Andropause Flashcards
What is testosterone deficiency syndrome also known as?
andropause
ADAM/PADAM
late onset hypogonadism
symptomatic late onset hypogonadism
age-associated testosterone deficiency syndrome
What is andropause?
male menopause
-very gradual changes
What is testosterone deficiency?
a clinical and biochemical syndrome characterized by a deficiency of testosterone or testosterone action, and relevant signs and symptoms
What might testosterone deficiency affect?
may affect the function of multiple organ systems and result in significant detriment in QoL, including alterations in sexual function
Differentiate primary and secondary causes of testosterone deficiency.
primary: testicular
-age, trauma, Kleinfelter
secondary: hypothalamic, pituitary, idiopathic
Describe the physiology of testosterone deficiency.
decreased T production, secretion, and peripheral conversion as men age
LH surge decreases
SHBG increases –> decreased bioavailable T
T receptor responsiveness altered
What is the rate of testosterone level decline after age 50?
T levels decrease around 1% per year after 50
Differentiate unbound and bound testosterone.
2% unbound (free T)
60% strongly bound to SHBG
38% weakly bound to albumin
What is bioavailable testosterone?
free and albumin bound (40%)
What are the physical and psychological symptoms of testosterone deficiency?
fatigue
decreased general well-being
decreased libido, decreased erection quality
mood changes, decreased intellectual activity, depression, irritability
decreased lean body mass, decreased muscle volume & strength
decreased BMD
decreased height
decreased hematopoiesis
increased visceral fat
What does testosterone deficiency often overlap with?
depression
What are some components of the physical exam for testosterone deficiency?
identify endocrine disturbances
testicular exam (gives idea of production)
hair distribution (below jawline, changes?)
evaluate: musculature, central obesity, posture
prostate exam (baseline as T can impact prostate, T doesnt cause prostate cancer)
observe for renal or liver failure
What are the risk factors for testosterone deficiency?
opioids
chronic disease (DM, COPD, inflammatory, HIV, renal)
obesity
metabolic syndrome
hemachromatosis
??concussion
What is the diagnosis of testosterone deficiency based on?
clinical picture AND lab findings
-must have both
Which testosterone lab test is helpful in diagnosis of testosterone deficiency?
free or bioavailable testosterone
-not total testosterone
When should testosterone levels not be tested?
during acute illness - transient decrease
What time of the day should testosterone levels be taken?
between 7-11am
-higher in AM and tapers off during the day
Why is CBC an important lab test in testosterone deficiency?
hematocrit because T stimulates erythropoesis
What is the non-pharmacological therapy for testosterone deficiency?
weight reduction
lifestyle modification (smoke, marijuana, alcohol)
stop opioids
treat sleep apnea
What is the pharmacological treatment for testosterone deficiency?
testosterone replacement therapy
What are the contraindications to TRT?
known hypersensitivity
breast cancer or suspected prostate cancer
planning fatherhood
recent stroke or coronary event/unstable CAD
What are relative contraindications to TRT?
CHF
BPH
severe sleep apnea
What are the routes of administration for TRT?
oral
injectable
transdermal
intranasal
What is the name of oral TRT?
testosterone undeconoate (Andriol)
How does Andriol need to be taken?
with a high fat meal
-absorbed through lymphatic system
What are the names of injectable TRT?
testosterone cypionate
testosterone enanthate (Delatestryl)
What are the pros and cons of injectable TRT?
pros: cheap
cons: injection
What is the yo-yo effect with injectable TRT?
feeling really good at the start and then poorly near the end
What are the names of transdermal TRT?
testosterone-USP (Androderm = patch, Androgel = gel)
testosterone topical (Testim)
What is the main adverse effect of the testosterone patch?
adhesive reaction
Where are testosterone gels applied?
anywhere there is not lots of body hair
-ex: upper arms, side of body, etc.
What is distinct about Testim?
its smell
What are the monitoring parameters for TRT?
asses response to clinical measures
six areas to monitor:
-erythropoiesis (HgB)
-prostate
-social behavioural & emotional state
-liver
-lipids
-sleep disorders
Which form of testosterone is most common in females?
DHEAS
Describe testosterone production in females.
50% adrenal
20% ovaries
30% peripheral conversion
99% bound to SHBG
What is the role of androgens in females?
follicular development
sexual function only when hypopituitarism
non-reproductive
-possible CV AEs
-little benefit for BMD
-no effect for mood and cognition
What are the risks of TRT in females?
same as for men
-acne, hirsutism
no short-term risk of breast or endometrial disease (no long-term studies)
What are the benefits of TRT in females?
no benefit of DHEA replacement
vaginal DHEA effective for GU sx
-has not been compared to vaginal estrogen
If TRT is used in females, what are some things to keep in mind?
10% of male dose
all off-label
mostly studied in women also taking estrogen
