Testosterone Deficiency Replacement Flashcards
Testosterone deficiency is defined as…
AKA Andropause
Clinical AND biochemical syndrome, characterized by deficiency of testosterone/testosterone action + relevant signs and symptoms
Primary testosterone deficiency is associated with…
Age
Trauma
Decrease in T production, secretion, and peripheral conversion in older age - T receptor responsiveness may also be altered
SHBG increases which binds to T
Secondary testosterone deficiency is related to…
HPA-axis issues
Potentially idiopathic
Physical and psychological symptoms of T deficiency may include…
Fatigue, decreased general well-being
Decreased libido, erection quality
Mood changes - depressive
Decreased body mass, muscle volume, strength
Decreased BMD - height
Decreased hematopoiesis = anemia presentation
Increase in visceral fat
**Often an overlap and co-existence of T deficiency and depression **
A physical exam is often done to investigate…
Possible endocrine disturbances
Testicular + prostate exam - size
Hair distribution
Evaluation of musculature, central obesity, posture
Liver/renal failure
Risk factors for T deficiency include…
Opioids
Chronic disease (renal, diabetes, COPD, inflammation, HIV)
Obesity, metabolic syndrome
Hemochromatosis
Possible concussion
Diagnosis of T deficiency needs to include BOTH…
Clinical picture AND lab findings
Sx’s are often vague and non-specific
This lab value is preferred for T:
What time of day is best?
Free, or bioavailable testosterone - 3-4 hours after waking
DO NOT test during acute illness
Other lab tests to consider (to help rule out T deficiency) include…
Hormones: LH, FSH, TSH, Prolactin
A1C
Lipids
LFT’s
CBC’s (hematocrit - T stimulates erythropoietin)
PSA (prostate)
Non-pharm tx options that can help with T deficiency include…
Lifestyle modification - weight reduction, smoking, alcohol usage
Stopping any chronic opioid usage
Treating sleep apnea
CI’s to starting testosterone replacement therapy include…
Definite CI’s:
Known hypersensitivity
Breast cancer/suspected prostate cancer
Planning fatherhood
Recent stroke, ACS, unstable CAD,
Relative CI’s:
HF
BPH
Severe sleep apnea
Testosterone oral formulation is not commonly used because…
Effectiveness is low - very little T makes it into bloodstream.
Would require fatty meal for absorption since it is absorbed through lymphatic system.
Injectable T includes the following products, and their dosing is…
T-cyprionate Q1-2 weeks IM
T-enanthate Q2-3 weeks IM
A downside with taking longer intervals between injectable T is that…
Deficiency symptoms may start to manifest a few days before their next injection - a sign to increase frequency
The best transdermal product for T is…
Gel
The patch efficacy is not great
Testosterone gel should be used…
Once daily - area with less body hair. No contact 2 hrs after application
Intranasal T does exist, however it is not used often because…
BID - QID dosing requirement
Monitoring T includes…
Assessing response to clinical measures (symptom improvement)
6 primary areas:
1. Erythropoiesis (CBC)
2. Prostate
3. Social, behavioural, emotional state
4. Liver, LFT’s
5. Lipids
6. Sleep
Follow up 3, 6 months, then yearly
Usage of testosterone in females is…
Off-label - ideally ~10% of male dose if using
