Male Hypogonadism

Question 1

what is male hypogonadism?

Answer 1

testosterone deficiency

Question 2

does testosterone have to be free and unbound to exert its effects?

Answer 2

yes

Question 3

what is testosterone converted to?

Answer 3

dihydrotestosterone and oestradiol

Question 4

what converts testoserone?

Answer 4

aromatase

Question 5

what causes gynaecomastia in men?

Answer 5

aromatase in adipose tissue converts free testosterone to oestradiol and dihydrotestosterone

Question 6

pre-pubertal presentation of male hypogonadism

Answer 6

small male sex organs
decreased body hair
high-pitched voice
low libido
gynaecomastia and eunuchoid habitus
decreased bone and muscle mass

Question 7

post-pubertal presentation of male hypogonadism

Answer 7

decreased libido, hair and testicular volume
low energy, bone and muscle mass
normal skeletal proportions, penis size and voice

Question 8

diagnosis of male hypogonadism

Answer 8

measure testosterone

Question 9

what time should testosterone be measured?

Answer 9

8-11am

Question 10

management of male hypogonadism

Answer 10

testosterone replacement therapy

Question 11

when should testosterone replacement therapy not be used?

Answer 11

hormone responsive cancer
haematocrit >50%
sleep apnoea
HF

Question 12

classification of male hypogonadism

Answer 12

1. primary

2. secondary

Question 13

what is primary hypogonadism

Answer 13

testes are affected

Question 14

causes of primary hypogonadism

Answer 14

congenital= Klinefelter's, cryptorchidism and Y chromosome microdeletion
acquired= trauma, chemo/radiotherapy, varicocele, orchitis, infiltrative disease (haemochromatosis) and medications (steroids)

Question 15

diagnosis of primary hypogonadism

Answer 15

decreased testosterone

high FSH/LH

Question 16

what is Klinefelter’s syndrome?

Answer 16

non-disjunction= division of gamates that is unequal resulting in 47XXY

Question 17

diagnosis of Klinefelter’s syndrome

Answer 17

karotyping

Question 18

presentation of Klinefelter’s syndrome

Answer 18

infertility
small testes
poor beard growth
narrow shoulders/ hips
breast development with few chest hairs

Question 19

what is secondary hypogonadism?

Answer 19

normal testes with hypothalamic/ pituitary dysfunction

Question 20

diagnosis of secondary hypogonadism

Answer 20

LH/FSH low

testosterone low

Question 21

causes of secondary hypogonadism

Answer 21

congenital= Kallman's syndrome and Prader-Willi syndrome
acquired= pituitary damage, hyperprolactinaemia, obesity, DM, drugs (steroids, opioids), eating disorders and excess exercise

Question 22

what is Kallman’s syndrome?

Answer 22

genetic disorder with GnRH deficiency and hyposmia/anosmia

Question 23

associations with Kallman’s syndrome

Answer 23

unilateral renal agenesis
red/green colour-blindness
cleft lip/ palate
bimanual synkinesis