Week 3: Men as Patients Flashcards
What is primary hypogonadism?
Testicular failure
- low testosterone and elevated gonadotropins (FSH/LH)
- negative feedback mechanism - pituitary releases more FSH and LH in order to signal the testicles to produce more testosterone
- treated in primary care
What is secondary hypogonadism?
Hypothalamic pituitary failure - something is wrong with the pituitary gland
- low testosterone and low or normal gonadotropins (FSH/LH)
- referred to an endrocrinologist
Signs and symptoms of hypogonadism
- depression - decreased mood, energy, quality of life
- ED/decreased sexual desire
- loss of body/facial hair
- decreased muscle mass
- decreased cognitive function
- decreased Hgb/Hct
- decreased bone mineral density/osteoporosis
Risks of testosterone replacement therapy (TRT)
- polycythemia
- prostate cancer
- testicular atrophy- infertility
- gynecomastia
- exacerbation of sleep apnea
- liver toxicity/tumor
Effects of TRT
- Increased energy, mood, quality of life
- Increased muscle mass
- Increased cognitive functioning
- Increased Hgb/Hct
- Increased sexual function/libido
- Increased bone density
- Improves insulin sensitivity
Goal of TRT
- Half live is 1 week or every 2 weeks
- Inject long intervals
Goal: bring lab values in middle/normal range
How do you monitor TRT?
- in morning when testosterone levels the highest
- testosterone level at 3 to 6 months from start of therapy, then every 6 months
- evaluate Hgb/Hct at 3 and 6 months then yearly
- evaluate serum cholesterol
- evaluate PSA before starting therapy (baseline) and then at 3 and 6 months
Pharmacodynamics of Phosphodiesterase type 5 Inhibitors
blocks/inhibits the catabolism/breakdown of cyclic GMP which results in an increased number and duration of erections
Important pharmacokinetic properties of sildenafil and vardenafil
- take on an empty stomach - do not take with fatty foods
- take 1-4 hours prior to sexual activity
- reduce dose in renal and hepatic impairment
Pharmacokinetic properties of tadalafil (Cialis)
- take dose before sexual activity - lasts up to 36 hours
- not affected by food or alcohol
- can also be used to treat BPH
Important considerations with the use of phosphodiesterase type 5 inhibitors
- will always cause some degree of lower blood pressure
- may cause additive hypotension when combined with antihypertensives or alpha-1 blockers
- contraindicated in patients taking nitrates (Nitrostat, Imdur, etc.)- can cause fatal hypotension
- do not give to pts w/ MI, stroke, arrhythmia in the past 6 months
Is there an association b/t TRT and cardiac events? Why?
No.
- If keep levels of testosterone normal, risk of cardiac events nonexistent
