hypogonadism

Question 1

functional hypogonadism

Answer 1

no organic pathology, potentially reversible

Question 2

examples of functional hypogonadism

Answer 2

-opioids, malnutrition, severe acute/chronic disease, anabolic steroids, HIV, late-onset (AKA age-related, adult onset) hypogonadism-associated with obesity

Question 3

organic hypogonadism

Answer 3

also known as classic hypogonadism; defined pathology, usually irreversible (exceptions : microprolactinoma, Cushing’s)

Question 4

men with hypogonadism=

Answer 4

signs and symptoms of testosterone deficiency and unequivocally and consistently low serum total (or free*) testosterone; exception men with Klinefelter’s

Question 5

when do you treat hypogonadism for Klinefelter’s

Answer 5

may treat when LH is elevated even if testosterone is in the reference range

Question 6

late onset functional hypogonadism

Answer 6

1.Middle-age and older man
2. Coexistence of androgen-deficiency like features and low serum testosterone
3. Absence of both intrinsic structural gonadal axis pathology and specific diseases that suppress gonadal axis

Question 7

diagnosis of functional hypogonadism in aging men

Answer 7

1. symptoms and signs suggestive of hypogonadism
2. Low serum total testosterone in fasting morning samples x2
3. Exclusion of organic causes for gonadal axis dysfunction

Question 8

symptoms and signs suggestive of hypogonadism

Answer 8

Specific symptoms:
-reduced libido
-decreased spontaneous erections
-erectile dysfunction
Less specific symptoms
-decreased energy
-decreased physical strength
-decreased motivation
-low mood
-decreased concentration
-hot flushes
Less specific signs
-loss of body/facial hair
-decreased testicular volume
-increased body fat/reduced muscle mass
-osteoporosis/low bone density
-central obesity

Question 9

treatment of functional hypogonadism

Answer 9

1.Address potentially reversible causes
-weight loss in secondary hypogonadism
-discontinuation of opioids, anabolic steroids
-resolution of medical illness
2. Testosterone supplementation therapy in selected cases

Question 10

testosterone formulation

Answer 10

1.oral
2.buccal (discontinued in the US)
3.Intranasal
4.IM
5.SubQ (injection and implantation)
6.Transdermal (gel

Question 11

treatment of hypogonadotropic hypogonadism in men desiring fertility

Answer 11

-gonadotropins: hcg (+/- hMG)
-Clomiphene (must have preserved pituitary)