R13 - Hormone Therapies

Question 1

Advanced prostate cancer goal

Answer 1

Shutdown HPG axis by increasing the negative feedback or blocking GnRH

Question 2

GnRH agonists and antagonists AE

Answer 2

– Low libido
– Infertility

– Females
* Hot flashes
* Vaginal dryness
* Amenorrhea

– Men
* Low T

Question 3

Puberty Blockers: GnRH agonist

Answer 3

Leuprolide IM or Histrelin implants

-Prevent breast tissue, menstruation, voice deepening, hair growth, Adams apple

Concern regarding bone mass

-Used for precocious puberty tx

Question 4

Low Testosterone Sx

Answer 4

• Sexual Symptoms
  – Low sexual desire/libido
  – Erectile Dysfunction (ED)
  – Weaker/fewer erections
  – Reduced sexual activity
• Nonsexual Symptoms
  – Low energy or fatigue
  – Bad mood or poor concentration
  – Reduced muscle mass / strength
  – Increased body fat
• Low levels of testosterone measured

Question 5

Hypogonad: Primary = Testicular failure

Answer 5

FSH/LH: HIGH

PRL: NORMAL

TEST: LOW

Question 6

Hypogonad: Secondary = CNS failure

Answer 6

FSH/LH: LOW

PRL: HIGH/NI

TEST: LOW

Question 7

Hypogonad: Androgen Receptor defects

Answer 7

FSH/LH: NORMAL

PRL: NORMAL

TEST: NORMAL

Question 8

Testosterone Replacement Therapy

Answer 8

• NO ORAL FORM!!
• Topical (daily)
• Injection 200 mg/wk
• Testopel insertion 10‐12 pellets q3‐4mo
• Titrate based on symptoms and side effects

Question 9

Testosterone causes _____

Answer 9

azoospermia

Question 10

Exogenous T systemically causes negative feedback
– LH and FSH are ____
– Intratesticular testosterone is ____
– Azoospermia

Can reverse with high dose ____

Answer 10

-reduced
-reduced
-HCG (LH analog)

Question 11

For ongoing increase in T levels that preserve fertility

Answer 11

– Clomiphine citrate
– Aromatase inhibitor