Lecture 22 - Men's Health Part 2 Flashcards
What are the effects of testosterone?
increases libido increase lean body mass increase grip strength increase self-reported physical function increase vertebral bone density
no improvement in depression scores
no decrease in fracture risk
no improvement in cognitive function
no enhanced response to phosphodiesterase inhibitors
What is evidence of low testosterone on hx or PE?
decreased sex drive decreased sexual activity inability to maintain erections (ED and low T typically co-exist) reduced beard growth loss of muscle mass decreased testicular size gynecomastia
What levels of T indicate possible testosterone deficiency?
<300 ng/dL
What is the work up for low testosterone?
check LH to r/o other problems
if LH is high = primary hypogonadism (testicular problem)
if normal or low = secondary hypogonadism (HPG axis problem)
What is the treatment for low testosterone?
Goal is to return testosterone level to “mid-normal” range
Testosterone Enanthat or Cypionate - IM injection once every 2 weeks
Nongenital Testosterone Patch - applied daily
Testosterone Gel - applied daily, concern for transfer of medication to others who come into contact with the pt
Buccal Adhesive testosterone
SubQ Crystalline Testosterone implants
What is a “normal” testosterone for an 80 y/o?
300
a 20 year old has 1000, and it decreases about 100 per decade of life
Testosterone Enanthate or Crypionate
testosterone treatment
IM injection once every 2 weeks; rise in testosterone with DHT within 24 hours; injections followed by changes in mood, sexual desire, and energy
Nongenital Testosterone Patch
testosterone treatment
applied daily, usually one patch sufficient
Testosterone Gel
testosterone treatment
applied to armpit –MC used today
applied daily, concern for transfer of medication to others who come in contact with the pt/get, wide variability in absorption requires frequent monitoring of serum testosterone levels; higher DHT to testosterone levels compared to normal, healthy men
Buccal Adhesive Testosterone
dissolving pill help against buccal mucosa twice daily; may cause/mucosal erosion
SubQ Crystalline Testosterone implants
surgical implantation; lasts 6 months; may have fibrosis around implant and scar tissue formation
What are the CV effects of testosterone therapy?
trial: older men on testosterone therapy with h/o chronic disease (DM, CVD, HTN, increase lipids) had greater number of CV events compared to placebo
Retrospective analysis (x2): higher frequency of CV events in older men on testosterone therapy with preexisting heart disease
basically if the have a hx, they will have a 2x greater risk of having hx (ex. heart attack) again
What effects does testosterone therapy have on prostate cancer?
no evidence connects cause and effect of exogenous testosterone therapy and prostate cancer
BUT prostate cancer tumor growth will be increased with exogenous testosterone therapy
subclinical prostate cancer will rapidly progress if the pt is on exogenous testosterone therapy
must be stopped if there is presence or suspicion of prostate cancer
“feeding the tumor”
What screening must you do for men on testosterone therapy?
DRE and PSA every 3 months for the first year and then twice a year thereafter
Should you check testosterone for all men?
NO
only if pt is symptomatic
Testicular torsion
most commonly caused by abnormality, sometimes TRAUMA <25 y/o twisting of the testis block blood from spermatic cord sudden onset of acute scrotal pain
90% salvage at 6 hours
50% salvage at 12 hours
10% salvage at 24 hours
PE: ABSENT CREMASTERIC REFLEX
elevated scrotum on affected side
What is the physical exam of a pt with testicular torsion?
PE: ABSENT CREMASTERIC REFLEX
elevated scrotum on affected side
enlarged painful testis
abnormal testicular lie
