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443-SRH and MSK > Hypogonadism > Flashcards

Hypogonadism Flashcards

1
Q

T functions (4)

A

Fetal masculinization (ex- becomes male)
Pubertal changes (boy to men)
Sexual function (have sex)
Sperm production (reproduce)

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2
Q

what happens with testosterone with age?

A

↓ testicular production (testes less responsive)
↑ in sensitivity of the hypothalamus
Peripheral conversion to estrogen
SHBG ↑

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3
Q

a condition resulting from or characterized by abnormally↓ functional activity of the gonads, with retardation of growth and sexual function

A

hypogonadism

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4
Q

disorders of the pituitary or hypothalamus resulting in inadequate gonadotropin stimulation of the testes

A

secondary hypogonadism

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5
Q

primary disorder of testicular function

A

primary hypogonadism

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6
Q

a clinical and biochemical syndrome associated with advancing age and characterized by typical symptoms and deficiency in serum testosterone levels- first used in guidelines in 2022

A

(Symptomatic) late onset hypogonadism (S)LOH

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7
Q

what is the correct medical terminology for hypogonadism

A

(Symptomatic) late onset hypogonadism (S)LOH

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8
Q

what does (P)DAAM stand for

A

(partial) androgen decline in the aging male

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9
Q

the term previously used to describe LOH

A

andropause

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10
Q

a clinical and biochemical syndrome characterized by a deficiency of testosterone, or testosterone action, and relevant s/s

A

testosterone deficiency

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11
Q

3 specific sx of hypogonadism

A

↓ libido
ED
↓ freq of morning erections

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12
Q

signs of hypogonadism

A

↓ body/ facial hair
Central obesity
↓ testicular volume
↓ muscle mass, ↑ body fat
Gynecomastia
Osteoporosis

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13
Q

higher BMI = _____ testosterone

A

lower

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14
Q

are screening tools for hypogonadism recommended? why or why not

A

not recommended -mostly been made by the pharmaceutical industry (bias)
poor sensitivity/ specificity- most sx listed are less specific + may encourage pts to take testosterone

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15
Q

how does T change from 25-75

A

T ↓ 35%, free T ↓ 50-60%

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16
Q

FT and TT decreases ___/yr starting around ~28yrs old

A

1%

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17
Q

there may be some variability in testosterone decreased by _________

A

racial group

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18
Q

T can be measured in (3)

A

urine, saliva, blood work

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19
Q

free T is ~___% of of total T

A

2%

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20
Q

ideal time to measure T is

A

fasting morning level, between 7-11am

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21
Q

what are some difficulties with measuring free T

A

cold standard equilibrium dialysis methods are too complex
no common RR to aid result interpretation
equations for free T may not be accurate due to SHBG variability + pt population

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22
Q

genetics are responsible for ___% of T variability

A

30%

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23
Q

how does exercise impact T levels

A

short, intense exercise increase T (~30%)

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24
Q

how does smoking imapct T levels

A

5-15% higher T

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25
Q

how does substance and alcohol use impact T levels

A

lower T

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26
Q

how does diet impact T

A

vegetarians have lower T

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27
Q

how do chronic diseases impact T

A

poor disease control generally associated with lower T and/or FT

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28
Q

COVID mechs for ED

A

endothelial dysfunction, psychological distress, impaired pulmonary hemodynamics, exacerbation of CV disease, impact on T levels, sensory loss (anosmia, ageusia)

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29
Q

before starting T therapy, what should be done?

A

address chronic conditions (obesity, increase exercise, osteoporosis, sleep apnea)
discontinue meds that interfere with T

30
Q

what is classified as late onset hypogonadism

A

> 30ysr old

31
Q

what is the goal for prepubertal hypogonadism

A

goal to stimulate long bone growth and induce mild virilization- do not interfere with spontaneous pubertal onset

32
Q

when should tx for prepubertal hypogonadism be started

A

age 14 (withhold tx until then)

33
Q

T therapy is recommended in hypogonadal men to induce and maintain

A

secondary sex characteristics

34
Q

what are some consistent findings of T trials in hypogonadal men

A

increased lean body mass and BMD + decreased fat in those with low serum T levels (but not in those with normal)
overall increased QoL

35
Q

T or F: T consistently decreases fat mass and increases BMD even in men that are not deficient

A

F- consistency only found in deficient men

36
Q

T derm effects

A

↑ in hair growth (beard, pubic, axillary)

37
Q

T CNS effects

A

improvement in fatigue (3-6mths), small improvement in depressive mood (1mth max benefit may take longer to show)

