chapter 49 Men as patients

Question 1

hypogonadism

Answer 1

• failure of testes to produce androgens or sperm or both
• main cause of male infertility
• primary: low testosterone and elevated gonadotropins
• secondary: low testosterone and low/normal gonadotropins
• tertiary: older men with high gonadotropins and normal testosterone
• in infancy: persistent failure of testes to descend may be pre-cursor to testicular dysfunction,or hypotrophic penis
• in puberty: delayed, absent or arrested testicular growth, voice doesn’t deepen, and little muscle mass in gained
• in adulthood: reproductive function stops, emotionally similar to menopause

Question 2

uses of testosterone replacement therapy

Answer 2

• for anemia: endogenous androgens stimulate erythropoiesis, increase hgb levels
• for bone density: testosterone plays major role in bone density
• for cognitive function: higher free testosterone concentrations associated with better performance of memory and cognitive function
• for lower urinary tract symptoms: increases bladder capacity and compliance
• for metabolic syndrome and DM 2: modulates insulin resistance and risk for metabolic syndrome
• for mood, energy, quality of life
• for muscle mass and strength
• for libido, sexual function, performance

Question 3

risks/contraindications for testosterone therapy

Answer 3

• erythrocytosis risk-monitor h/h->17.5 g/dL hgb or >54% hct overdose/abuse
• hypoxia, sleep apnea
• prostate ca
• boys-acne and gynecomastia, aggressive behavior, premature epiphyses-leading to short stature
• adolescents - “rhoid rage”

Question 4

drug interaction with testosterone therapy

Answer 4

• high risk medication: anisindione, dicumarol, warfarin

- if necessary-dosage may need to be adjusted

Question 5

common problems that require medication for males

Answer 5

• erectile dysfunction:trt, phodiesterase type 5 inhibitors
• benign prostatic hyperplasia
• prostatitis/male pelvic pain syndrome
• hair loss

Question 6

leading causes of death in men

Answer 6

-heart disease, cancer, unintentional accidents

Question 7

average normal testosterone level in men

Answer 7

normal:400-600 ng/dL

Question 8

testosterone clinical use and dosing

Answer 8

• depot esters 200 mg IM every 2 wks

- transdermal or buccal resulting in systemic absorption of 2.5 mg-10 mg daily

Question 9

monitoring while on TRT

Answer 9

• evaluate efficacy 3-6 months with checks of testosterone levels (goal 400-600) and h/h
• eval bone density every 1-2 years
• eval PSA levels and digital rectal exam before therapy and 3&6 months

Question 10

erectile dysfunction

Answer 10

tx; TRT, phosphodietrase type 5 (PDE-5) inhibitors-taken 1-4 hours prior to sexual activity

i. e. sildenafil (viagra), vardenafil (Levitra), tadalafil (cialis)
- side effects: hearing and vision problems

Question 11

hair loss

Answer 11

tx: topical minoxidil, systemic finasteride
monitoring: can take up to 1 year to see improvement
- liver toxic and increase in PSA
- toxic to fetus

Question 12

homosexual men

Answer 12

• higher rates of HIV and syphilis
• 17x greater incidences of anal cancer than heterosexual men
• 33% of gay men smoke