Androgen Deficiency 3.3 Flashcards
Androgens are important for normal?
Bone, muscle and fat metabolism
Erythropoiesis
Libido
Mood, cognitive health
Deficiency = decreased testosterone levels
What are some conditions that cause high LH and low testosterone (testes - primary or hypergonadotrophic hypogonadism)
- Klinefelter syndrome
- Cryptorchidism (undescended testes)
- Orchidectomy, orchitis (mumps after puberty), cytotoxic or radiation damage, traumam, testicular torsion
What are some conditions caused by low LH and low testosterone (hypothalamus and pituitary gland - secondary or hypogonadotrophic hypogonadism)?
- hypothalamic lesions, pituitary tumours
- haemocrhomatosis
- idiopathic
How does age cause androgen deficiency (testosterone)?
- levels drop by 1/3 from 30-80 years of age, decreases by 0.5-2% per year
- reduce testicular ability to produce testosterone = late onset hypogonadism (LOH)
> accelerated by comorbidities especially obesity
What are some other causes of testosterone deficiency (androgen deficiency)
- systemic disease (T2DM, obesity, depression)
- prescribed medication
> androgen deprivation therapy
> opioid
> glucocorticoids
> dopamine antagonists
> anabolic steroids
- recreational drugs such as marijuana, amphetamines, opoids, alcohol XS
Signs and symptoms of androgen deficiency (testosterone)?
- reduced libido, decreased spontaneous erections
- hot flushes or sweats
- reduce facial hair or growth
- loss of axillary and pubic heair
- breast discomfort or gynaecoamstia
- small testes
- osteoporosis
- less specific = see attached image
Diagnosis of androgen deficiency (testosterone)?
Consistent S and S
Fasting morning total testosterone level, sex hormone binding globulin (SHBG) and LH (+/- FSH)
Management of androgen deficiency (testosterone)?
Consider underlying causes = lose weight, exlude and pituitary gland/hypothalamus issues
What are the types of TRT?
Oral, IM injection, cream, gel, patch
> gel,cream or shorter acting IM injections start treatemnt
> maintanence usually with gel, cream or long acting IM injection
- may initiate lower doses (1/2 dose) in older men
When is TRT CI?
AE of TRT?
How to monitor for TRT?
What is androgenic alopecia? Treatment considerations?
Options for androgenic alopecia?
No treatment
Hair piece (wig or hair extensions)
Drug treatment 1 for androgenic alopecia
Drug treatment 2 for androgenic alopecia?
Monitoring for androgenic alopecia?
Osteoporosis in men? What is it associated with?
Associated with androgen deprivation therapy and corticosteroids
Drugs for postmenopausal women and men aged above 50 years for osteoporosis
