13 Thera VI Andropause/Testosterone Cosep Flashcards
What is Andropause?
Often referred to as “male menopause” or ADAM (Androgen deficiency in the aging male). Testosterone decreases as men age
What is the prevalence of Andropause?
20% of men 60-80 years of age have low testosterone
What are the physical symptoms of low testosterone?
Fatigue. Muscle weakness. Decreased bone mineral density. Decreased muscle mass. Increased fat. Impaired hematopoiesis
What are the sexual/emotional symptoms of low testosterone?
Decreased libido. ED. Oligospermia. Depression. Anxiety. Mood swings. Loss of memory. Cognitive dysfunction
What are the hormone levels like in Primary low testosterone?
Low testosterone levels, high gonadotropines/LH/FSH
What are the hormone levels like in Secondary low testosterone?
Low testosterone and low gonadotropine releasing hormone (GnRH)
What is testosterone production like with age?
Younger men have diurnal variation in serum testosterone concentrations. Older men lose this diurnal rhythm. Sex-hormone-binding globulin (SHBG) increases. Leydig cells decrease. Blood supply to gonads impaired
What is testosterone binding like?
60% of testosterone is bound to SHBG. 38% bound to Albumin. 2% Free T
What are the causes of primary (testicular failure) hypogonadism?
Klinefelter’s syndrome. Vanishing testes syndromes. Fetal testicular loss. Anorchia
What are the causes of secondary (pituitary failure) hypogonadism?
Kallman’s syndrome. Prader-Willi syndrome. Pituitary adenoma
What are some chronic diseases linked to hypogonadism?
Obesity. DM. CVD. Lung cancer. Prostate disease. Inflammatory diseases. Endocrine disorders
What are some medications associated with hypogonadism?
Alcohol. Opioids. Anabolic steroids. Ketoconazole. GLucocorticoids. Spironolactone. Cimetidine. Phenytoin. Flutamide
What are the normal Serum Total Testosterone levels?
300-1050 ng/dL
What are the normal Free Testosterone levels?
50-210 ng/L
What are some potential benefits of testosterone replacement?
Bone. Body composition. Cardiovascular. Sexual effects. Emotional effects
What are the ADRs associated with Testosterone Replacement?
Acne. Fluid retention. Edema. Polycythemia. Suppression of sperm production. Gynecomastia. Sleep apnea. Increase in lean body mass. Weight gain. Aggressive behavior. Hepatic dysfunction
What are the Safety issues in testosterone replacement?
Increase LDL and TGs, decrease HDL. Induce insulin resistance and carbohydrate intolerance. Increase risk for prostate and breast cancer
What are the pretreatment screenings that should be done?
Baseline hemoglobin/hematocrit. Prostate-specific antigen (PSA) level. Digital rectal exam (DRE). Liver function tests. Lipid profile