Hypogonadism Flashcards
What are symptoms and signs of hypogonadism?
fatigue, loss of muscle mass, obesity, erectile dysfunction, low libido, loss of initiative , depression, poor concentration
While typically driven by signs and symptoms, when are silent conditions that hypo T should be checked?
anemia, loss of bone density, on chemotherapy, DM, male infertility, narcotic use, chronic steroid use
If low testosterone, what is lab test to obtain?
LH
If LH low, what is next?
prolactin
if prolactin is high, what is next step?
refer to endocrinologist
When should other labs be checked?
Only if with TITS (gynecomastia, breast tenderness, nipple tenderness). check E
before starting TRT, what are the labs you need?
CBC (H/H) - track polycythemia
PSA if > 40
When is intervention for high Hct?
54%
if prior to starting it is over 50%, refer to hematology
how to treat?
dose adjustmentW
refer to hematology / phlebotomy
What is low testosterone a risk for?
cardiovascular disease (increased MACE - MI, stroke, etc)
What is TRT not clearly improve?
cognitive, energy, lipid, DM, QoLW
What is data on prostate cancer and testosterone?
No definitive evidence that there is any link.
For pts with hx of prostate CA - inform that there is no clear data on risk:benefit comparison
Post prostatectomy, can start depending on there clinical data
same with radiation therapy, same with AS
SDM
Is there evidence that testosterone leads to DVT?
No
Will MACE risk improve after starting testosterone?
It is not clear if it increases or decreases MACE
What is first line strategy for hypogonadism?
Lifestyle changes
What is target testosterone level?
450-600
If recent cardiovascular event, how much time should you wait?
3-6 months
What is warning on oral testosterone agents?
oral alkylated - NO - liver metabolism
testosteorne undeconate - OK
