Module 3.3 (Androgen Deficiency)

Question 1

Androgens are important for normal?

Answer 1

Bone, muscle and fat metabolism

Erythropoiesis

Libido

Mood, cognitive health

Deficiency = decreased testosterone levels

Question 2

What are some conditions that cause high LH, high FSH, and low testosterone (testes - primary or hypergonadotrophic hypogonadism)

> primary hypergonadism = dsysfunction of actual testicles, testicles aren’t producing testosterone

Answer 2

• Klinefelter syndrome
• Cryptorchidism (undescended testes)
• Orchidectomy, orchitis (mumps after puberty), cytotoxic or radiation damage, traumam, testicular torsion

Question 3

What are some conditions caused by low LH, low FSH and low testosterone (hypothalamus and pituitary gland - secondary or hypogonadotrophic hypogonadism)?

> secondary hypogonadism

= FSH and LH normally should increase testosterone by stimulating testicles

Answer 3

• hypothalamic lesions, pituitary tumours
• haemocrhomatosis
• idiopathic

Question 4

How does age cause androgen deficiency (testosterone)?

Answer 4

• levels drop by 1/3 from 30-80 years of age, decreases by 0.5-2% per year
• reduce testicular ability to produce testosterone = late onset hypogonadism (LOH)

> accelerated by comorbidities especially obesity

Question 5

What are some other causes of testosterone deficiency (androgen deficiency)

Answer 5

• systemic disease (T2DM, obesity, depression)
• prescribed medication

> androgen deprivation therapy (leuprorelin, goserelin, triptorelin)

> opioid

> glucocorticoids (beclamethasone, budesonide, hydrocortisone, prednisolone)

> dopamine antagonists

> anabolic steroids

• recreational drugs such as marijuana, amphetamines, opoids, alcohol XS

Question 6

Signs and symptoms of androgen deficiency (testosterone)?

Answer 6

• reduced libido, decreased spontaneous erections
• hot flushes or sweats
• reduce facial hair or growth
• loss of axillary and pubic heair
• breast discomfort or gynaecoamstia
• small testes
• osteoporosis
• less specific = see attached image

Question 7

Diagnosis of androgen deficiency (testosterone)?

Answer 7

Consistent S and S

Fasting morning total testosterone level, sex hormone binding globulin (SHBG) and LH (+/- FSH)

Question 8

Management of androgen deficiency (testosterone)?

Answer 8

Consider underlying causes = lose weight, exclude any pituitary gland/hypothalamus issues.

Question 9

What are the types of TRT?

Answer 9

Oral, IM injection, cream, gel, patch

> gel,cream or shorter acting IM injections start treatemnt

> maintanence usually with gel, cream or long acting IM injection

• may initiate lower doses (1/2 dose) in older men

Question 10

When is TRT CI?

Answer 10

Cant use when fertility is desired, testosterone (exogenous) suppresses LH concentration and suppresses concentrations of intra-testicular testosterone which is essential for spermatogenesis.

Question 11

AE of TRT?

Answer 11

Question 12

How to monitor for TRT?

Answer 12

Question 13

What is androgenic alopecia? Treatment considerations?

Answer 13

Question 14

Options for androgenic alopecia?

Answer 14

No treatment

Hair piece (wig or hair extensions)

Question 15

Drug treatment 1 for androgenic alopecia

Answer 15

Topical minoxidil 2-5%

Question 16

Drug treatment 2 for androgenic alopecia?

Answer 16

Question 17

Monitoring for androgenic alopecia?

Answer 17

Question 18

Osteoporosis in men? What is it associated with?

Answer 18

Associated with androgen deprivation therapy and corticosteroids

Question 19

Drugs for postmenopausal women and men aged above 50 years for osteoporosis

Answer 19