Week 3: Men as Patients

Question 1

What is primary hypogonadism?

Answer 1

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

Question 2

What is secondary hypogonadism?

Answer 2

Hypothalamic pituitary failure - something is wrong with the pituitary gland

• low testosterone and low or normal gonadotropins (FSH/LH)
• referred to an endrocrinologist

Question 3

Signs and symptoms of hypogonadism

Answer 3

• 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

Question 4

Risks of testosterone replacement therapy (TRT)

Answer 4

• polycythemia
• prostate cancer
• testicular atrophy- infertility
• gynecomastia
• exacerbation of sleep apnea
• liver toxicity/tumor

Question 5

Effects of TRT

Answer 5

• 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

Question 6

Goal of TRT

Answer 6

achieve optimal functioning by reaching mid-normal testosterone levels one week after administration

Question 7

How do you monitor TRT

Answer 7

• testosterone level at 3 to 6 months from start of therapy
• evaluate Hgb/Hct at 3 and 6 months then yearly
• evaluate serum cholesterol
• evaluate PSA before starting therapy and then at 3 and 6 months

Question 8

Pharmacodynamics of Phosphodiesterase type 5 Inhibitors

Answer 8

blocks/inhibits the catabolism/breakdown of cyclic GMP which results in an increased number and duration of erections

Question 9

Important pharmacokinetic properties of sildenafil and vardenafil

Answer 9

• 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

Question 10

Pharmacokinetic properties of tadalafil (Cialis)

Answer 10

• take dose before sexual activity - lasts up to 36 hours
• not affected by food or alcohol
• can also be used to treat BPH

Question 11

Important considerations with the use of phosphodiesterase type 5 inhibitors

Answer 11

• 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