Sexuality and Sex Hormones

Question 1

Biological sex

Answer 1

Set of biological attributes

Question 2

Gender identify/expression

Answer 2

Internal sense of gender

Societal roles, behaviours, expression

Question 3

Sexual orientation

Answer 3

Sexual, romantic, physical attraction to others

Question 4

3 main sex hormones

Answer 4

Testosterone
Di-hydrotestosterone
Estrogens

Question 5

Klinefelter syndrome

Answer 5

47 XXY (phenotypic male)
Most common cause of low testosterone
May not be diagnosed until infertility work up
Semen analysis: azoospermia (lack of sperm)
This is primary hypogonadism

Question 6

Signs and symptoms of low testosterone

Answer 6

Mild: decreased libido* (first thing to go), decreased vitality, fatigue, modd changes, insomnia
Moderate: anemia, delayed ejaculation, flushes, erectile dysfunction, decreased muscle mass, increased visceral body fat
Severe: testicular atrophy, weakness, osteopenia/porosis, loss of facial, axially and pubic hair

Question 7

In men low testosterone generally leads to what 4 things

Answer 7

Loss of sexual desire
Loss of sleep associated erections
Delay in ejaculation and low volume ejaculate
Variable loss of sexual erections

Question 8

What are some things that can cause secondary hypogonadism?

Answer 8

Brain tumour
Hemochromatosis
Opioids, corticosteroids, alcohol
HIV

Question 9

In
1. Primary
2. Secondary
hypogonadism is LH/FSH going to be low or high

Answer 9

1. High

2. Low or inappropriately normal

Question 10

Benefits of replacing testosterone in younger men

Answer 10

Restores sexual function, bone density, and muscle power
Decreased upper abdominal obesity/insulin resistance
Improves metabolic parameters when type 2 DM or metabolic syndrome is comorbid
May decrease CV risks from low testosterone

Question 11

Should testosterone be replaced in older men

Answer 11

Not sure - the evidence is missing
Possible CV harm
Benefit to anemia and bone density
Some increase in sexual desire, sexual frequency and mood
No effect on cognition or energy

Question 12

Contraindications to testosterone replacement (6)

Answer 12

PSA > 4 nM
Abnormal prostate on DRE
HCT > 50%
Untreated obstructive sleep apnea
Severe cardiac failure
Breast or prostate cancer

Question 13

Risks of pharmacological doses of testosterone

Answer 13

CV: SCD, thrombogenesis
Liver cancer
Psych: mood swings, aggression, paranoia, anxiety, roid rage
Infertility, small testes, gynecomastia, acne

Question 14

3 times we intentionally suppress T

Answer 14

Androgen deprivation therapy for prostate cancer
Treatment of severe paraphilias
Trans male to female hormone therapy

Question 15

2 ways to suppress T

Answer 15

LH releasing hormone agonists and antagonists

Anti-androgens/androgen blockers

Question 16

Expected changes for hormone replacement therapy when transitioning from male to female

Answer 16

Breast development and body fat redistribution
Decreased muscle mass, body and facial hair
Decreased sexual desire and ED
Decreased fertility
Decreased testicular size
Emotional changes

Question 17

Intersex

Answer 17

Born with sexual anatomy that doesn’t fit the typical definitions of female or male
Born with female external genitalia, but having mostly male-typical internal genitalia
Born with genitals that seem to be in-between the usual

Question 18

Complete androgen insensitivity

Answer 18

X-linked recessive
Y chromosome means you make testosterone, but cannot respond to it
Androgen receptor gene mutations
Female typical external genitalia
Absent vagina or short vagina with blind end
Testes in abdomen, inguinal canals, or labia majora
Normal female breast development
Absent pubic hair
No spermatogenesis
Testosterone levels normal or increased (in XY reference range)

Question 19

Partial androgen insensitivity

Answer 19

Less common than CAIS
Spectrum extends from phenotypic women (with breasts) and partial virilization of external genitalia with clitoromegal to phenotypic males with variable defects in genital virilization and may also have other signs

Question 20

What hormone is responsible for masculinization

1. In utero
2. At puberty

Answer 20

1. DHT

2. Testosterone

Question 21

5-alpha reductase deficiency

Answer 21

Born with ambiguous genitalia (large clit, separate scrotum, apparent vaginal opening)
Externally appear female
Internal sex organs are male
At puberty the increased testosterone causes masculinization (voice, penile growth, male body type)

Question 22

Polycystic Ovarian Syndrome

Answer 22

High LH and testosterone
Most common endocrine disorder in premenopausal women
Can have hirsutism/acne/obesity

Question 23

Congenital adrenal hyperplasia

Answer 23

High T in utero acting on brain and body
Effects of excessive androgen action in XX fetus
Autosomal recessive
Varying degrees of masculinization of genitalia in female fetuses, no visual abnormalities in male fetuses
Potentially fatal if cortisol and aldosterone severely reduced

Question 24

Should you test for low testosterone in women?

Answer 24

No!

Questionable relevance of blood level

Question 25

Does an androgen deficiency disease lead to low sexual desire in women?

Answer 25

No
No correlation between levels of sexual dysfunction and levels of testosterone/metabolites of testosterone in females
So no need to prescribe testosterone in women

Question 26

Expected changes with hormone replacement therapy in female to male transition

Answer 26

Menses stop, pregnancy potential remains
Irreversibly enlarged clitoris
Facial hair increases, thicker/coarser body hair
Male pattern baldness
Increased skin oiliness, acne
Increased muscle mass, strength
Body fat redistribution
Voice deepens
Vaginal dryness
Possible irritability, anger
Possible increased sexual desire

Question 27

Changes in vulvar and vaginal tissue as estrogen decreases

Answer 27

Decreased blood vessels (pallor, decreased lubrication)
Dryness and discomfort at rest and with sex
Decreased elasticity
Decreased genital sensitivity (may prevent orgasm)
Menopause may precipitate another pain syndrome causing dyspareunia

Question 28

Provoked vestibulodynia

Answer 28

Pain at the vaginal opening
Common in premenopausal women
Can also occur at menopause (or other times of hormonal shifts)