• regulated by hypothalamic-pituitary-gonadal axis

  • majoritty testosterone inactivated in liver and exceted in kidneys

  • levels decline at rate of 1%/year after 40yo

    • “andropause”

Testosterone deficiency

  • in association with advancing age

    • late-onset hypogonadism

      • symptoms non-specific

        • poor morning erection

        • low sexual desire

        • erectile dysfunction

Primary hypogonadism

  • decrease testosterone production due to testicualr abnormal

    • infection

    • chemotherpay

    • small % in advanceing age

    • increase LH

Secondary hypogonadism

  • disorder of HPA

    • tumours

    • LH low with low testosterone

who to test

  • only males who display symptoms and signs suggestive of hypogonadism

  • routine testign not recommended

  • before testing rule out:

    • coexisting acute or chronic illness

    • long term use of medicine

      • opioids

      • corticosteroids

    • high etoh

    • illicit drug use

    • eating disordre

    • excessive exercise

Erectile dyfucntion

  • not recomended in absence of other symptoms of late-onset hypogonadism

ALl patients with suspected hypogonadism should be referred to endocrinologist

testosterone replacement

  • 3mo trial with clincial and reproducible biochemical evidence of testosterone deficiency

    • in consultation with endocrinolosit

  • before:

    • prostate historyexam and

    • PSA

    • FBC

  • not appropriate for:

    • diagnosed prostate or breast cancer

    • Palpable prostate nodule or inudraiton or PSA >4

    • severe lower urinary tract symptoms associated with BPH

    • elevated haematocrit >50%

    • Untreated severe sleep apnoea

    • poorly controlled heart failure

  • not causative of new prostate cancer

  • exogenous testosterone decrease sperm production

  • adverse effects

    • prostatic hypertrophy

    • polycythaemia

      • may occur 3mo within treatment initiation

  • testosterone undecanoate 120-160mg od po

    • poorly absorbed

    • divided doses with food

  • testosterone patches 2x2.5mg/day applied before bed

    • often poorly tolerated

  • IM testosterone cypionate or testosterone esters

    • 50-400mg q2-4wk

    • Reandron = very long acting infectable form of undecanoate

      • not subsidised

  • require recommendation from endocrinolgist to be subsidised

  • Patches fully subsidised without restriction

  • follow-up 3/12

    • adverse effects

    • alter dose

    • PSA 3-6mo and DRE