Rule out: Hypogonadisim or Low Testosterone

Rule out: Hypogonadisim or Low Testosterone

 


 

HOW TO MAKE THIS DIAGNOSIS:

    • Consistent symptoms and signs + unequivocally low serum testosterone levels.

 

    • Initial diagnostic test: measurement of morning total testosterone level by a reliable assay:- testosterone is subject to circadian rhythms.

 

  • Confirm the diagnosis by repeating the measurement of morning total testosterone.

 


 

SCALE CAN HELP WITH SCREENING OF SYMPTOMS:

The Androgen Deficiency in Ageing Males (ADAM) questionnaire

1.Do you have a decrease in libido (sex drive)?

2.Do you have a lack of energy?

3.Do you have a decrease in strength and/or endurance?

4.Have you lost height?

5.Have you noticed a decreased enjoyment of life?

6.Are you sad and/or grumpy?

7.Are your erections less strong?

8.Have you noticed a recent deterioration in your ability to play sports?

9.Are you falling asleep after dinner?

10.Has there been a recent deterioration in your work performance?

If the answer is ‘yes’ to question 1 or 7, or at least 3 of the other questions, low testosterone may be present.

 


 

WHAT IS CUTOFF VALUE FOR TESTOSTERONE LEVELS:

  • FDA defines hypogonadism as testosterone level ≤300 ng/dL.
    • According to International Society of Andrology (ISA), International Society for the Study of Ageing Male (ISSAM), European Association of Urology (EAU), European Academy of Andrology (EAA), American Society of Andrology (ASA) defines as testosterone level ≤230 ng/dL.

 

  • For patients with total testosterone levels between 230 and 350 ng/dl:- repeat measurement of total testosterone + measure SHBG (sex hormone binding globulin) concentrations to calculate free testosterone levels, or measure free testosterone levels directly by equilibrium analysis.
  • Measure Serum FSH and LH levels to rue out primary or secondary hypogonadism:
    • Elevated LH and FSH = primary hypogonadism.

 

    • Low or low-normal LH and FSH levels = secondary hypogonadism.

 

  • Normal LH or FSH levels + low testosterone = focus on hypothalamus and/or the pituitary (secondary hypogonadism) —> check prolactin level.

 


 

TREATMENT WITH FOLLOWING TESTOSTERONE FORMULATIONS:

 

Intramuscular injections (testosterone enanthate or testosterone cypionate)

75–100 mg weekly or 150–200 mg every 2 weeks

Transdermal patches (non-scrotal)

2.5–7.5 mg applied nightly for 24 h

Transdermal gels

5–10 g applied daily to upper arms/shoulders, or abdomen (5–10 mg testosterone systemically absorbed)

Buccal tablets

30 mg tablet applied to the buccal mucosa every 12 h

Subcutaneous pellets

6–10, 75 mg pellets implanted subcutaneously every 4–6 months

Oral capsule or tablet (methyl testosterone)

Should not be used for the treatment of hypogonadism because of risk of liver toxicity and hepatocellular carcinoma

Source: Int J Clin Pract. 2010 May; 64(6): 682–696.

 


 

CONTRAINDICATIONS & PRECAUTIONS FOR TESTOSTERONE TREATMENT.

CONTRAINDICATIONS:

    1. Male breast cancer

 

    1. Prostate cancer (known or suspected)

 

  1. Known or suspected sensitivity to ingredients used in the testosterone delivery systems

PRECAUTIONS:

    1. Benign prostatic hyperplasia; lower urinary tract symptoms.

 

    1. Edema in patients with preexisting cardiac, renal, or hepatic disease.

 

    1. Gynaecomastia

 

    1. Precipitation or worsening of sleep apnea

 

    1. Azoospermia; testicular atrophy

 

  1. Erythrocytosis

 


Source:

    1. J Clin Endocrinol Metab, June 2010.

 

    1. Transl Androl Urol. 2016 Apr; 5(2): 207–212.

 

  1. Int J Clin Pract. 2010 May; 64(6): 682–696.

Please do post your questions or comments below. 


Dr. Harvinder Singh, M.D. (Admin)


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