The Aging Male

Question 1

3 important aspects of healthy aging in our male population?

Answer 1

prostate health
bone and muscle health
CV health

Question 2

what happens to SHBG as men age?

Answer 2

increases= less free testosterone in the blood

Question 3

why does testosterone production decrease with age?

Answer 3

hypothalamus secretes less gonadotropin-releasing hormone, as a result production of LH by the pituitary gland decreases which results in decreased testosterone production

Question 4

what happens to Leydig cell #?

Answer 4

decrease and progressively produce less T

also testes respond less vigorously to stimulation LH= less T synthesis

Question 5

what happens to aromatase enzyme activity as men age?

Answer 5

increases which converts more T to estradiol

Question 6

how does estradiol effect male health?

Answer 6

interacts w/SHBG to cause 8x increase in IC cAMP in human prostate tissue= increased growth

Question 7

potential sxs associated with andropause?

Answer 7

reduced libido
disturbed sleep
depression
fatigue
irritability
hot flashes

Question 8

potential effects of hormonal shifts?

Answer 8

thinning skin, slower wound healing, muscle weakness, increased incidence of osteoporosis, atherosclerosis, heart dz

Question 9

oral T bioavailability? what adverse health effects have been associated with its use?

Answer 9

bioavailability of oral T is poor

has been linked to liver dz and liver CA

Question 10

ADRs of testosterone?

Answer 10

acne and oiliness of skin
breast tenderness and enlargement
erythrocytosis
induction or exacerbation of sleep apnea
leg edema
exacerbation of heart disease dt acceleration of atherogenesis
cardiac hypertrophy
prostate CA

Question 11

strict C/Is to testosterone replacement therapy?

Answer 11

presence of prostate CA or a PMHx of prostate CA

presence of breast CA or PMHx of breast CA

Question 12

at what age and amount does DHEA peak in men? importance of DHEA?

Answer 12

at about 25 yo w/a serum level of ~30 mg/d

precursor for both androstenedione and androstenediol= precursors for T

Question 13

what two organic causes should be rule outed for impotency before starting T?

Answer 13

diabetes

hypothyroidism

Question 14

ADRs of viagra?

Answer 14

chest pn
HTN
heart attacks
warning if pt is also taking meds for angina or HTN meds from nitrate class of drugs

Question 15

what amino acid could be useful in treatment of impotency?

Answer 15

L-arginine b/c it is a pre-cursor to nitric oxide

Question 16

herb that can help tx impotency?

Answer 16

muira puama

Question 17

b/c the prostate also has smooth muscle, what else does it respond to aside from alpha reductase?

Answer 17

nervous stimuli from alpha-1 stimulation by increasing # of muscle cells

Question 18

obstructive ssxs of prostate dz?

Answer 18

urinary hesitancy, decreased urinary stream, prolonged urination w/intermittency and incomplete bladder emptying

Question 19

irritative sxs of prostate dz?

Answer 19

frequency, urgency, nocturia, urge incontinence

Question 20

conditions that can appear with prostate dz?

Answer 20

UTI, urethritis, urethral strictures, carcinoma, bladder stones or interstitial cystitis

Question 21

conventional tx of BPH?

Answer 21

5-alpha reductase inhibitor such as finaseteride or an alpha-1 blocker such as prazocin

Question 22

what is the absolute value of serum PSA most useful for determining?

Answer 22

extent of prostate CA and assessing the response to prostate CA treatment

Question 23

aside from prostate CA, what is another reason that PSA might be elevated?

Answer 23

prostatitis w/or w/o active infxn

Question 24

what herb is known to inhibit the actions of 5-alpha reductase as well as blocking DHT binding to prostate sites?

Answer 24

serenoa repens (saw palmetto)
exerts an anti-inflammatory effect on prostate by localized inhibition of the arachadonic acid cascade via COX and 5-lipooxygenase pathway

Question 25

what two nutrients could help with prostate dz?

Answer 25

EFAs in flax seeds

zinc

Question 26

SEs of viagra?

Answer 26

h/a
dizziness or lightheadedness
flushing of face and chest wall
upset stomach
nasal congestion
vision changes
painful or prolonged erection

Question 27

non-pharm recommendations for impotency?

Answer 27

reduce inflammatory mediators whenever possible
stop smoking
limit EtOH consumption, esp EtOH containing hops
improve liver health
reduce stress!

Question 28

how does prostate CA affect male mortality?

Answer 28

2nd MC type of CA

responsible for more male deaths than any other CA except lung CA

Question 29

considerations for diminishing prostate CA risk?

Answer 29

reduce dietary cholesterol
maintain healthy body weight
minimize exposure to milk, herbicides, pesticides, meat from pork and chickens
diets high in lycopene

Question 30

what supplement has been shown to decrease prostate CA risk?

Answer 30

selenium

Question 31

what ethnicity has been shown to have increased rates of prostate CA?

Answer 31

african american males more than caucasian males