Module 1- Disease State

Question 1

Jatenzo is indicated for?

Answer 1

Testosterone replacement therapy in adult males for conditions associated with a deficiency, or absense of endogenous testosterone.

Question 2

What is testosterone?

Answer 2

An androgen that is the primary sex hormone in men. Plays a key role in normal male development.

Question 3

The normal range for early morning total testosterone in healthy adult males is about what?

Answer 3

> 300 ng/dL

Question 4

At what time of day are testosterone levels usually highest?

Answer 4

Early morning

Question 5

LH stimulates the Leydig cells within the testes, which then produce testosterone. FSH stimulates the Sertoli cells, which are essential for spermatogenesis. All of these signals are controlled by what?

Answer 5

The HPG axis and negative feedback loop.

Question 6

Testeosterone follows a circadian pattern. What does this mean?

Answer 6

It tends to peak in the morning (between 8-10am) before falling rapidly (within 5 hours), then climbing again to the peak (approximately 19 hours later.)

Question 7

What 2 things are required to diagnose male hypogonadism?

Answer 7

2 early morning serum testosterone readings (separate tests) combined with signs and symptoms.

Question 8

What type of HG can spermatogenesis be restored?

Answer 8

Secondary HG

Question 9

What is primary HG? What are some causes of it?

Answer 9

Abnormalities that originate in the testes. Primary HG causes low T concentrations, impairment of spermatogenesis & elevate gonadotropin levels.

Causes are:
Klinefelter syndrome
Cryptorchidism
Cancer chemotherapy, or radiation to the testes.
Trauma to the testes.
Bilateral torsion
Infectious orchitis
HIV infection
Anorchia syndrome (vanishing testes)
Orchiectomy
Toxic damage from alcohol, or heavy metals

Question 10

What is secondary HG? What are some causes of it?

Answer 10

Abnormalities that originate in the hypothalamus, or pituitary gland. Results in low T concentrations and impairment of spermatogenesis. However, results in low GnRH levels.

Causes are:
Hypothalamic, or pituitary tumors
Kallman syndrome
Head trauma
Infiltrative destructive disease of the hypothalamus, or pituitary
Pituitary surgery, or radiation

Question 11

What is the difference between structural and genetic HG?

Answer 11

Structural HG is a dysfunction in the testes, hypothalamus, or pituitary gland.

Genetic is congential, or inherited.

Question 12

What are some specific and non-specific signs of HG?

Answer 12

Incomplete, or delayed sexual development. Loss of body hair, smaller than average testes.

Non-specific-
decreased energy, motivation, initiative, or self-confidence.
feeling sad, blue, depressed mood, or persistent low-grade depressive disorder
poor concentration and memory
sleep disturbance
mild, unexplained anemia
increased body fat and BMI

Question 13

In what forms are TRT offered?

Answer 13

Transdermal Gel
Oral Capsules
SQ Injection
Nasal Gel
Implantable pellets

NON FDA APPROVED!
Compounded creams and gels

Question 14

What is the normal range of T levels in healthy men?

Answer 14

300-1000 ng/dL

Question 15

Describe the HPG axis in a healthy man?

Answer 15

Hypothalamus—>pituitary gland———>Testes

Question 16

How is testosterone produced?

Answer 16

LH stimulates the Leydig cells in the testes.

Question 17

When are T levels highest in a man?

Answer 17

Early morning.

Question 18

A clinical diagnosis of testosterone defiency requires?

Answer 18

A level of testosterone that’s < 300 ng/dL (2x, seaparate morning labs)
Signs & Symptoms

Question 19

Secondary HG involves?

Answer 19

The hypthalamus and pituitary gland

Question 20

What are the symptoms of HG?

Answer 20

smaller testes, loss of body hair, increased body fat and BMI.

Question 21

TRT is not recommended in?

Answer 21

Men with breast cancer
Men with prostate cancer
Men with age related HG
Women who are pregnant

Question 22

TRT Monitoring should include?

Answer 22

Compliance check, Testosterone levels, PSA, blood pressure check.

Question 23

HG caused by congenital, structural, or destructive disorders resulting in dysfunction of the tests is called?

Answer 23

Primary HG

Question 24

HG resulting from abnormalities affecting the hypothalamus, or pituitary gland is considered what type?

Answer 24

Secondary HG

Question 25

HG can be caused by conditions that are…..

Answer 25

Congenital, structurtal, or neither

Question 26

What total T level does the AUA recommend clinicians use as a reasonable cutoff to support diagnosis of low T?

Answer 26

> 300ng/dL

Question 27

What are some specific signs of low T?

Answer 27

Incomplete, or delayed sexual development, loss of body hair and smaller than average testes.

Question 28

Name risk factors, or etiology of primary HG for on label use of TRT?

Answer 28

Raditation to the testes

Question 29

What is bound T?

Answer 29

Accounts for 98% of testosterone. Bound to protein carriers, or Albumin to facilitate its transport throughout the body.

Question 30

What is free T?

Answer 30

Accounts for 2% of testosterone. What connects to testosterone receptors in the body. Responsible for creation of secondary sexual characteristics in men (facial hair, deeper voice.)