Testosterone replacement therapy Flashcards
Who should get testosterone replacement therapy?
men with clinical androgen deficiency (low libido, ED, loss of body hair gynecomastia, decreased bone density and testicular atrophy) and two unequivocally low morning serum tosterone.
Range for testosterone
<200-300
testosterone levels show significant variablility so if initial test is low needs to be repeated as AM
Why measure free testosterone levels?
Variations in sex hormone binding globulin may be decreased in certain conditions (obesity and DM) can lead to misleading total testosterone results.
Absolute contraindications to testosterone replacement therapy?
breast or prostate cancer, polycythemia, sever lower urinary tract symptoms (AUA>19) unstable heart failure, PSA>4, untreated OSA.
AUA urinary tract symptoms
based on a scale created by American Urological Association to rate BPH symptoms
Potential complication of testosterone replacement therapy in untreated OSA pts or elevated hematocrit
can increase risk for VTE.
FSH and LH are helpful with low testosterone levels because:
Distinguish between primary and secondary causes
primary (high LH and FSH)
secondary (low or normal FSH and LH)
Features suggestive of testosterone deficiency
incomplete sexual development, decreased libido, potency, decreased early morning erections gynecomastia decreased 2ndary sex characteristics (less shaving), small testicles (normal acult are 4-7 cm, volume 20-25 ml), hot flashes, low sperm count, osteoporosis.
testosterone values pattern
follows a circadian rhythm and highest in early AM and lowest around 8 pm.
Serum testosterone levels decrease with age.
When do we get an MRI of brain?
if there’s suspicion of secondary hypogonadism (look for pituitary dysfunction)
pt will have vision changes or low FH or LH.
normal size of testicles
4-7 cm in length and volume of 20-25 ml
What processes cause sex hormone binding protein to be abnormal?
obesity and male senescence
