Update on Androgen Deficiency. Acknowledgments. Curatio PowerPoint TemplateControversies in Male Hypogonadism Bradley D.

Size: px
Start display at page:

Download "Update on Androgen Deficiency. Acknowledgments. Curatio PowerPoint TemplateControversies in Male Hypogonadism Bradley D."

Transcription

1 The General Practice Education Day Healthed / Generation Next August 22 nd Sydney Update on Androgen Deficiency Robert I. McLachlan, FRACP, PhD Director, Andrology Australia Principal Research Fellow, Hudson Institute of Medical Research Consultant Andrologist, Monash IVF Group Disclosures None Acknowledgments David Handelsman: ANZAC Institute, Sydney Gary Wittert: T4DM study Univ Adelaide Carolyn Allan: Hudson Institute, Melbourne Endocrine Society Australia Working Party Recent concepts and interventions Sex hormone actions At risk groups challenges in detection Controversies in management Treatment options & monitoring Androgen Deficiency (AD) No unequivocal clinical features nor agreed serum biomarkers of androgen sufficiency Diagnosis requires synthesis of clinical features and biochemistry Androgen deficiency is a syndromic diagnosis not one defined by blood levels: Statistical population-based distribution (e.g. serum calcium) Therapeutic targets (e.g. cholesterol) Bhasin S et al. Steroids. 2008;73:1311. Androgen deficiency in adults General sense of well being, poor concentration tiredness, poor stamina mood change - depression, irritability Sexual libido ejaculate volume erectile failure Organ specific features muscle mass and strength osteoporosis and fracture increased fat mass cardiovascular & metabolic Androgen deficiency in adults General sense of well being, poor concentration tiredness, poor stamina mood change - depression, irritability Sexual libido ejaculate volume erectile failure Organ specific features muscle mass and strength osteoporosis and fracture increased fat mass cardiovascular & metabolic Symptoms screening tools like AMS not helpful 1

2 Androgen deficiency in adults GnRH Testosterone: Three hormones in one General sense of well being, poor concentration tiredness, poor stamina mood change - depression, irritability Sexual libido ejaculate volume erectile failure Organ specific features muscle mass and strength osteoporosis and fracture increased fat mass cardiovascular & metabolic What mediates these diverse actions? LH Testosterone 6 mg/day aromatase (0.2%) Hepatic oxidation & conjugation Renal excretion Inactivation pathway 5a-reductase (5-10%) Amplification pathway (prostate, skin) DHT Direct pathway (muscle) Estradiol Androgen receptor Androgen receptor Y Estrogen receptors Diversification pathway (brain, bone) D Handelsman Implications of Three hormones in one J Clin Endo Metab 2010, 95, 2536 Testosterone is the molecule of choice for physiological androgen replacement Testosterone Therapy in Men with Androgen Deficiency Syndromes: Endocrine Society Clinical Practice Guideline Use, misuse and abuse of androgens. The Endocrine Society of Australia consensus guidelines for androgen prescribing Med J Australia 2000 ;172:220 Published Online: July 02, 2013 Conway A, Handelsman DJ, Lording DW, Stuckey B, Zajac JD. Update in preparation... Androgen replacement is warranted at ANY age when deficiency due to Hypothalamo-pituitary-testicular axis Hypothalamus Defined testicular or hypothalamo-pituitary disease Benefit of physiological replacement is based on evidence of safety & efficacy Challenge: to identify the patients Testosterone Estradiol Behaviour Prostate Muscles Skin & Hair Lipids Bone marrow Inhibin B GnRH Testis Pituitary Secondary testicular failure LH, FSH pulsatile Primary testicular failure 2

