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Article
May 1985

Ketoconazole Metamorphosis: An Antimicrobial Becomes an Endocrine Drug

Author Affiliations

Division of Infectious Diseases Santa Clara Valley Medical Center and Institute for Medical Research 751 S Bascom Ave San Jose, CA 95128 and Stanford University Medical School

Arch Intern Med. 1985;145(5):813-815. doi:10.1001/archinte.1985.00360050057008
Abstract

The report by Shepherd et al in this issue of the Archives1 is the latest step in an evolving story. For me, the story began in 1979, in the second year of my early studies with ketoconazole as a therapy for deep mycoses.2 A young male patient with coccidioidomycosis, on no other medications, developed gynecomastia. It was this observation and the development of gynecomastia in a second patient receiving ketoconazole therapy the next year that led to a collaboration with Allan Pont, MD, then chief of endocrinology at Santa Clara Valley Medical Center, San Jose, Calif, to investigate whether this occurrence might be explained by a ketoconazole-induced alteration of sex hormone synthesis or action. We initially found that random testosterone determinations in several patients showed a temporal relationship with the time of their daily ketoconazole dose. We thought the best way to substantiate this relationship would be

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