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ICM- Human Sexuality
Androgens (T Pierce)
43
Medical
Professional
11/12/2009

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Cards

Term
HPG axis (explain secondary and primary failure)
Definition
  • GnRH released from hypothalamus
  • anterior pituitary release FSH and LH
  • gonads make hormones

Primary failure- problem with testes/ovaries

Secdondary failure- problem with pituitary, hypothalamus

Term
Precursor compound for testosterone
Definition
cholesterol
Term
Testosterone levels throughout life
Definition
  • peak in second trimester
  • peak at birth
  • declind until 10
  • begin to rise continually and tonic high levels until age 80
Term
Function of LH
Definition
spikes during the day and causes increase in testosterone production
Term
Compare testosterone variability based on age
Definition
  • young men- higher then older men and peak at 8 AM
  • older men- tonic levels, lower than young men
Term
Binding proteins for testosterone
Definition
  • SHBG
  • albumin (less tightly bound, so more bioavailable)

Remember, very small fraction is free

Term
Effect of aging on free testosterone, why
Definition
  • free testosterone goes down with age due to slight increases in SHBG

Note also LH does go up with age

Term
testosterone assays
Definition
  • total
    • widely available
    • inexpensive
    • simple to perform
    • reliable
  • free testosterone
    • equilibrium dialysis is gold standard
    • analog method inaccurate
  • bioavailable testosterone- gives most info
Term
Conditions that decrease total SHBG
Definition
  • obesity
  • hypoT
  • androgen abuse
  • progestin abuse
  • glucocorticoids
  • nephrotic syndrome
Term
Conditions that increase SHBG
Definition
  • aging
  • hyperT
  • androgen deficiency
  • estrogens
  • anticonvulsants
  • hepatitic cirrhosis
  • HIV
Term
signs/symptoms of low testosterone
Definition
  • decrease libido
  • erectile dysfunction
  • regression of secondary sex characteristics
  • osteoporosis
  • decrease muscle strnght
  • depression
    • lethargy
    • inability to concentrate
    • sleep disturbance
    • irritability
    • decrease interest in activities
  • additional signs/symptoms
    • incomplete sexual development
    • breast discomfort, gynecomastia
    • very small or shrinking testes
    • infertility
    • mild anemia
    • decrease spontaneous erections
    • hot flashes, sweats
Term
causes of primary hypogonadism
Definition
  • Klinefelter's syndrome
  • mumps orchitis
  • testicular trauma (bicycle accident)
  • radiation
  • autoimmune disease
  • drugs
    • chemotherapy
    • cyclophosphamide
Term
symptoms of Klinefelter's
Definition
  • sparse facial and body hair
  • gynecomastia
  • firm testes less than 4 mL
  • female body habitus
  • long arms and legs
  • present at puberty when semineferous tubules undergo fibrosis and hyalinization resulting in firm testes
Term
associations with Klinefelter's
Definition
  • chronic pulmonary disease
  • varicose veins
  • cerebrovascular disease
  • osteoporosis
  • glucose intolerance
  • primary hypothyroidism
  • breast cancer
  • taurodontism (early tooth decay)
Term
causes of secondary hypogonadism
Definition
  • pituitary disorder
    • hemachromatosis (bronze diabetes)
    • tumor, trauma, infiltrative
    • hyperPRL
    • hypopituitarism
  • hypothalamic tumor/trauma
  • critical illness
  • congential disorder of gonadotropin secretion
    • ex: Kallmann's syndrome with anosmia
  • drugs- marijuana, heroin, opiates, progesterone
Term
approach to dx of hypogonadism
Definition
  • morning total testosterone or bioavailable testosterone
  • if low T, you must figure out why
  • check gonadotropins
    • if low, secondary
    • if high, primary

