Androgen Deficiency

Question 1

What are the features of androgen deficiency in man?

Answer 1

GENERAL
-Decreased sense of wellbeing
-poor concentration, tired
-mood change: depression, irritability
SEXUAL: universally reduced libido
ORGAN SPECIFIC: 
-reduced muscle mass
-osteoporosis/#s
-increased fat mass
-gynaecomastia
-loss of body hair
-small testes
-infertility

Question 2

Clinical features of male androgen deficiency with onset in 1st / 3rd TM?

Answer 2

1st TM: partial virilisation w/ ambiguous genitalia. Complete deficiency ==> female genitalia.
3rd TM: micropenis, cryptorchidism.

Question 3

Clinical features of male anger deficiency with pre-pubertal onset?

Answer 3

• Incomplete pubertal maturation

- Testes

Question 4

Clinical features of male anger deficiency with adult onset?

Answer 4

Decreased:
-libido
-mood
-muscle mass
-BMD
Increased: fat mass

Question 5

What are the primary acquired causes of androgen deficiency?

Answer 5

Testicular damage:

• trauma
• orchitis
• toxins
• drugs esp spiro, ketoconazole.

Question 6

What are the primary congenital causes of androgen deficiency?

Answer 6

• Klinefelter Syndrome
• cryptorchidism
• mutations in androgen biosynthesis enzymes
• LH/FSH receptor mutations
• Myotonic dystrophy

Question 7

Primary v secondary androgen deficiency?

Answer 7

Primary: LH/FSH elevated.
Secondary: LH / FSH low-N

Question 8

Genetic causes of secondary androgen deficiency?

Answer 8

• Kallmann’s syndrome
• Idiopathic hypogonadotropic hypogonadism
• LH/FSH beta subunit mutations

Question 9

Karyotype of Klinefelter’s syndrome?

Answer 9

47 XXY

Question 10

Types of testosterone product available in Australia?

Answer 10

• Injection (Deep IM)
• Transdermal Patch or Cream or Gel
• Subdermal implant
• Oral: testosterone undecanoate

Question 11

Contraindications to testosterone replacement therapy?

Answer 11

• Prostate Ca
• Breast Ca
• Erythrocytosis / hyper viscosity
• Untreated OSA
• Severe LUTS
• Class III or IV CCF
• Desire to have a child

Question 12

AEx testosterone replacement therapy?

Answer 12

• Erythrocytosis
• Acne and oily skin
• Detection subclinical Prostate Ca
• Growth of metastatic prostate Ca
• Reduced sperm production and fertility
• Worsening BPH

Question 13

Ongoing monitoring in patients on testosterone replacement therapy?

Answer 13

• History and physical (+ DRE)
• Testosterone levels
• LFTs
• PSA
• Lipids
• Haematocrit