3 Basic approach to androgen deficiency Think of it: history and examination 1 st Blood: Serum total testosterone (fasting) between 0800 and 1000hr : circadian variation Adjust time frame for shift workers Wittert G. Curr Opin Endocrinol Diabetes Obes ; Repeat total T Confirmatory blood testing 30% normalize on repeat Serum LH: primary vs secondary testicular failure Serum SHBG and calculated free T Elevation: age, hyperthyroidism, liver disease, anti-epileptic therapies Suppression: obesity, insulin resistance, androgen exposure When a pathological cause of AD suspected Classic Androgen deficiency Low T, low LH? Pituitary failure Primary (high LH) impaired testis function Serum prolactin (prolactinoma) Iron studies (haemochromatosis) Pituitary function : cortisol, FT4, TSH, growth hormone Hypothalamo-pituitary MRI Low T, high LH Primary testicular failure Karyotype suspected Klinefelters Syndrome Y chromosome microdeletion in infertility context Klinefelter s syndrome Infertile men Testicular damage vascular, cancer Rx Secondary (low LH) hypothalamo-pituitary Prolactinoma Congenital GnRH deficiency (rare) Klinefelter s Syndrome 47XXY Commonest chromosomal disorder 1:600 males Commonest cause of undiagnosed androgen deficiency Almost all androgen deficient as adults - Benefit from replacement 70% escape diagnosis lifelong Bojesen JCEM 2003 detection strategies a major challenge Reject your stereotypical images of KS Classical KS in textbooks gynecomastia abdominal obesity small testicular volume varicose veins Profound learning difficulties narrow shoulders reduced body hair horizontal pubic hairline From: Nieschlag and Behre,

4 Classical KS Profound learning difficulties in textbooks narrow shoulders Not always!! gynecomastia may appear entirely normal reduced and body hair adequately virilised when clothed Classical KS in textbooks narrow shoulders Not always!! gynecomastia may appear entirely normal reduced and body hair adequately virilised when clothed abdominal obesity small testicular volume varicose veins horizontal pubic hairline From: Nieschlag and Behre, 2007 abdominal obesity horizontal pubic small testicular ~10,000 missed KS males in Australia hairline volume Failure to systemically examine male genitalia : flaw in education & practice From: Nieschlag and varicose veins Behre, 2007 Classical KS in textbooks narrow shoulders Not always!! gynecomastia may appear entirely normal reduced and body hair adequately virilised when clothed Small testes found on routine genital examination abdominal obesity horizontal pubic small testicular ~10,000 missed KS males in hairline Australia volume Failure to systemically examine male genitalia : flaw in education & practice From: Nieschlag and varicose veins Behre, 2007 Klinefelter s syndrome: The most overlooked cause of androgen deficiency. St John B & McLachlan RI Endocrinology Today 2015; 4(1): 8-14 Small testes found on routine genital examination Male infertility : IVF programs All types of practice Male health evaluation requires full history & routine physical exam Male factor infertility accounts for ~30% Spermatogenic failure is most common cause Azoospermia : ~14% are Klinefelters Androgen deficiency ~ 1 in 8 infertile men 4

5 Male infertility : IVF programs Now it gets tricky... Male factor infertility accounts for ~30% Spermatogenic failure is most common cause Azoospermia : ~14% are Klinefelters Androgen deficiency ~ 1 in 8 infertile men Low testosterone associated with Chronic disease Obesity Diabetes? Age per se When if ever is testosterone treatment warranted? Now it gets tricky University of Washington Olympic Gold Medal Crew Low testosterone associated with Chronic disease Obesity Diabetes? Age per se All share common non specific symptoms with androgen deficiency When if ever is testosterone treatment warranted? Courtesy J Amory 1936 University of Washington Olympic Gold Medal Crew 50-Year Reunion Courtesy J Amory 5

