What are the contraindications of TRT?
Evidence of prostate cancer
Erythrocytosis or hyperviscosity
Severe lower urinary tract symptoms (obstructive due to prostate growth)
Class III and IV HF
Desire to have a child
What is the normal volume of the testes?
Why isn't oral testosterone used?
Metabolished in the liver
- interacts with other drugs
- Causes derangement of LFTs
What are some causes of primary deficiency?
Acquired - testicular damage
- Drugs - spironolactone/ketoconazole
- Klinefelter syndrome
What are some conditions associated with decrease SHBG?
Use of glucocorticoids, progestins, and androgenic steroids
What are some side effects of testosterone?
Acne and oily skin
Reduced sperm production and fertility
Male pattern balding
Worsening of BPH symptoms
Growth of breast cancer
What is the advantage of testosterone gel?
Slow rise in testerone to avoid rapid pubertal effects
What are some causes of secondary deficiency?
Structural - tumour
- Surgery, radiation, trauma
- Infiltration - sarcoid
- Kallmann's syndrome
- Morbid obesity
- Acute/chronic illness
What is the karyotype and prevalence of Klinefelter's?
What are some conditions associated with elevated SHBG?
Use of anticonvulsants
What are some organ specific features of testosterone deficiency?
Reduced muscle mass and strength
Osteoporosis and fractures
Increased fat mass
How does bone respond to testosterone?
Increase in bone mass density
What are some negative physiological effects of testosterone
Increase prostate volume
What are the hormone levels in Klinefelter's?
Low/normal TT (total testosterone) - declines with age
Why does testosterone effect fertility?
It switches off endogenous testosterone production and disrupts the FSH, LH axis - temporary or permanently
How does Klinefelter's present?
Disruptive at school
Tiny testes (pea-like)
What is the most effective testosterone replace therapies available?
Reandron - 4 yearly deep IM injection
Testa gel - on the forearm