Endocrinology

Question 1

Male androgen deficiency symptoms

Answer 1

low libido, reduced spontaneous erections, hot flushes, reduced facial hair, breast discomfort, gynaecomastia, loss of axillary and pubic hair, small testes (normal 15-25ml), low bone mass

Question 2

Male androgen deficiency investigations
How to do the test
What affects testing

Answer 2

Measure fasting morning (8-10am) total testosterone -> if low repeat with FSH and LH

Do not measure when unwell or directly afterwards

Obesity, diabetes, depression, opioids, glucocorticoids can cause mild reduction in testosterone (can cause functionally low serum testosterone, with normal LH + FSH)

Question 3

Male primary hypogonadism test results

Answer 3

testicular disorders that reduce testosterone production and spermatogenesis, leading to incr LH + FSH

Question 4

Male primary hypogonadism causes

Answer 4

Klinefelter
Cryptorchidism
Orchidectomy
Orchitis
Cytotoxic or radiation damage to testes
Torsion or trauma
Androgen synthesis inhibitors

Question 5

Male secondary hypogonadism test results

Answer 5

central disorder so low LH + FSH + testosterone

Question 6

Male secondary hypogonadism causes

Answer 6

Pituitary tumours, surgery or radiotherapy
Haemochromatosis - iron deposition in hypothalamus and pituitary
Hypophysitis
Idiopathic hypogonadotrophic hypogonadism (e.g. Kallmann syndrome)
GnRH analgoues

Question 7

How to treat testosterone deficiency

Answer 7

Must be via specialist
Testosterone replacement suppresses spermatogenesis so also needs referral to fertility specialist
Contraindicated with current prostate or breast Ca, desiring fertility, elite athletes
Transdermal gel or cream is first line OR IM

Question 8

Monitoring on testosterone treatment

Answer 8