Testosterone deficeincy - ? normal ageing or ?disorder
Primary hypogonadism - testicular failure
Secondary hypogonadism - pituitary / hypothalamus disorder
Late onset hypogonadism - some primary and secondary - inc with age, alcohol, steroids, disease (liver / renal failure)
Androgen insensitivity
 
Testing - always repeat abN, <8 - replace, >12 don't .....
Testosterone levels fluctuate - fasting, alcohol, diurnal rhythm
Binding - SHBG (inc with age) unusable
SHBG - inc with hyperthyroid, liver disease, androgen deficiency, oestrogen xs
 
If Testos low - check LH FSH and prolactin
 
Sx
slowed hair growth - axillae, genitals, beard
dec muscle and inc fat
dec libido, erectile dysfunction, oligospermia
lethargy, mood changes
 
Erectile dysfunction - most commonly - diabetes and CVD
 
Low Testos
Osteoporosis
Diabetes
CVD
Dementia / depression
 
treat - mostly as to Sx NOT as to testos levels
short term (6/12) course and review may be useful
use tabs (qds) injection (weekly), implant etc
pre-Rx - check PSA - testos may exacerbate prostate cancer but not thought to initiate it - if any Sx or raised PSA - refer to urologist prior to testos Rx
during Rx - monitour - testos (timing), PSA, bone density, FBC (3,6,12 mthly then yrly)