Pharmacodynamics<unk>  is a GnRH agonist, or an agonist of the GnRH receptor. It is a superagonist of the GnRH receptor with potency for induction of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) secretion of about 20 to 170 times that of GnRH itself. By activating the GnRH receptor in the pituitary gland,<unk>  induces the secretion of LH and FSH from the gonadotrophs of the anterior pituitary, which travel to the gonads through the bloodstream and activate gonadal sex hormone production as well as stimulate spermatogenesis in men and induce ovulation in women. With chronic administration of<unk>  however, the GnRH receptor becomes desensitized and completely stops responding both to<unk>  and to endogenous GnRH. This is because GnRH is normally released from the hypothalamus in pulses, which keeps the GnRH receptor sensitive, whereas chronic<unk>  administration results in more constant exposure and desensitization of the receptor. The profound desensitization of the GnRH receptor results in a loss of LH and FSH secretion from the anterior pituitary and a consequent shutdown of gonadal sex hormone production, markedly diminished or abolished spermatogenesis in men, and anovulation in women. In men, approximately 95% of circulating testosterone is produced by the testes, with the remaining 5% being derived from the adrenal glands. In accordance, GnRH analogues like<unk>  can reduce testosterone levels by about 95% in men. Sex hormone levels, including those of estradiol and progesterone, are similarly profoundly suppressed in premenopausal women. The suppression of estradiol levels is 95% and progesterone levels are less than 1 ng/mL (normal range during the luteal phase approximately 10–20 ng/mL); the resulting levels are equivalent to those in postmenopausal women.<unk>  has been found to suppress testosterone levels in men with prostate cancer from 426 ng/dL to 28 ng/dL (by 93.4%) with 200 μg by subcutaneous injection once per day and from 521 ng/dL to 53 ng/dL (by 89.8%) with 400 μg by nasal spray once every 8 hours (1,200 μg/day total). The difference in suppression may have been due to poor compliance. A few small studies have also assessed the suppression of testosterone levels with<unk>  nasal spray twice a day instead of three times a day. One such study found that testosterone levels in men with prostate cancer were suppressed during treatment with<unk>  from 332 ng/dL to 215 ng/dL (28.9% lower than controls) with 200 μg by nasal spray twice a day (400 μg/day total), from 840 ng/dL to 182 ng/dL (71.4% lower than controls) with 500 μg by nasal spray twice a day (1,000 μg/day total), and from 598 ng/dL to 126 ng/dL (80.4% lower than controls) with 50 μg by subcutaneous injection once a day. Pharmacokinetics<unk>  is ineffective via oral administration due to first-pass metabolism in the gastrointestinal tract. Its bioavailability is 2.5 to 3.3% by intranasal administration and 70% by subcutaneous injection. The plasma protein binding of<unk>  is approximately 15%. The metabolism of<unk>  occurs in the liver, kidneys, and gastrointestinal tract and is mediated by peptidases, specifically pyroglutamyl peptidase and chymotrypsin-like endopeptidase. The elimination half-life of<unk>  regardless of route of administration is about 72 to 80 minutes.<unk>  and its metabolites are eliminated in urine and bile, with approximately 50% of<unk>  excreted in urine unchanged.
Buserelin
Goserelin
Gestodene
Fosfestrol
Dimestrol
Dienestrol
Hexestrol
Allenestrol