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Endo/Repro > Male Physiology > Flashcards

Male Physiology Flashcards

1
Q

Spermatogenesis

A
  1. Male germ cell compartment constitutes a stem cell population
  2. Mitosis begins in embryo
  3. Mitosis and meiosis occur throughout adult life
  4. Spermatogenesis occur in seminiferous tubules of testes
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2
Q

Spermatogenesis staggered throughout seminiferous tubules

A

Spermatogenic wave is defined as time it takes for reappearance of same stage within given segment

  • each stage of wave follows in orderly sequence
  • production of sperm in waves ensures spermatozoa are produced continuously
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3
Q

Spermatogenesis

A

(+) correlated with testosterone levels

  • continous through life -> decreases with age
  • can be affected by temp for up to 2 months post insult
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4
Q

Hypothalamo-Pituitary gonadal axis

A

GnRH –> FSH and LH

  • FSH -> (on sertoli cells) cell products, androgen-binding protein, and inhibin (- feedback to FSH)
  • LH –> (on leydig cells) testosterone
    • testosterone inhibits negatively on LH and GnRH, but positively on sertoli
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5
Q

Relationship between leydig cells and sperm

A

Positive linear relationship between # of leydig cells and sperm production

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6
Q

Andropause

A
  1. Decreased testicular function -> loss of spermatocytes, leydig cells, sertoli cells, decreased testosterone production
  2. Symptoms -> +/- erectile function, weight gain
  3. Diagnosis -> measuring morning total testosterone
  4. Treatment -> hormone replacement, sleep, eat, exercise
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7
Q

Natural Androgens

A

Testosterone is potent testicular androgen -> 95% made by leydig cells

  • testosterone converted to DHT (5alpha-reductase)
  • SHBG binds androgens and estrogens
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8
Q

Androgen Functions

A

Promote health and function of:
- seminal vesicle, prostate, genital tract, external genitalia, hair growth, voice
Anabolic effects:
- muscle building, bone growth and closure of epiphysis, sodium and water retention

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9
Q

Synthetic Androgens

A

Oral, pellets, patch, transbuccal

- 1st pass metabolism for natural androgens, reduce first pass for synthetics

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10
Q

Methyl testosterone

A

C-17alpha-alkyl substitution -> orally active, esterification retards absoprtion, retards metabolism, hepatotoxic

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11
Q

Oxandrolone

A

C-17alpha-alkyl substitution (DHT derivative)

  • cannot be converted by aromatase, lowers hepatotoxicity
  • anabolic steroid -> muscle growth
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12
Q

Adverse effects of Androgens

A

Growth interruption (bone closure)

  • priapism = massive erection
  • sodium/water retention
  • jaundice
  • hepatic carcinoma
  • hypogonadism
  • aggressive behavior
  • urinary obstruction
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13
Q

Why all the side effects?

A

they bind multiple receptors –> multiple effects

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14
Q

Medical Castration

A

Purpose - interfere with precocious puberty, treat androgen dependent cancers, reduce libido

  • androgen receptor antagonists
  • nonpulsatile GnRH agonists
  • nonpulsatile GnRH antagonists
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15
Q

Intracrinology

A

Women -> all estrogens and androgens made locally in tissue from DHEA
Men -> testosterone made in testis, other androgens produced by adrenals
*GnRH agonists/antagonists wipe out testicular production, doesn’t effect other tissues

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16
Q

Androgen Antagonists

A

Flutamide, Bicalutamide, Nilutamide
- nonsteroidal pure receptor antagonist
- advanced prostate cancer
S.E. = gynecomastia, hepatotoxicity

17
Q

GnRH agonists

A

Bind GnRH receptors and stimulate release of FSH, LH for therapeutic purposes (continous administration shuts down the HPG axis)
Gonadorelin -> assessment of gonadal response
Leuprolide -> synthetic analog of GnRH
- castration for cancer (continuous administration)

18
Q

GnRH antagonists

A

Bind to GnRH receptors in anterior pituitary -> block action of GnRH -> reduces FSH, LH -> reduces testosterone production
Degarelix -> advanced prostate cancer, BPH
Ganirelix, Cetrorelix

No immediate androgen flare like the GnRH agonists

19
Q

5-alpha reductase inhibitors

A

inhibits conversion of testosterone to DHT (specific androgen for growth and maintenance of prostate)
- BPH, prostate cancer, male patterned baldness
Finasteride -> 50% metabolized, 50% excreted in feces
Dutaseride

20
Q

Physiology of Erection

A
  1. PS stimulation -> relaxation via NO
  2. NO binds receptors on VSM
  3. increases intracellular cGMP
  4. cGMP promotes arteriole dilation
  5. PDE-5 in VSM degrades cGMP
  6. Vasodilation ensues -> flaccid penis
21
Q

PDE-5 inhibitors

A

Sildenafil

  • prevents degradation of cGMP
  • orally effective, headache, flushing, dyspepsia, nasal congestion
  • don’t use with nitrates or alpha-blockers

Endo/Repro (34 decks)

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