Men's Health Flashcards
Male Health Issues
-CHD
-Prostate cancer
-LUTS/BPH
-Alopecia
-Testicular cancer
-ED
-HYPOgonadism (delayed puberty)
-Peyronie’s Disease
Role of Testosterone
Puberty
-bone and muscle growth
-body and facial hair
-penis growth
-testicular growth
-spermatogenesis
-inc libido
Men’s Health issues during puberty/adulthood
-Delayed sexual maturity (HYPOgonadism)
-Testicular cancer
-Alopecia
Hypogonadism
-incomplete/delayed sexual maturity
-lack of testicular growth at 14
-functional (secondary) or organic/genetic
most common cause of hypogonadism
-Constitutional delay of growth and puberty
Hypogonadism treatment
-usually requires testosterone supplement
-IM testosterone esters 50mg monthly inc by 25 mg up to 100mg
Testicular cancer prognosis
-pretty good even stage 3
Testicular cancer treatment
-surgery (orchiectomy)
-radiation
-chemo
Alopecia types
-androgenic (most common)
-areata
-universalis
-traction
-drug-induced
Androgenic alopecia
-male pattern baldness
-usually by 40
-genes play factor
Alopecia areata
-autoimmune
-patchy hair loss
-mAb treatment
Alopecia universalis
-complete loss of all body hair
Traction alopecia
-over time from tension
Drug-induced alopecia
-anabolic steroids
-cancer chemo (reversible)
Alopecia mech
-hairs transition from large, thick, pigmented to short, wispy, gray
Alopecia treatment
-Finasteride (Propecia)
-Minoxidil (Rogaine)
-both
-hair transplant
Finasteride mech
-inhibit type II 5-a reductase
-inhibits conversion of testosterone to DHT
-decreased DHT conc in scalp by 60%
-stopped progression in 86% of men
Finasteride (Propecia) dose
-1mg PO qd
-continuous use needed to maintain efficacy
Finasteride side effects
-decreased libido
-ED
-dec volume of ejaculate
-low incidence tho
-women of child bearing age should AVOID handling
Minoxidil (Rogaine)
-alopecia treatment
-OTC?
Minoxidil mech
-enlarge mini hair follicles
-may inc blood supply
-stimulate hair follicle
Minoxidil dosing
-topical 5% foam or solution
-apply BID every day!
-may take 4 months to see results
-apply to dry scalp and hair (wet hair will dilute!)
Topical finasteride and minoxidil
-treat alopecia
-gel, solution, spray
-5% Minoxidil, 0.25% finasteride
HYPOgonadism causes
-aging
-diabetes, Aids, arthritis, CKD
-long-term corticosteroid use
-obesity
Diagnosis of HYPOgonadism
-low testosterone levels WITH symptoms
Signs of low testosterone
-dec libido
-gynecomastia
-loss of body hair
-reduce muscle bulk and strength
Testosterone concentrations
-dec with age
-300-1100ng/dL
Low testosterone diagnosis
-serum testosterone levels measured in pts with specific signs of low T
-test in morning for total testosterone
-<300ng/dl
-confirm w 2nd test = free testosterone < 5ng/dl
Treatment of Hypogonadism
-hormonal therapy
-ONLY use when hypogonadism is diagnosed
Testosterone replacement products
-patches
-gels
-solutions
-IM
-buccal
-SC pellets
-capsules
IM injection
-100mg weekly or 200mg every other week
-enanthat or cypionate
-high concentrations during dosings
-mood swings
-cheapest
THT patch
-5mg
-1-2 patches nightly
-most similar to normal T levels
-avoid exposure to water for 3 hours
THT gel
-5-10g
-apply to COVERED area of skin daily
-shoulders, upper arms, ab
-WASH HANDS
THT solution
-30mg-120mg to armpits qd
-apply deodorant first
-wash hands
THT buccal tablet
-30mg q 12 hours
-do NOT chew or swallow
THT SQ pellet
-implanted q3-6 months
-delayed onset (3-4 months)
THT oral capsule
-158-237mg BID
-undecanoate
-take with food
-draw serum test 6 hours after AM dose
OTC hypogonadism treatment
-most imply T will inc
-most are hormone precursors from natural products
-efficacy and side effects unknown
CONTRAINDICATIONS to THT
-prostate cancer
-breast cancer
-hematocrit > 50%
-baseline PSA > 4ng/ml or >3 in men at high risk of prostate cancer
-recent or poorly controlled CVD
Black box warning of THT
-gel: secondary exposure to children
-maybe cardiac risk
-injection > patch
Hypogonadism monitoring
-3-6 months after initiating therapy
-testosterone levels should be between 400-700 ng/dl
-if hematocrit >54%, STOP therapy until it lowers
Androgen misuse and abuse
-athletes
-gynecomastia
-weight gain
-acne
-dec testicles
-mood
-hepatotoxicity
Prostate cancer risk factors
-age
-african ancestry
-family history
Prostate cancer 5-yr survival rate
-100% in local and regional
-29% in bone
Prostate cancer bits
-most common man cancer
-2nd leading cause of cancer deaths in men
-gleason score
-treatment dependent on Gleason score
-most men with dx dont die
Prostate cancer screening
-Prostate specific antigen (PSA)
-normal ~ 4ng/mL
PSA <4
-15% chance of cancer
PSA 4-10
-25% chance of cancer
PSA > 10
-50% chance of cancer
PSA screening
-men w PSA < 2.5 only need to be retested every 2 years
-screen yearly is PSA > 2.5
-NOT if older than 70
-consider baseline screening of high risk pt at age 40-45
noncancer causes of high PSA
-older age
-prostatitis
-UTI
-ejaculation
-BPH
-finasteride
