19 Testicular Disorders Flashcards
(22 cards)
Conditions associated with ⬇️ SHBG concentrations (7)
Obesity
Diabetes mellitus
Use of glucocorticoids, some progestins, and androgenic steroids
Nephrotic syndrome
Hypothyroidism
Acromegaly
Polymorphisms in the SHBG gene
Acromegaly is associated with (⬇️ / ⬆️) SHBG
⬇️ SHBG
Hypothyroidism is associated with (⬇️ / ⬆️) SHBG
⬇️ SHBG
Obesity is associated with (⬇️ / ⬆️) SHBG
⬇️ SHBG
Diabetes mellitus is associated with (⬇️ / ⬆️) SHBG
⬇️ SHBG
Glucocorticoid use is associated with (⬇️ / ⬆️) SHBG
⬇️ SHBG
Androgenic steroids are associated with (⬇️ / ⬆️) SHBG
⬇️ SHBG
Estrogen use is associated with (⬇️ / ⬆️) SHBG
⬆️ SHBG
Hyperthyroidism is associated with (⬇️ / ⬆️) SHBG
⬆️ SHBG
Conditions associated with ⬆️ SHBG concentrations (7)
Aging
HIV disease
Cirrhosis and hepatitis
Hyperthyroidism
Use of some anticonvulsants
Use of estrogens
Polymorphisms in the SHBG gene
Indications for measuring free testosterone (2)
Conditions associated with altered SHBG concentrations
Total testosterone concentrations in the borderline zone around the lower limit of the normal range (e.g., 200-400 ng/dL)
Conditions with high prevalence of low testosterone and for which measurement of serum testosterone is indicated (7)
Pituitary mass, radiation to the pituitary region, or other diseases of the sellar region
Treatment with medications that affect T production or metabolism, such as opioids and glucocorticoids
Withdrawal from long-term AAS use
HIV-associated weight loss
Infertility
Osteoporosis or low trauma fracture
Low libido or erectile dysfunction
Indications for pituitary imaging in secondary hypogonadism (4)
Severe secondary hypogonadism [e.g., serum T , 150 ng/dL (5.2 nmol/L)]
Panhypopituitarism
Persistent hyperprolactinemia
Symptoms or signs of tumor mass effect (such as new-onset headache, visual impairment, or visual field defect)
Conditions in which testosterone administration is associated with a VERY HIGH risk of adverse outcomes (2)
Metastatic prostate cancer
Breast cancer
Conditions in which testosterone administration is associated with a MODERATE to HIGH risk of adverse outcomes (6)
Unevaluated prostate nodule or induration
Unevaluated PSA >4 ng/mL (>3 ng/mL in individuals at high risk for prostate cancer, such as African Americans or men with first-degree relatives who have prostate cancer)
Hematocrit >48% (>50% for men living at high altitude)
Severe LUTS associated with benign prostatic hypertrophy as indicated by AUA/IPSS >19
Uncontrolled or poorly controlled congestive heart failure
Desire for fertility in the near term
Adverse events for which there is evidence of association with testosterone administration (5)
Erythrocytosis
Acne and oily skin
Detection of subclinical prostate cancer Growth of metastatic prostate cancer Reduced sperm production and fertility
Uncommon adverse events for which there is weak evidence of association with T administration (4)
Gynecomastia
Male pattern balding (familial)
Growth of breast cancer
Induction or worsening of obstructive sleep apnea
Monitoring of hematocrit during testosterone therapy
Baseline
3-6 months
12 months
Annually
Frequency of prostate monitoring during testosterone therapy (DRE and PSA)
Baseline
3-12 months
According to guidelines after 1 year
Indications for urological consultation during testosterone therapy
PSA rise >1.4 ng/dL above baseline
PSA >4 ng/dL
Prostate abnormality detected on DRE
Dosing schedule of testosterone undecanoate 1000 mg
1000 mg IM every 10-14 weeks
Specific symptoms and signs of testosterone deficiency in men (3)
Incomplete or delayed sexual development
Loss of body (axillary and pubic) hair
Very small testes (<6 mL)
