Men's Health Flashcards by Brooke Thornburg

Male Health Issues

-CHD
-Prostate cancer
-LUTS/BPH
-Alopecia
-Testicular cancer
-ED
-HYPOgonadism (delayed puberty)
-Peyronie’s Disease

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Role of Testosterone

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Puberty

-bone and muscle growth
-body and facial hair
-penis growth
-testicular growth
-spermatogenesis
-inc libido

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Men’s Health issues during puberty/adulthood

-Delayed sexual maturity (HYPOgonadism)
-Testicular cancer
-Alopecia

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Hypogonadism

-incomplete/delayed sexual maturity
-lack of testicular growth at 14
-functional (secondary) or organic/genetic

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most common cause of hypogonadism

-Constitutional delay of growth and puberty

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Hypogonadism treatment

-usually requires testosterone supplement
-IM testosterone esters 50mg monthly inc by 25 mg up to 100mg

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Testicular cancer prognosis

-pretty good even stage 3

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Testicular cancer treatment

-surgery (orchiectomy)
-radiation
-chemo

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Alopecia types

-androgenic (most common)
-areata
-universalis
-traction
-drug-induced

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Androgenic alopecia

-male pattern baldness
-usually by 40
-genes play factor

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Alopecia areata

-autoimmune
-patchy hair loss
-mAb treatment

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Alopecia universalis

-complete loss of all body hair

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Traction alopecia

-over time from tension

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Drug-induced alopecia

-anabolic steroids
-cancer chemo (reversible)

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Alopecia mech

-hairs transition from large, thick, pigmented to short, wispy, gray

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Alopecia treatment

-Finasteride (Propecia)
-Minoxidil (Rogaine)
-both
-hair transplant

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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

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Finasteride (Propecia) dose

-1mg PO qd
-continuous use needed to maintain efficacy

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Finasteride side effects

-decreased libido
-ED
-dec volume of ejaculate
-low incidence tho
-women of child bearing age should AVOID handling

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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