS
  The search process identified 153 citations, 63 of which contained relevant information; 2 additional publications were identified while other citations were being reviewed. Fifteen LOE 2 studies and multiple LOE 4 reports provided efficacy data, confirming a high level of prophylactic efficacy for androgen therapy in HAE, with occasional reports of poor prophylactic response. Common adverse events include weight gain, menstrual irregularities, virilization, headaches, myalgias or cramps, mood changes, and elevations in creatine phosphokinase level, liver function test results, and serum lipid level. The risk of adverse events is often correlated with dose and/or treatment duration. Rare cases of hepatic adenomas and hepatocellular carcinoma associated with long-term androgen use often had no preceding changes in liver function test results.
  
  
  CONCLUSIONS
  Androgen therapy may be effective for most patients with HAE; however, potential risks and adverse effects must be carefully considered and discussed with patients when considering options for long-term HAE prophylaxis.
authors.affiliation: Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California, San Diego, La Jolla, California. Electronic address: mriedl@ucsd.edu.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Riedl
mesh_terms: D000728:Androgens / Q000009:adverse effects / Q000627:therapeutic use*; D054179:Angioedemas, Hereditary / Q000188:drug therapy*; D000818:Animals; D003613:Danazol / Q000009:adverse effects / Q000627:therapeutic use*; D054796:Drug Dosage Calculations; D005260:Female; D006801:Humans; D050356:Lipid Metabolism / Q000187:drug effects; D008599:Menstruation Disturbances / Q000209:etiology; D009765:Obesity / Q000209:etiology; D018570:Risk Assessment; D013197:Stanozolol / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D014770:Virilism / Q000209:etiology
chemical_list: D000728:Androgens; D013197:Stanozolol; D003613:Danazol