38
Q

T genitourinary effects

A

improvement in libido (1mth), ED (6-12mths)

39
Q

T endocrine effects

A

improvement in T levels, insulin sensitivity (few days) and glycemic control (3-12mths)

40
Q

T CV effects

A

↑ in fat free mass + lean mass (6-12mths), ↓ waist circ, ↓ in total cholesterol and LDL (1mth), improvement in HF and exercise capacity improvement in ECG ST segment depression due to exercise

41
Q

T trials that are typically not adequately powered to assess ____ or ____ events

A

CV or prostate cancer

42
Q

hematologic T effects

A

↑ hematocrit in anemic men (3-6mths)

43
Q

T effect MSK

A

improvement in BMD (6mths), ↓ fracture risk, ↑ muscle strength, slowed progression of mobility limitations

44
Q

AEs of T (with evidence of association) (5)

A

Erythrocytosis
Acne and oily skin
Detection of subclinical prostate cancer
Growth of metastatic prostate cancer
↓ sperm production and fertility (less endogenous production = shuts down spermatogenesis)

45
Q

Uncommon AEs for which there is weak evidence of association with T admin:

A

Gynecomastia
Male pattern hair loss
Growth of breast cancer
Induction or worsening of OSA

46
Q

IM T specific AEs

A

Fluctuations in mood or libido
Pain at injection site
Coughing episodes immediately after injection

47
Q

transdermal T gels and solutions specific AEs

A

Potential risk for T transfer to partner or another person who is in close contact
Skin irritation, odor at application site
Stickiness, slow drying, dripping

48
Q

are oral T tablets recommended for hypogonadism?

A

no- effects on liver and cholesterol

49
Q

T nasal gel SEs

A

Rhinorrhea, epistaxis, nasal discomfort, nasal congestion, parosmia

50
Q

which of the following is a formulation specific AE for IM testosterone
1. irritation of gums
2. parosmia
3. coughing episodes immediately after administration
4. effects on liver and cholesterol after admin

A

3

51
Q

testosterone increases risk of _________, _________ , ______ compared to placebo
(CV RF)

A

total CV events
atherosclerotic events
major adverse CV events

52
Q

____ suppression is often used for prostate cancer tx

A

testosterone suppression

53
Q

men with hx of _____ often have low T and sx

A

prostate cancer

54
Q

can you use T supplementation if pt has hx of prostate cancer, resulting in hypogonadism

A

may consider if 1yr of cure psot cancer tx
avoid if mod-high risk prostate cancer or still under active surveillance

55
Q

oral T issues

A

hepatotoxicity, erratic absorption, cholesterol raising, high first pass effect

56
Q

transdermal T reaches SS in

A

2-3d

57
Q

transdermal T characteristic includes
1. reach SS in 4-5 d
2. be applied to the scrotum
3. wait to shower or swim after application
4. have hepatotoxicity

A

3

58
Q

where should TD T not be applied

A

scrotum

59
Q

which T inj contains cottonseed oil

A

Testosterone cypionate (depot-testosterone)

60
Q

which T inj contains sesame oil

A

Testosterone enanthate (Delatestryl)

61
Q

T distribution depends on

A

SHBG, albumin (small amount bound to albumin, mostly SHBG)

62
Q

T si metabolized by ___________ to ___, _____

A

5 alpha reductase to DHT, estradiol

63
Q

T interacts with

A

Warfarin (↑ INR)
Insulin / hypoglycemics (T ↓ glucose)
Cyclosporin (↑ levels, nephrotoxicity)

64
Q

is DHEA recommended for hypogonadism

A

no but may still be used

65
Q

DHEA production peaks in _________ and decliens ________

A

peaks in early adulthood
declines over time

66
Q

what is the evidence behind CAM for hypogonadism

A

some evidence that T can be normalized

67
Q

clomiphene MOA in hypogonadism

A

Competes with estrogen at receptors at hypothalamus and pituitary negative feedback leads to ↑ FSH and LH from anterior pituitary leads to ↑ T production

68
Q

clomiphene class

A

SERM

69
Q

GnRH MOA in hypogonadism

A

GnRH stimulatesLH and FSH from anterior pituitary, leading to T production

70
Q

hCG is an analog of

A

LH

71
Q

aromatase inhibitors MOA in hypogonadism

A

inhibit peripheral conversion of T to estradiol lower feedback from reduced estradiol levels on HPA ↑ gonadotropins

72
Q

what are 3 classes of investigational tx for hypogonadism

A

SERM
gonadotrophins
aromatase inhibitors

443-SRH and MSK (24 decks)

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