6 Low T - How to Sell Disease Schwartz & Woloshin JAMA June 3 rd 2013 A man on TV is selling me a miracle cure that will keep me young forever. It s called Androgel for treating something called Low T, a pharmaceutical company recognized condition affecting millions of men with low testosterone, previously known as getting older. The Colbert Report,1st December Serum Testosterone (nmol/l) Healthy Man Study Sartorius G et al Clin Endocrinol 2012 ;77:755 Testosterone n=325 men, 2900 serum specimens Age (years) Serum Testosterone (nmol/l) Healthy Man Study Sartorius G et al Clin Endocrinol 2012 ;77:755 Testosterone n=325 men, 2900 serum specimens Serum T did not vary with age Age (years) Andropause hypothesis T Age Symptoms Barometer of Health hypothesis Disease European Male Aging Study (EMAS) Relationship between Age and Testosterone in 3220 Men >60% population Wu FCW et al. J Clin Endocrin Metab 93(7): (2008) 6

7 European Male Aging Study (EMAS) Relationship between Age and Testosterone in 3220 Men Andropause hypothesis Age Barometer of Health hypothesis BMI <25 BMI BMI 30 T A Disease 2 B Symptoms Wu FCW et al. J Clin Endocrin Metab 93(7): (2008) Andropause hypothesis Age Barometer of Health hypothesis Philosophy of Testosterone Treatment Physiological replacement ( natural therapy ) T? Testosterone as adjunct in management A Symptoms Disease 2 B Replicate normality in HYPOGONADAL men Definition and identification of subjects Pharmacological treatment (as a drug) Dose for desired effect in EUGONADAL men Risk : benefit ratio What is your goal? Does testosterone work? Are there better approaches? Serum T 6.4 nm: maybe testosterone will help? When is enough too much? 7

8 Serum testosterone rises as body weight falls Grossmann M JCEM 2011, 96, 2341 Serum T levels Testosterone as a drug emerging therapeutic roles requiring RCT data 1. Metabolic syndrome & diabetes 2. Frailty age or disease related sarcopenia Weight loss Ageing, overweight men with type 2 diabetes and low T levels lifestyle measures such as weight loss and exercise 3. Depression 4. Cardiovascular health Testosterone for Prevention of Type 2 Diabetes in High Risk Men: placebo-controlled RCT Wittert G Andropause hypothesis Age Barometer of Health hypothesis Hypothesis: Reduce onset/reverse Type 2 DM in men with low T, over and above a lifestyle program T Disease Secondary endpoints: body composition systemic & vascular inflammation mood, QOL, psychosocial function adherence to the lifestyle program ~420 randomised Target 1000? Testosterone as adjunct in management A Symptoms 2 B Andropause hypothesis Age Barometer of Health hypothesis Current climate in TRT in aging men Testosterone Replacement Therapy Faces FDA Scrutiny Garnick M. JAMA, 2015: 313, 563 T Compelling case for RCTs on specific endpoints efficacy safety A Symptoms Disease 2 B Disease Mongering of Age-Associated Declines in Testosterone and Growth Hormone Levels Perls T & Handelsman DJ J American Geriatrics Society, 2015 in press PBS support threshold in men > 40 yr without a defined testicular or pituitary cause lowered to 6nM 8

9 Cardiovascular risk : evidence is contradictory and inconclusive US FDA review : no increase of major CV events in testosterone-treated men. Observational studies In older men: increased and decreased CV events Mostly retrospective studies, non-randomised, multiple biases and confounders RCTs CV events with high dose Te therapy in frail old men Unconfirmed in another RCT in similar men Meta-analysis: 3,000 mainly older men - in range of CV events..many limitations to data But FDA mandates labelling of US testosterone products to warn about a possible increased risk of heart attack and stroke Use with caution, if at all, in older men, especially with known cardiovascular disease. Unstable cardiac disease or recent CV (within 6-12 months) constitute contraindications Dr No Testosterone? Dr Not first option and not without deep reflection Lifestyle Diet Exercise Managing Homer Medical diabetes, hypertension, dyslipidemia Psychosexual issues Judicious use of PDE5 inhibitors Consideration of androgen therapy Realistic benefits RCT data low quality Risks -? cardiovascular Testosterone does not enhance efficacy of sildenafil in erectile dysfunction: RCT data years Total T <10 nm Optimal sildenafil dose Testosterone / placebo gel for 14 weeks Testosterone no added benefit to sildenafil alone Spitzer M Ann Intern Med :681 9

