Didactic Series. Hypogonadism and HIV. Daniel Lee, MD UCSD Medical Center, Owen Clinic July 28, 2016

Transcription

1 Didactic Series Hypogonadism and HIV Daniel Lee, MD UCSD Medical Center, Owen Clinic July 28, 2016 This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number and title for grant amount (# U1OHA , Regional AIDS Education and Training Centers, PAETC award: $3,018,761). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, not should any endorsements be inferred by HRSA, HHS or the U.S. Government.

2 Learning Objectives 1) To review signs and symptoms of hypogonadism 2) To discuss guidelines on how to diagnose hypogonadism 3) To review treatment options and monitoring of hypogonadism 2

3 Biologic Functions of Testosterone Plays a key role in development of male reproductive tissues 1 Penis Prostate Responsible for development of secondary male sexual characteristics 1 Facial hair Pubic hair Body hair Muscle mass Important in maintaining sexual libido, sperm production, and bone health 1 Plays a key role in carbohydrate, fat, and protein metabolism 2 3

4 3 4

5 Question 1: Is HIV associated more with primary or secondary hypogonadism? 1. Primary hypogonadism 2. Secondary hypogonadism 3. Equally both 5

6 Primary vs. Secondary Hypogonadism Primary Hypogonadism Disease of the testes Low testosterone High FSH High LH Examples: Klinefelter s Syndrome Mumps orchitis Testicular Injury HIV Secondary Hypogonadism Disease of the pituitary or hypothalamus Low testosterone Low/low-normal FSH Low/low-normal LH Examples: Pituitary adenoma Kallmann Syndrome 6

7 4 7

8 Question 2: According to the Endocrine Society Guidelines, which test do you use to diagnose hypogonadism? 1. Total testosterone 2. Free testosterone 3. Either total or free testosterone 8

9 4 9

10 4,5 10

11 4,5 5 11

12 6 12

13 Testosterone Treatment Options 4 Buccal Tablet Controlled-release, bioadhesive tablets 2 times daily Topical gel Available in sachets, tubes, and pumps 1 time daily Topical solution Applied topically 1 time daily via pump with applicator Intramuscular injections IM injection every 1 to 2 weeks or IM every 10 weeks Patch 1 or 2 patches, applied 1 time daily Subcutaneous pellets Implanted SQ; dose and regimen vary with formulation Nasal gel Applied intranasally to both nostrils 3 times daily 13

14 4 4 14

15

16 Discussion Points Do symptoms correlate to testosterone levels? Which testosterone level should be checked in HIV+ patients total, free, bioavailable, all? Should adjustments in dosing be made based on age (ie. using age-adjusted normal levels)? Does the risk of toxicity of testosterone justify its use in the long-term? In the short term? Do you ever stop testosterone replacement? Other Questions? 16

17 References 1) The Endocrine Society. Fact Sheet: Low testosterone and men s health. Accessed June 27, ) Kelly DM, Jones TH. Testosterone: a metabolic hormone in health and disease. J Endocrinol. 2013; 217(3): R25-R45. 3) Bhasin S, Jameson J. Disorders of the testes and male reproductive system. In: Longo D, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J, eds. Harrison s Principles of Internal Medicine. 18 th ed. New York, NY: McGraw-Hill; ) Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010: 95(6): ) Fisher DA, ed. The Quest Diagnostics Manual for Endocrinology. San Juan Capistrano, CA: Quest Diagnostics Nichols Institute; ) Bhasin S, Pencina M, Jasuja GK, et al. Reference Ranges for Testosterone in Med Generated Using Liquid Chromatography Tandem Mass Spectrometry in a Community- Based Sample of Healthy Nonobese Young Men in the Framingham Heart Study and Applied to Three Geographically Distinct Cohorts. J Clin Endocrinol Metab. 2011; 96(8):