Androgen Deficiency in Men (core) Flashcards
What are the contraindications of TRT?
Evidence of prostate cancer
Breast cancer
Erythrocytosis or hyperviscosity
Untreated OSA
Severe lower urinary tract symptoms (obstructive due to prostate growth)
Class III and IV HF
Desire to have a child
What is the normal volume of the testes?
>20mL
Why isn’t oral testosterone used?
Metabolished in the liver
- interacts with other drugs
- Causes derangement of LFTs
What are some causes of primary deficiency?
Acquired - testicular damage
- Trauma
- Toxins
- Drugs - spironolactone/ketoconazole
Congenital
- Klinefelter syndrome
- Cryptorchidism
What are some conditions associated with decrease SHBG?
Morbid obesity
Nephrotic kidney
Hypothyroidism
Use of glucocorticoids, progestins, and androgenic steroids
What are some side effects of testosterone?
Common:
Erythrocytosis
Acne and oily skin
Prostate cancer
Reduced sperm production and fertility
Uncommon:
Gynecomastia
Male pattern balding
Worsening of BPH symptoms
Growth of breast cancer
OSA
What is the advantage of testosterone gel?
Slow rise in testerone to avoid rapid pubertal effects
What are some causes of secondary deficiency?
Structural - tumour
- Surgery, radiation, trauma
- Infiltration - sarcoid
Genetic
- Kallmann’s syndrome
Functional
- Hyperprolactinaemia
- Morbid obesity
- Cushing
Partial/Transient
- Acute/chronic illness
What is the karyotype and prevalence of Klinefelter’s?
XXY
1:660
What are some conditions associated with elevated SHBG?
Ageing
Cirrhosis
Hyperthyroidism
Use of anticonvulsants
HIV
What are some organ specific features of testosterone deficiency?
Reduced muscle mass and strength
Osteoporosis and fractures
Increased fat mass
Gynaecomastia
How does bone respond to testosterone?
Increase in bone mass density
What are some negative physiological effects of testosterone
Increased haematocrit
Increase prostate volume
What are the hormone levels in Klinefelter’s?
Low/normal TT (total testosterone) - declines with age
LH high
Why does testosterone effect fertility?
It switches off endogenous testosterone production and disrupts the FSH, LH axis - temporary or permanently
