Tetsosterone Deficiency

Question 1

Define testsosterone deficiency

Answer 1

Testosterone deficiency is a clinical AND biochemical syndrome characterized by a deficiency of testosterone or testosterone action, and relevant symptoms and signs

Question 2

Impact of Testosterone Deficiency

Answer 2

May affect the function of multiple organ systems and result in a significant detriment in the quality of life

Question 3

Testosterone Deficiency Types

Answer 3

Primary – related to the testicles (age, trauma, Kleinfelter)

Secondary – can be hypothalamic, pituitary, or idiopathic

Question 4

pHsyiology of Tetsosterone Deficiency

Answer 4

Decreased testosterone production, secretion and peripheral conversion as men age.

T levels decrease by about 1% each year after age 50.

Decreased LH surge
Increase in SHBG which decreases the bioavailable T

Bioavailable T is a better marker to measure than total T

T receptor responsiveness is altered

Question 5

Bioavilable T and lAb Testing

Answer 5

2% unbound, 60% strongly bound to SHBG, 38% weakly bound to albumin
40% is bioavailable (unbound + albumin bound)
Do not test during acute illness as there is a transient decrease
Must take sample between 7:00 and 11:00am (or 3-4 hours after waking in shift workers)

Question 6

Sx of Tetsosterone Dericiency

Answer 6

Fatigue and decreased general wellbeing
Decreased libido and erection quality
Mood changes, depression, irritability
Decreased lean body mass, muscle volume and strength
Decreased bone mineral density
Decreased height
Decreased hematopoiesis
Increased visceral fat

Question 7

Phsycial Exam Findings testosterone deficiency

Answer 7

Decreased body hair below the jaw
Testicles might be smaller than normal
Low muscle volume and more central obesity
Do a prostate exam to ensure it is normal before starting treatment

Question 8

Testosterone Deficinecy often ovrlaps with

Answer 8

Depression

Question 9

Tetsosterone Deficiency Risk FACtors

Answer 9

Opioids!!
Chronic illness (diabetes, COPD, inflammatory diseases like arthritis, renal, HIV)
Obesity
Metabolic syndrome
Hemochromatosis
Maybe concussion histor

Question 10

Non-Rx TX testosterone Deficiency

Answer 10

Weight reduction
Lifestyle modification (smoking, alcohol, marijuana)
Stop opioids
Treat sleep apnea

Question 11

testosterone FOmrulations. Key differences?

Answer 11

Oral – poor bioavailability, must take with high fat meal

Injectable – every 1-2 weeks, yo-yo effect
Patch – not very available, irritation an issue
Gel – inconvenient, testim has a musky smell, but still like it
Intra-nasal – several times a day dosing

Question 12

Contraindictaions and Relative CI of Testosterone TX

Answer 12

ontraindications – hypersensitivity to T, breast cancer, suspected prostate cancer, planning fatherhood (can cause infertility), recent stroke or coronary event, unstable CAD
Relative contraindications – CHF, BPH, severe sleep apnea

Question 13

Testeroene THerapy Monitoring

Answer 13

Erythropoiesis (hemoglobin and hematocrit)
Prostate
Social behaviour and emotional state (can make men aggressive)
Liver
Lipids
Sleep disorders