Patients requiring oral corticosteroids should be weaned slowly from systemic corticosteroid use after transferring to Advair Diskus. Prednisone reduction can be accomplished by reducing the daily prednisone dose by mg on a weekly basis during therapy with Advair Diskus. Lung function (mean forced expiratory volume in 1 second [FEV 1 ] or morning peak expiratory flow [AM PEF]), beta-agonist use, and asthma symptoms should be carefully monitored during withdrawal of oral corticosteroids. In addition, patients should be observed for signs and symptoms of adrenal insufficiency, such as fatigue, lassitude, weakness, nausea and vomiting, and hypotension.
The secretion of cortisol is mainly controlled by three inter-communicating regions of the body, the hypothalamus in the brain, the pituitary gland and the adrenal gland . This is called the hypothalamic–pituitary–adrenal axis. When cortisol levels in the blood are low, a group of cells in a region of the brain called the hypothalamus releases corticotrophin-releasing hormone , which causes the pituitary gland to secrete another hormone, adrenocorticotropic hormone , into the bloodstream. High levels of adrenocorticotropic hormone are detected in the adrenal glands and stimulate the secretion of cortisol, causing blood levels of cortisol to rise. As the cortisol levels rise, they start to block the release of corticotrophin-releasing hormone from the hypothalamus and adrenocorticotropic hormone from the pituitary. As a result the adrenocorticotropic hormone levels start to drop, which then leads to a drop in cortisol levels. This is called a negative feedback loop.
The side effects of Nebido can include those of an androgenic nature. The androgenic side effects of Nebido are, however, highly dependent on genetic predispositions and will not affect all men. The possible androgenic side effects of Nebido include accelerated hair loss in those predisposed to male pattern baldness, acne in sensitive individuals and body hair growth.
While by no means always necessary, some men may find the use of a 5-alpha reductase inhibitor to be useful. The testosterone hormone is metabolized by the 5-alpha reductase enzyme, which reduces the testosterone hormone to dihydrotestosterone (DHT). The DHT is what leads to the androgenic related effects. By incorporating a 5-alpha reductase inhibitor, you will reduce the hormones androgenicity. It will not be a complete reduction, but it will be significant. However, such inhibitors are not always recommended and should only be used as needed as they can hinder the potency of the testosterone hormone.