mens health Flashcards
Major Male Health Issues
Associated with Advancing Age
Coronary Heart Disease LUTS - lower urinary tract symptoms BPH Prostate Cancer Testicular Cancer Erectile Dysfunction Hypogonadism “Andropause”
prostate cancer is most common in what race
blakc
PSA screening
screening for prostate cancer currently very controversial leading to too many false positives*** - subsequent tests and biopsies begin screening at age 40 f/u every 2-4 years based on risk f/u every year in high risk groups value of screening in over 75 yo ??? More specific testing???
serum testosterone pattern
kick starts puberty then decreases with age
200 - 900 - 200
peaks at around 22
role of testosterone
Bone and muscle growth Hair growth Sexual organ maturation Spermatogenesis Increased libido
hypogonadism
Hormonal deficiency (“Andropause”) Risk Factors: Aging, Chronic Illness (Diabetes, AIDS, Rheumatoid arthritis, CKD), Long-term use of corticosteroids, Obesity testosterone deficiency symptoms: decreased libido, weight gain, loss of energy, may play some role in ED diagnosis: low testosterone WITH specific signs and symptoms, must have both for diagnosis, initial test done in the AM to measure total testosterone and confirm with second test
total testosterone level under ___ is positive for low testosterone
300 ng/dL
confirmation of low testosterone
A total testosterone test or free testosterone test should be repeated to confirm diagnosis.
Because testosterone is bound to Sex Hormone Binding Globulin (SHBG), a free testosterone test should be performed in patients that are suspected of having altered SHBG concentrations.
Free testosterone level under 5 ng/dl confirms low
testosterone
conditions that could decrease SHBG
Moderate obesity
Nephrotic syndrome
Hypothyroidism
Use of glucocorticoids, progestins, and androgenic steroids
conditions that could increase SHBG
Aging Hepatic cirrhosis Hyperthyroidism Use of anticonvulsants Use of estrogens HIV infection
many formulations of testosterone replacement products
Patches Gels Solutions IM depo Buccal SQ Pellets
testosterone injection
Testosterone enanthate or cypionate, 75-100 mg IM weekly or 200 mg every two weeks
Supraphysiologic conc during part of dosing interval – possible mood swings
testosterone patch
One to two 5 mg patches applied nightly* over the skin of the back, thigh, or upper arm, away from pressure areas.
**Most similar to physiologic testosterone levels.
Avoid prolong exposure to H2O for 3 hrs after application.
testosterone gel
5–10 g of a 1% testosterone gel applied daily over a covered area of non-genital skin.
- Shoulders, upper arms, abdomen
- Patients should wash hands after application
testosterone solution
30mg – 120mg (1 to 4 applications) applied to the arm pits once daily.
- Wash hands after use.
- Apply deodorant prior to application.
testosterone buccal tablet
30 mg of a bioadhesive buccal testosterone tablet applied to buccal mucosa every 12 hours.
-Do not chew or swallow
testosterone SQ pellets
Pellets implanted SQ at intervals of 3 to 6 months
- Dose and regimen vary with the formulation used.
- Onset delayed 3-4 months with first dose
testosterone contraindications
Prostate cancer
Breast cancer
Hematocrit > 50%
Baseline PSA greater than 4 ng/ml, or PSA >
3 ng/ml in men at high risk of prostate cancer
Recent or poorly controlled CVD
testosterone black box warning
Black Box Warning for Gel formulation: Concerns with secondary exposure to children.
There is some controversy regarding the cardiac risk associated with testosterone supplementation - Injection more than patches and gels
On 9/18/14, the FDA Advisory Panel voted to impose strict new limitations on the multibillion-dollar testosterone drug industry.
testosterone monitoring
Patients should be monitored 3 to 6 months after initiating therapy.
- Testosterone levels should be measured with a goal between 400 and 700 ng/dL
- Hematocrit should be measured: if over 54%, therapy should be stopped and reinitiated when it drops to a safe level.
androgen misuse and abuse
Androgen therapy has been misused by athletes to increase physical capabilities. Potential side effects of supraphysiologic doses: -Gynecomastia -Weight gain -Acne -Decreased testicular size -Mood alteration -Hepatotoxicity
BPH pathophysiology
normal size gland (under 20 g)
surrounds the proximal urethra
growth is common after age 40
contains several types of tissue: Embedded with alpha-1a adrenergic receptors, Stimulation by NE results in smooth muscle contraction with subsequent narrowing of urethra
Type-II 5-alpha reductase in the prostate gland: Converts testosterone to dihydro-testosterone [DHT], High concentrations also found in scalp
Dihydro-testosterone [DHT]: responsible for prostate enlargement and growth, some men appear to be genetically predisposed to producing large quantities
BOO
bladder outlet obstruction Decreased force of stream Hesitancy to initiate voiding Strain or push to urinate Terminal dribbling Intermittency
irritative symptoms
Secondary to incomplete bladder emptying Nocturia Frequency Urgency Dysuria Urge incontinence QOL
diagnosis of BPH made by
clinical symptoms
digital exam
measuring flow rate
measuring residual volume: Bladder scan, over 25-30ml
AUA Symptom Score (mild 1-7; moderate 8-19; severe 20-35) - treatment depends on severity
