Male Hypogonadism: Facts and Myths

1. Male Hypogonadism: Facts and Myths HISHAM ALREFAI,MD,CCD Cert. Endocrinology & Diabetes Diplomate, Clinical Lipidology Hypertension Fellowship Cert. Clinical Densitometry.

4. Case#1 A 49 years old man referred for diabetes management. Review of other symptoms is positive for fatigue, lack of motivation, and decreased libido with preserved erectile function. The exam revealed central obesity, A1C of 8.9%, elevated TG, and low HDL.

5. Which of the following about low testosterone in diabetics is true? • Hypogonadism is rare in diabetics • The incidence of hypogonadism in diabetics approaches 30% across all age groups. • Hypogonadism occurs only in diabetic older than 65 year old. • All men with diabetes will eventually develop hypogonadism.

7. Based on recent studies, which of the following symptoms would make you suspicious of low level of testosterone? • Decreased level of energy • Lack of motivation • Diminished libido • Moodiness and irritability • Erectile dysfunction

9. Case# 2 A 68 years old man is admitted with a hip fracture as a result of falling from standing position. Five ears earlier, he had a forearm fracture due to a minor injury. He admits losing 2 inches of height. Mild kyphosis is detected on exam

10. The Initial W/U should include all except: • CBC • Thoracic Spine Xray • CMP • Vitamin D evaluation • Testoterone level • Dexa Scan • Bone Scan

11. Which one of the following do not need to be obtained prior to initiating T. ? • PSA • Hematocrit • Prolactin, LH, and FSH • Glucose • MRI of pituitary

12. Contraindications of Testosterone Replacement Therapy in Men • Known or suspected prostate cancer • Male breast cancer • Known or suspected sensitivity to ingredients used in testosterone therapy systems Petak SM, et al. AACE Clinical Practice Guidelines. Available at: http://www.aace.com/clin/guides/hypogonadism.html

13. Testosterone Therapy andPossible Prostate Changes • Increased risk of BPH • Increases in PSA levels • Increases in prostate volume • Stimulation of growth in previously undiagnosed tumors • No data support testosterone therapy as a cause of prostate cancer Hajjar RR, et al. J ClinEndocrinolMetab. 1997:82;3793-3796 Basaria S, et al. Drugs Aging. 1999;15:131-142

16. Keep your finger on the prostate

18. Potential Risks of Testosterone Therapy • Prostatic hyperplasia and prostate cancer in those already at increased risk • Edema in patients with preexisting cardiac, renal, or hepatic disease • Gynecomastia • Precipitation or worsening of sleep apnea • Hepatic adverse effects with oral therapy Petak SM, et al. AACE Clinical Practice Guidelines. Available at: http://www.aace.com/clin/guides/hypogonadism.html

19. Case#3 A 32 year old man is receiving narcotic therapy for advanced ankylosing spondylitis. He is complaining of night sweat and depressive mood.

20. What lab set would confirm the diagnosis of hypogonadism? Total T of less than 200 ng/ml with elevated LH Total T of less than 300 ng/ml with normal LH A recent drop of 300 ng/ml of Total T with normal LH Total T of 350 ng/ml with elevated LH

21. Which of the following treatment option is the mainstay of testosterone replacement therapy that avoids level swings? • Testosterone patch • Testosterone pellets • Testosterone injections • Testosterone gel • Buccal testosterone

23. Endocrinology=Proper Hormone replacementMedicine: Quality of life> Quantity of life

24. The Endocrine society 2006 suggested measurement of T. for: Type 2 DM Osteoporosis or low trauma fracture especially younger patients. Moderate to severe COPD ESRD and hemodialysis HIV-associated weight loss Meds affect testosterone production such as glucocorticoids, ketoconazole, and opioids Sellar region disease.

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