Sex hormones during life

Question 1

What is the first sign of puberty in females?

Answer 1

Thelarche- breast development

Question 2

What happens in thelarche?

Answer 2

1. Elevation of papilla only
2. Breasts bud with elevation of breasts and papilla and enlargement of areola
3. Further enlargement of breasts and papilla with no separation of their contours
4. Projection of areola and papilla to form a secondary mound
5. Mature breast, projection of papilla only as areola conforms to breast contour

Question 3

What is the first sign of puberty in males?

Answer 3

Genitalia- testicular volume in boys

Question 4

How does genitalia develop in boys?

Answer 4

1. Testes, penis and scrotum same size as early childhood
2. Early enlargement of testes 2-6cm^3, scrotal skin reddens and changes in texture
3. Penis lengthens, testes enlarge 6-12cm^3 , growth of scrotum
4. Further penile and scrotal growth, testes 12-15 cm^3
5. Genitalia adult in size and shape, testes >15cm^3

Question 5

What is the development of pubic hair called?

Answer 5

Pubarche

Question 6

What occurs in pubarche?

Answer 6

1. Vellus hair no different from abdominal hair
2. Slightly pigmented downy hair
3. Darker, courser, more curled hair
4. Adult pubic hair that does not reach thighs (Axillary hairs)
5. Adult hair now on thighs

Question 7

What are terms that end in ‘-arch’ and what do they mean?

Answer 7

Gonadarche- activation of gonads by HPG axis
Menarche- menstrual cycle activation
Spermarche- spermatogenesis 
Adrenarche- adrenal androgen production
Pubarche- pubic hair development
Thelarch- breast development

Question 8

What are secondary sexual characteristics in females?

Answer 8

Oestrodial:
Breast development
Hair growth 
Sweat gland composition- skin oiliness/ acne
Changes to external genitalia

Question 9

What are secondary sexual characteristics in males?

Answer 9

Testosterone:
Deepening of voice
Hair growth
Sweat gland composition
Changes to external genitalia

Question 10

What hormonal changes occur in females throughout puberty?

Answer 10

Increased FSH and LH

Question 11

What hormonal changes occur in males throughout puberty?

Answer 11

Increased testosterone

Question 12

Before what age is puberty early?

Answer 12

8 years

Question 13

After what year is puberty delayed?

Answer 13

14 years

Question 14

What do we call a lack of periods?

Answer 14

Primary amenorrhea: no period by 16 years
Secondary amenorrhea: periods start then stop for 3-6 months
Oligoamennorhea: few periods, irregular or infrequent cycles (4-9 cycles per yr)

Question 15

What are the stages of menstruation?

Answer 15

1. Follicular phase:
   - small rise in FSH
   - 2-3 follicles grow . Produce E2 (oestrodial) and inhibin B
   - these reduce FSH through neg. feedback
   - Restricts FSH window and non-dominant follicles undergo atresia
2. Ovulation:
   - A dominant ‘ Graafian’ follicle emerges
   - E2 continues to increase
   - Switch to high E2 (positive feedback)
3. Luteal phase
   - corpus Leuteum made which produces progesterone and oestrogen

Question 16

How does GnRH pulsitility change duding menstruation?

Answer 16

In the luteal phase you get slowing of pulses

Continuous non-pulsatile administration of GnRH leads to decreases FSH and LH secretion

Question 17

What is hypogonadism?

Answer 17

Decreased oestrogen in a woman/ degreased testosterone in a male

Question 18

What is primary hypogonadism?

Answer 18

Problem with testes or ovaries

Negative feedback is lost and rise of FSH and LH

Question 19

What are causes of primary hypogonadism?

Answer 19

Males: Infection of testes, trauma, cancer
Females: menopause

Question 20

What is secondary hypogonadism?

Answer 20

Problem with pituitary

low/ normal LH/FSH but low E2/testosterone

Question 21

What are causes of secondary hypogonadism?

Answer 21

Pituitary tumour

Question 22

What occurs in menopause?

Answer 22

Lack of negative feedback from oestrodial to hypothalamus and pituitary
Low E2, high FSH/LH, low inhibin

Question 23

What are symptoms of menopause?

Answer 23

Skin dryness
Thin hair
Hot flushes/ sweating
Sleep disturbances
Mood disturbances 
Osteoporosis 
Sexual dysfunction 
Weight gain
Amenorrhea
Climateric- irregular periods in the years approaching menopause

Question 24

What is treatment for menopause?

Answer 24

Oestrogen replacement- HRT (hormone replacement therapy)

Add progesterone

Question 25

What is an ovarian reserve marker?

Answer 25

Anti- mullein hormone (Sertoli cell)

Question 26

Are there andopauses in males?

Answer 26

After ~50 yrs testosterone decreases by about 1% each year

Late onset hypogonadism is menopause for men

Question 27

What is early menopause called?

Answer 27

Premature ovarian insufficiency
Conception can happen in 20%
Diagnosis is high FSH
Causes: autoimmune, cancer therapy

Question 28

What is testosterone bound to?

Answer 28

60% is SHGB bound testosterone
38% is albumin bound
2% is free testosterone- has effect in tissues

Question 29

When should testosterone be measured?

Answer 29

Testosterone has diurnal rhythm so should be measured before 11am

Question 30

What are symptoms of testosterone deficiency?

Answer 30

Sexual dysfunction- reduced libido, erectile dysfunction
Hair growth
Energy levels- fatigue
Mood disturbance
Body composition- increased fat/ reduced muscle mass
Spermatogenesis - high levels of intratesticular testosterone needed
Bone health

Question 31

What can testosterone be converted to?

Answer 31

Can be converted to oestrogen by age, obesity, insulin, gonadotrophin, alcohol with aramotase

Can be converted to di-hydro-testosterrone by 5 alpha reductase