3 important aspects of healthy aging in our male population?
bone and muscle health
what happens to SHBG as men age?
increases= less free testosterone in the blood
why does testosterone production decrease with age?
hypothalamus secretes less gonadotropin-releasing hormone, as a result production of LH by the pituitary gland decreases which results in decreased testosterone production
what happens to Leydig cell #?
decrease and progressively produce less T
also testes respond less vigorously to stimulation LH= less T synthesis
what happens to aromatase enzyme activity as men age?
increases which converts more T to estradiol
how does estradiol effect male health?
interacts w/SHBG to cause 8x increase in IC cAMP in human prostate tissue= increased growth
potential sxs associated with andropause?
reduced libido disturbed sleep depression fatigue irritability hot flashes
potential effects of hormonal shifts?
thinning skin, slower wound healing, muscle weakness, increased incidence of osteoporosis, atherosclerosis, heart dz
oral T bioavailability? what adverse health effects have been associated with its use?
bioavailability of oral T is poor
has been linked to liver dz and liver CA
ADRs of testosterone?
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
strict C/Is to testosterone replacement therapy?
presence of prostate CA or a PMHx of prostate CA
presence of breast CA or PMHx of breast CA
at what age and amount does DHEA peak in men? importance of DHEA?
at about 25 yo w/a serum level of ~30 mg/d
precursor for both androstenedione and androstenediol= precursors for T
what two organic causes should be rule outed for impotency before starting T?
ADRs of viagra?
warning if pt is also taking meds for angina or HTN meds from nitrate class of drugs
what amino acid could be useful in treatment of impotency?
L-arginine b/c it is a pre-cursor to nitric oxide
herb that can help tx impotency?
b/c the prostate also has smooth muscle, what else does it respond to aside from alpha reductase?
nervous stimuli from alpha-1 stimulation by increasing # of muscle cells
obstructive ssxs of prostate dz?
urinary hesitancy, decreased urinary stream, prolonged urination w/intermittency and incomplete bladder emptying
irritative sxs of prostate dz?
frequency, urgency, nocturia, urge incontinence
conditions that can appear with prostate dz?
UTI, urethritis, urethral strictures, carcinoma, bladder stones or interstitial cystitis
conventional tx of BPH?
5-alpha reductase inhibitor such as finaseteride or an alpha-1 blocker such as prazocin
what is the absolute value of serum PSA most useful for determining?
extent of prostate CA and assessing the response to prostate CA treatment
aside from prostate CA, what is another reason that PSA might be elevated?
prostatitis w/or w/o active infxn
what herb is known to inhibit the actions of 5-alpha reductase as well as blocking DHT binding to prostate sites?
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
what two nutrients could help with prostate dz?
EFAs in flax seeds
SEs of viagra?
h/a dizziness or lightheadedness flushing of face and chest wall upset stomach nasal congestion vision changes painful or prolonged erection
non-pharm recommendations for impotency?
reduce inflammatory mediators whenever possible
limit EtOH consumption, esp EtOH containing hops
improve liver health
how does prostate CA affect male mortality?
2nd MC type of CA
responsible for more male deaths than any other CA except lung CA
considerations for diminishing prostate CA risk?
reduce dietary cholesterol
maintain healthy body weight
minimize exposure to milk, herbicides, pesticides, meat from pork and chickens
diets high in lycopene
what supplement has been shown to decrease prostate CA risk?
what ethnicity has been shown to have increased rates of prostate CA?
african american males more than caucasian males