The onset of a refractory response to androgens in the anemia of bone marrow failure.

Patients with bone marrow failure may have a hematopoietic response to an androgen preparation after they have no response from the use of a previous testosterone preparation. The failure to try a variety of hormone preparations may lead to improper conclusions as to a potential marrow proliferation for a clinical response. In some instances the use of a 5beta steroid metabolite may initiate stem cell proliferation in patients previously refractory to testosterone or nontestosterone esters. These obsevations suggest that some patients refractory to testosterone may be unable to form adequate 5beta metabolities by alterations in 5alpha reductase or enhanced metabolic transformation of the androgen. All patients should be evaluated with several androgen esters before concluding that their marrow cannot achieve a hematopoietic response.