19 Testicular Disorders

Question 1

Conditions associated with ⬇️ SHBG concentrations (7)

Answer 1

Obesity
Diabetes mellitus
Use of glucocorticoids, some progestins, and androgenic steroids
Nephrotic syndrome
Hypothyroidism
Acromegaly
Polymorphisms in the SHBG gene

Question 2

Acromegaly is associated with (⬇️ / ⬆️) SHBG

Answer 2

⬇️ SHBG

Question 3

Hypothyroidism is associated with (⬇️ / ⬆️) SHBG

Answer 3

⬇️ SHBG

Question 4

Obesity is associated with (⬇️ / ⬆️) SHBG

Answer 4

⬇️ SHBG

Question 5

Diabetes mellitus is associated with (⬇️ / ⬆️) SHBG

Answer 5

⬇️ SHBG

Question 6

Glucocorticoid use is associated with (⬇️ / ⬆️) SHBG

Answer 6

⬇️ SHBG

Question 7

Androgenic steroids are associated with (⬇️ / ⬆️) SHBG

Answer 7

⬇️ SHBG

Question 8

Estrogen use is associated with (⬇️ / ⬆️) SHBG

Answer 8

⬆️ SHBG

Question 9

Hyperthyroidism is associated with (⬇️ / ⬆️) SHBG

Answer 9

⬆️ SHBG

Question 10

Conditions associated with ⬆️ SHBG concentrations (7)

Answer 10

Aging
HIV disease
Cirrhosis and hepatitis
Hyperthyroidism
Use of some anticonvulsants
Use of estrogens
Polymorphisms in the SHBG gene

Question 11

Indications for measuring free testosterone (2)

Answer 11

Conditions associated with altered SHBG concentrations
Total testosterone concentrations in the borderline zone around the lower limit of the normal range (e.g., 200-400 ng/dL)

Question 12

Conditions with high prevalence of low testosterone and for which measurement of serum testosterone is indicated (7)

Answer 12

Pituitary mass, radiation to the pituitary region, or other diseases of the sellar region
Treatment with medications that affect T production or metabolism, such as opioids and glucocorticoids
Withdrawal from long-term AAS use
HIV-associated weight loss
Infertility
Osteoporosis or low trauma fracture
Low libido or erectile dysfunction

Question 13

Indications for pituitary imaging in secondary hypogonadism (4)

Answer 13

Severe secondary hypogonadism [e.g., serum T , 150 ng/dL (5.2 nmol/L)]
Panhypopituitarism
Persistent hyperprolactinemia
Symptoms or signs of tumor mass effect (such as new-onset headache, visual impairment, or visual field defect)

Question 14

Conditions in which testosterone administration is associated with a VERY HIGH risk of adverse outcomes (2)

Answer 14

Metastatic prostate cancer
Breast cancer

Question 15

Conditions in which testosterone administration is associated with a MODERATE to HIGH risk of adverse outcomes (6)

Answer 15

Unevaluated prostate nodule or induration
Unevaluated PSA >4 ng/mL (>3 ng/mL in individuals at high risk for prostate cancer, such as African Americans or men with first-degree relatives who have prostate cancer)
Hematocrit >48% (>50% for men living at high altitude)
Severe LUTS associated with benign prostatic hypertrophy as indicated by AUA/IPSS >19
Uncontrolled or poorly controlled congestive heart failure
Desire for fertility in the near term

Question 16

Adverse events for which there is evidence of association with testosterone administration (5)

Answer 16

Erythrocytosis
Acne and oily skin
Detection of subclinical prostate cancer Growth of metastatic prostate cancer Reduced sperm production and fertility

Question 17

Uncommon adverse events for which there is weak evidence of association with T administration (4)

Answer 17

Gynecomastia
Male pattern balding (familial)
Growth of breast cancer
Induction or worsening of obstructive sleep apnea

Question 18

Monitoring of hematocrit during testosterone therapy

Answer 18

Baseline
3-6 months
12 months
Annually

Question 19

Frequency of prostate monitoring during testosterone therapy (DRE and PSA)

Answer 19

Baseline
3-12 months
According to guidelines after 1 year

Question 20

Indications for urological consultation during testosterone therapy

Answer 20

PSA rise >1.4 ng/dL above baseline
PSA >4 ng/dL
Prostate abnormality detected on DRE

Question 21

Dosing schedule of testosterone undecanoate 1000 mg

Answer 21

1000 mg IM every 10-14 weeks

Question 22

Specific symptoms and signs of testosterone deficiency in men (3)

Answer 22

Incomplete or delayed sexual development
Loss of body (axillary and pubic) hair
Very small testes (<6 mL)