Andropause Flashcards
andropause is a.k.a
Late Onset Hypogonadism or partial androgen deficiency of the aging male
Andropause is menopause in men T/F
F
When will testosterone start to decline?
40 y.o
T/F Osteoporosis, muscle loss and cognitive change is common to andropause and menopause
T
What enzyme converts Testosterone to DHT?
5-a-reductase
When does testosterone peak?
8-11AM
When is testosterone lowest?
before waking up
Side effects of anabolic steroids
aggression, testicular atrophy
What modulates testosterone synthesis?
LH
What secretes testosterone?
Leydig Cells
T/F there is decreased Leydig cells in older men, thus decline in testosterone production
T
How much of testosterone is bound to SHBG?
98%; biologically inactive
[Increase/Decrease]
SHBG in obese
increase
When does prostate start to enlarge?
age 50
T/F In patients with prostatic cancer, administration of
exogenous testosterone can cause cancer to
metastasize
T
The following are true about PADAM except
a. decreased visceral fat
b. ical Manifestations
c. Changes in mood and sleep pattern, decreased
intellectual activity, irritability
d. Decreased lean body mass, muscle volume, and
strength
e. Decreased body hair and skin alterations
A
The following are true about PADAM except
a. Development of gynecomastia
b. Decreased bone mineral density osteoporosis
c. ncreased visceral fat
d. Decreased sexual desire, erectile quality, orgasms,
and ejaculation
e. Lower levels of testosterone always mean PADAM
E
When is it best to do testosterone testing?
8-11AM
You are hypogonadal when your testosterone levels are
<200ng/L
What is best assay for testosterone testing?
Equilibrium analysis
How to rule out carcinoma?
PSA and DRE
Complex associated abnormalities due to metabolic syndrome (androgen and glucose)
Increased risk for CV and DM
3 criminals of andropause
Metabolic Syndrome, late onset hypogonadism, erectile dysfunction
Testosterone deficiency leads to
reduced lipolysis, reduced metabolic rate, visceral fat deposition, and insulin resistance
Central obesity: waist circumference: Caucasians, Asians
> =94cm, >=90cm
Metabolic Syndrome Values Increased triglycerides Decreased HDL Systolic: Diastolic:: Increased fasting plasma glucose:
> 1.7 mmol/L (≥150
mg/dL);<40 mg/dL); ≥130 mmHg; ≥85 mmHg;≥5.6 mmol/L (100 mg/dL) or Type II DM;
How to treat Hypogonadism?
Hormone supplementation: IM 200mg monthly; Oral prep Testosterone undecanoate (andriol 40 mg); Mesterolone (proviron 25 mg) Transdermal testosterone injectable: Nebido® 5α-reductase inhibitors
alkylated forms of oral hormone supplementation may cause ________;Large doses can lead to ____________________
Liver disease;;hepatitis, cholestatic jaundice possibly hepatoma
Effect testosterone on nitrogen retention and protein synthesis
increase; thus increase in skeletal muscle mass and strength.
Effect of Testosterone Replacement
- Slow bone degradation and increase bone
mineral density - increase in total and LDL cholesterol
- Improvement in mood and reverse depression
- More concentration and more positive approach
to life
You may absolutely not undergo testosterone replacement if you have the ff except
a. Prostate Specific Antigen (PSA) > 4 ng/ml
b. Abnormal DRE findings
c. Polycythemia
d. Snoring
e. Severe cardiac insufficiency
D
You may absolutely not undergo testosterone replacement if you have
Snoring
a. Lower Urinary Tract Syndrome (LUTS)
b. increased red blood cells, hemoglobin (>60)
c. Hyperlipidemia
d. Respiratory difficulties
B
T/F testosterone supplementation may increase cerebrovascular accident due to thickness of blood
T
If symptoms persist even after testosterone replacement, what will you do?
Stop treatment
Which division of the nervous system is responsible for erection?
parasympathetic nervous system
Erectile dysfunction is related to
endothelial dysfunction
True about erection a. Erectile dysfunction is a CV problem b. ED may be a sign of atherosclerosis c. Erection is a neurovascular event D. AOTA
D
T/F Erections need testosterone
F
Most important risk factors for ED
o Age o Cardiovascular disease o Hyperlipidemia o Diabetes mellitus o Drug side-effects o Smoking
What is most notorious risk for erectile dysfunction
Diabetes
T/F desire is associated with erection
F; it is associated with testosterone
True about Sexual Function in the Elderly Except
a. Actual latent period between sexual stimulation and
erection increases
b. no change in erectile turgidity
c. Ejaculation is not as explosive
d. Volume of ejaculate is less
e. Refractory period is longer.
B
What are aphrodisiacs for?
increase appetite for sexual activity, but does not enhance erection
Enumerate aphrodisiacs
Malunggay, ginseng, ginger, celery, onions, okra,
jackfruit, coconut, milk, durian, avocado
Give the reason for gynecomastia
decreased testosterone and increase in estradiol and estrone
indole alkaloid causing blood vessel dilation and increase
blood flow; α-2 receptor blocker
Yohimbine
side effects of yohimbine
palpitations, tremor, hypertension, anxiety and nausea
with antiplatelet property that improves vascular endothelial abnormalities and release of nitric oxide, increases interest in sex, increases performance
Ginseng
mainly for dementia, no difference between placebo, improves memory
Gingkgo biloba
precursor of nitric oxide, no addition benefit noted vs. placebo, need high dose (5 g) to show difference
L-Arginine
effect of zinc on erections
none
Enumerate Phosphodiesterase-5 Inhibitors
Sildenafil (Viagra)
Vardenafil
Tadalafil (Cialis)
Udenafi
Mode of action of phosphodiesterase-5-inhibitors
blockage of PDE-5 increases cGMP levels, leading to
persistent, continued erection; PDE-5 inhibitor does not increase production of cGMP per se, but only slows down its break down
Contraindications of Phosphodiesterase-5 Inhibitors
patients taking nitrates, patients with congestive heart failure or previous heart attack, In patients taking alpha-blockers (for BPH), antihypertensive drugs
Enumerate treatment options for erectile dysfunction
VCD’s (vacuum constriction devices) Intraurethral injection (MUSE) inject vasodilators (Prostaglandin E1, papaverine) into penis, Penile prosthesis Intracavernosal injection, Oral therapy
