Androgen Deficiency

Question 1

Hypogonadism.

1/ diagnosis

Answer 1

1/ clinical symptoms + repeated early morning testosterone levels

(RACGP article)

Question 2

What are the ranges of testosterone levels that are
1/ low
2/ borderline
3/ considered normal?

Answer 2

1/ <8nmol/L
2/ 8-12nmol/L
3/ >12 nmol/L

(RACGP article)

Question 3

What is the effect of exogenous testosterone?

Answer 3

Suppresses secretion of pituitary gonadotrophins, decreases endogenous testosterone secretion from the testis and deprives developing sperm of signals required for normal maturation.

(RACGP article)

Question 4

Does testosterone therapy for hypogonadism improve fertility?

Answer 4

No

Question 5

Diabetes and Obesity can decrease levels of SHBG, therefore measure X

Answer 5

measure free testosterone level

Question 6

Explain the hypothalamic pituitary gonadal axis

Answer 6

GnRH, stimulates LH and FSH
LH stimulates Leydig cells to produce testosterone
FSH stimulates Sertoli cells

Testosterone has a negative feedback loop and inhibits LH

Question 7

How is testosterone carried in the body?

Answer 7

Testosterone
2% free
98% bound: 65% to Sex Hormone Binding Globulin & 33% to Albumin

Question 8

Causes of low testosterone

Answer 8

Chronic Disease (e.g. obesity and diabetes)

Primary (high LH and FSH)
Damage to testicular (trauma, orchitis, toxins)
Drugs (spironolactone, Ketoconazole, anabolic steroids,
opiates, glucocorticoids)
Congenital (.e.g Klinefelter’s syndrome, Cryptorchidism)

Secondary causes
  Tumour
  Surgery
  Trauma 
  Infiltration
    Fe overload 
    Sarcoid 
  Genetic
  Function
    Hyperprolactinemia 
    Morbid Obesity 
    Cushing's Syndrome 
    Alcohol excess