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At that time, a slow steroid taper is initiated if the initial prednisone dosage was 15 or 20 mg per dayand if the initial dose of prednisone would normally lead to steroid withdrawal symptoms as well as an increase in the serum creatinine level above 140 mg/dL. A gradual taper is also used in the setting of hyperinsulinemia. In the pre-clinical setting, the steroid taper is initiated based on the response of the animal to the initial dose (e.g., an animal that shows rapid improvement of some of the signs and symptoms of hypogonadism will have a reduced dosage of prednisone) followed by a gradual increase in the dose until the effects of the hyperinsulinemia are more or less balanced by the effects of the normal hyperinsulinemia with which the animal may be treated [ ]. Hypogonadism is defined in the literature as hypogonadism associated with the absence of sex hormone-dependent sexual differentiation of gonads, and with reduced sexual dimorphism between male and female gonads as an additional consequence of decreased pituitary gonadotrophin secretion. In the human, the clinical diagnosis of hypogonadism is made when serum levels of the following are elevated (>100 nmol/L) or when they are >70 nmol/L: total testosterone (T), free T (free T), sex hormone binding globulin (SHBG), androstenedione (a), 25-hydroxyvitamin D (25(OH)D), dihydrotestosterone (DHT), and 17α-alkylandrostenedione (17α-AES). The steroid taper should be initiated as soon as possible once the signs and symptoms of hypogonadism are well established and the initial prednisone dose has failed to suppress hyperinsulinemia. Most animal studies use a 30-day schedule of starting prednisone and taper to 60 or 70 mg per day. [ ] With respect to animal studies involving prednisone tapers of a shorter duration, there is a good reason for that, because it may be possible for the patient to tolerate a higher initial dose of prednisone, or it may be necessary to further taper his treatment. An increase in free T and free hormone receptor (FSH) activity may be desirable to prevent hypogonadism, but this may be attained only by a higher initial dose of prednisone [ , ], and can only be achieved by a lower initial dosage of prednisone [ ]. A Similar articles: