Dysfunction of the Male System

Question 1

Describe the 5 stages of pubertal maturation in males

Answer 1

• 1: no pubic hair or enlargement of the penis or testes
• 2: testicular enlargement to over 2.5cm, start of pubic hair
• 3: penal enlargement, enlarging testicles, more pubic hair
• 4: further enlargement of scrotum and testes, darkening of pubic hair
• 5: adult genital appearance

Question 2

What is the average age of puberty in males and females?

Answer 2

• males: 14

- females: 13

Question 3

What is hypogonadism?

Answer 3

when there is not enough circulating testosterone for development of secondary sexual characteristics or maturation of genitalia

Question 4

Describe primary gonadal failure

Answer 4

• failure is in the testes
• due to feedback mechanism hypothalamus and GnRH react by overproducing LH
• due to seminiferous tubules not developing it results in overproduction of FSH

Question 5

Describe secondary gonadal failure

Answer 5

• failure is in hypothalamus or pituitary
• low testosterone
• low or no LH

Question 6

What are the 3 main causes of hypogonadism in phenotypic males and their treatments?

Answer 6

• temporary delay of pubery: short-term low-dose sex steroid treatment
• hypogonadotrophic hypogonadism: sex steroid replacement, GnRH administration
• hypergonadotrophic hypogonadism: sex steroid replacement

Question 7

What are causes of temporary delay of puberty?

Answer 7

• constitutional delay of puberty (familial, sporadic)
• chronic illness (eg. malabsorption, malnutrition, hypothyroidism)
• hormonal disturbance

Question 8

What are some causes of hypogonadotrophic hypogonadism (secondary hypogonadism)?

Answer 8

• Kallman’s Syndrome

- hypopituitarism (eg. tumour/trauma)

Question 9

What are some causes of hypergonadotrophic hypogonadism (primary hypogonadism)?

Answer 9

• Klinefelter’s Syndrome (XXY)
• anorchia
• orchitis (eg. mumps)
• radiation treatment/cytotoxic chemo
• surgical/traumatic castration

Question 10

Describe features of Kallman’s Syndrome

Answer 10

• failure of development of GnRH cells in hypothalamus
• low FSH, LH and testosterone
• anosmia (can’t smell)
• treatment with testosterone injections can increase penis size and hair but cannot fix infertility (due to no FSH)

Question 11

What are the symptoms/consequences of male hypogonadism?

Answer 11

• sexual dysfunction
• fatigue
• depressed mood
• osteoporosis
• decrease in muscle mass and strength
• loss of facial and body hair

Question 12

What are the ways testosterone can be administered?

Answer 12

• IM injection: every 2-3 weeks
• oral: 3-4 times daily
• SC pellets: every 4-6 months
• transdermal patch
• buccal