Testosterone Replacement therapy exam questions with 100% correct answers(graded A+)

When would you use testosterone replacement therapy? hypogonadism andropause What is hypogonadism? redution in testosterone production congential or acquired What is andropause? clinical ageing syndrome symptom complex in presence of low levels of testosterone WHat are some signs and symptoms of andropause? loss of libido erectile dysfuntion lethargy decreased cognition restlessness depression loss of strength Which age group has the highest prevalence of hypogonadism? 80+ What is the prevalence of hypogonadism? 4-5 million men What are some causes of hypogonadism? primary testicular failure hypogonadotrophic hypogonadism trauma idiopathic obesity severe systemic illness e.g. HIV medications hormone changes normal ageing Comparing normal males to ageing males. What is the differnece in the bioavailability of testosterone? normal - 70% ageing - 25% WHat are the primary (testicular) effects of low testosterone with ageing? low leydig cell decreased functionality and secretary capacity of remaining cells decreased testosterone secretion What are the 2nd (central) effects of low testosterone with ageing? decreased hypothalamic secretions of GnRH LH release changes altered signally to testes How would you measure testosterone? plasma free testosterone plasma total testosterone What is plasma total testosterone? what time of day is best to take it? measures free and protein bound morning What is plasma free testosterone? WHat group of patients is this recomended in? measure non- protein bound testosterone fractions older patients What other tests may you perform and why? LH and FSH (to see if its primary or secondary) serum prolactin (high prolactin = pituitary tumour) Long term conequences of andropause? increased risk of fractures Some contraindications to testosterone replacement therapy in men? known/suspected prostate cancer male breast cancer elevated hemocrit sensitivity to ingredients What types of androgen preparations can you have? oral parenteral transdermal patch transdermal gel Name a oral androgen preparation methyltestosterone fluoxymesterone testosterone undercanoate Issues with oral angrogens? high first pass inactivation multiple daily dosing risk of hepatoxicity