Dont make this dx of androgen deficiency during acute or subacute illness

Term
Effect of testosterone supplementation in older men
Definition
  • increase muscle mass
  • decrease fat mass
  • no change in strength
  • no change in physical function
  • some experience increase in bone mineral density at lumbar spine
    • depends on androgen dose and degree of baseline testosterone deficiency
Term
Guideline for tx of low testosterone
Definition
  • low testosterone on consistent level
  • symptomatic
Term
Current testosterone formulations
Definition
  • T gel
  • buccal testosterone
  • IM testosterone undecanoate (not in US)
Term
PK's of testosterone drugs
Definition
  • gels- it will give you a steady state level
  • intramuscular injection- causes peaks and valleys from point of injections
Term
Effect of testosterone drugs on skin
Definition
  • infrequent acne
  • skin rxns (high with patch and low with gel)
Term
Testosterone on erythrocytosis
Definition
  • transdermal gel (less often)
  • transdermal patch (less often)
  • IM injections it is very much a problem
Term
CI: testosterone drugs
Definition
  • erythrocytosis hyperviscocity
  • breast cancer
  • prostate cancer or nodule
    • severe UT symptoms
  • heart failure
  • untrated obstructive sleep apnea
Term
information need before prescribing testosterone
Definition
  • monitoring
    • IM- midway btw injections
    • patch- 3-12 hrs after application
    • gel: 1-2 wks on tx
  • physical- acne, gynecomastia, palpable prostate
  • blood test- hematocrit, PSA
  • questionare- sleep apnea
  • follow Hct and PSA 3 months after starting than yearly
  • if Hct greater than 52, reduce dose
  • PSA greater than 4, refer to urologist
Term
Ovarian steroids: function of theca and granulosa cells
Definition
  • theca cells- make androgens
  • granulosa cells- make estrogen
Term
androgen levels in women with age
Definition
  • decline in total testosterone was greatest in early reproductive years
  • no decline of testosterone across menopause
  • highest levels at 18-24
Term
hyperandrogenism in women
Definition
  • hirsutism
  • acne
  • clitoromegaly
  • male pattern baldness
Term
define hirsutism, how happens, scoring for severity
Definition
  • excessive terminal hair in male pattern on women (hair on abdomen, chest)
  • due to interaction between androgen and hair follicle sensitivity to androgen
    • become oily
  • grade via Ferriman Gallwey scale
Term
hirsutism evaluation
Definition
  • history
    • hirsutism in other female family member
    • ethnicity
    • PCOS risk factors (irregular menses)
    • rate of onset
    • any virilization
  • labs
    • no labs if mild hirsutism with regular menses and no features suggestive of secondary cause, as is most likely idiopathic
    • otherwise, free testosterone best initial lab
Term
hirsutism tx
Definition
  • cosmetic and physical measuring
    • bleach, wax, shave
    • electrolysis and laser therapy (long term may be the best option)
  • cell cycle inh (cream applied to face but not much improvement)
  • antiandrogens
  • oral contraception (max effect in 9-12 months)
Term
definition of polycystic ovary syndrome
Definition
  • at least 2 of 3
    • oligo/amenorrhea
    • hyperandrogenemia/hyperandrogenism
      • hirsuitism, acne, male pattern hair loss)
    • polycystic overies on US
  • usually manifst in teenage years
Term
other components that exacerbate polycystic ovarian syndrome
Definition
  • hyperinsulinemia (insulin R)
  • obesity
  • impaired glucose tolerance
  • dyslipidemia
  • increase coronary calcifications on electron beam CT
  • obstructive sleep apnea
  • endometrial hyperplasia/carcinoma
Term
conditions you must rule out with polycystic ovary syndrome
Definition
  • Cushings
  • acromegaly
  • hyperPRL
  • nonclasical congenital adrenal hyperplasia
  • androgen secreting tumor
Term
tx polycystic ovary syndrome
Definition
  • oral contraception
    • use progestin so antiandrogenic
    • estrogen increase SHBG so there is less frequent testosterone
    • estrogen suppress LH and androgens
  • wt loss
  • antiandrogens
  • insulin sensitizers (DM)
Term
causes of androgen insufficiency
Definition
  • ovarian (chemo, radiation, oophorectomy)
  • adrenal (insufficiency, -ectomy)
  • hypothalamic/pituitary- hypopituitarism
  • medication related- corticosteroids, oral contraception
  • idiopathic
Term
Effect of DHEA on androgen insufficiency
Definition
  • beware of DHEA products (not regulated)
    • some dont have any DHEA
    • some have much less than what they claim
    • one had 50% higher
Term
antiandrogenb uses in men and women
Definition
  • in men, bicalutamide used as GnRH agonist to tx prostate cancer
  • women, spironolactone in low ose prevent androgen binding to R< at high dose inhibits testosterone synthesis
  • Finasteride (alpha 5 reductase inhibitors)
    • for male pattern balding or decrease prostate size in BPH
Term
Mech of anabolic steroids
Definition
  • 17 alpha alkalated substiution
  • esterfication (longer carbon chain means greater half life)
  • steroid nucleus
Term
Effect of anabolic steroids
Definition
  • muscle hypertrophy
    • increase muscle fiber diameter
    • increase lean body mass
    • positive nitrogen balance
    • retention o potassium, sulfates, phosphates
  • increase RBC mass
  • CNS- dont know effect on brain
  • glucocorticoid R antagonist (inh. catabolism)
Term
Adverse effects of Anabolic steroids
Definition
  • CV
    • increase LDL
    • decrease HDL
    • fluid retention
  • hepatic
    • liver cancer
    • LFT elevations
  • endocrine/reproductive
    • decrease FSH, LH
    • in males, infertility, testicular atrophy
    • in females, hirsutism, voice deepening, amenorrhea, clitoral hypertrophy, male pattern baldness
  • dermatology- acne
Term
neuropsyc. effects of anabolic steroids
Definition
  • euphria
  • energy
  • sexual arousal
  • negative mood
    • irritability
    • mood swings
    • violent feelings
    • hostility
  • cognitive impairment
    • distractibility
    • forgetfulness
    • confusion
Term
management of testosterone treatment for transexuals
Definition
  • lab monitoring
    • testosterone, estradiol
    • lipids
    • LFT's
    • glucose
    • hematocrit
  • screening
    • pelvic exams
    • pap smears
    • endometrial US
    • DXA bone density
Term

tx for transexual (female to male)

 

Definition
  • testosterone esters 200 mg IM
  • trasndermal testosterone 5g/day (with or w/o testosterone)
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