10 Testosterone preparations Testosterone preparations Testosterone replacement: individualized approach Tailored to clinical setting induction virilisation vs replacement in adulthood Compliance Age Courtesy of M Zitzmann, Munster Reandron Testosterone Preparations Adoption of Reandron Australia T gel, patch, axilla,cream T esters im Serum Te (nm) T implant T undecanoate im Reandron Days Weeks Normal range No oral or synthetic formulations Handelsman MJA 2012:196, Issues with T undecanoate 15 years experience Europe, 10 yr in Australia Widey reported in long term use Zitzmann M J Sex Med 2013: 10:579 Wang C J Androl 2010;31:457 Inject 4ml slowly 2 mins! Post injection cough ~1:50 injection; mild/mod. Midddleton Eur J Endocrinol 2015 Jan 30 Monitoring androgen therapy Age-appropriate general medical care lipids, blood pressure, weight Special considerations: elderly: avoid long acting formulations - polycythemia prostate health cardiovascular health sleep apnea prior history or risk factors Desire for fertility is a contraindication 10

11 Systematic reviews of prostate cancer risk Testosterone therapy in hypogonadal men and prostate cancer risk: a systematic review. Shabsigh R Int J Impot Res 2009;21:9 44 studies: No increased prostate cancer risk Effect of testosterone replacement therapy on prostate cancer: systematic review & meta-analysis. Cui Y Prostate Cancer Prostatic Dis 2014;17: RCTs, n= 2351: no increase in short-term Long-term data are warranted Key messages 1. Native testosterone is preferred sex steroid 2. Focus on identifying established deficiency 3. Low T level are frequently associated with common comorbidities - these ought be the primary focus 4. RCT data on testosterone as a drug awaited 5. Testosterone therapy is readily monitored: convenience = compliance Clinical summary guides Courses for GPs accredited education provider through RACGP Course description Younger male health male infertility, testicular cancer, Online ALM (Free) Klinefelters, PE, prostatitis Older male health Aboriginal and Torres Strait Islander males Type androgen deficiency, erectile Online ALM (Free) dysfunction & co-morbid disease, prostate disease. Tailored knowledge and skills to Male Health Education initiate dialogue and DVD engagement (Free) RACGP QI &CPD Point s 40 Category 1 40 Category 1 30 PRPD points 30 PRPD points 4 Category 2 2 Core points Men s sexual and Postgraduate Unit Dept. of reproductive health General Practice, Monash Univ. Distance education (Feepayable) Contact the Coordinator 11

12 Many thanks! 12

Outline. Classic Androgen deficiency. Cardiovascular Risk and Testosterone Fact vs Fiction. Professor Robert I McLachlan AM, FRACP, PhD

Outline. Classic Androgen deficiency. Cardiovascular Risk and Testosterone Fact vs Fiction. Professor Robert I McLachlan AM, FRACP, PhD Health Ed Brisbane Saturday 27 th October 2018 Cardiovascular Risk and Testosterone Fact vs Fiction Professor Robert I McLachlan AM, FRACP, PhD Hudson Institute of Medical Research, Monash University Department

More information

15% ART accounts for ~4% of Australian births

15% ART accounts for ~4% of Australian births The General Practice Education Day HealthEd / Generation Next 23 rd July Brisbane Declarations Male Infertility & Assisted Reproduction Equity interest in Monash IVF Group Prof Robert I McLachlan FRACP,

More information

15% ART accounts for ~4% of Australian births

15% ART accounts for ~4% of Australian births The General Practice Education Day HealthEd / Generation Next 20 th February Sydney Declarations Male Infertility & Assisted Reproduction Prof Robert I McLachlan FRACP, Ph.D. Consultant Andrologist, Monash

More information

15% ART accounts for ~4% of Australian births

15% ART accounts for ~4% of Australian births The General Practice Education Day HealthEd / Generation Next 5 th March Melbourne Declarations Male Infertility & Assisted Reproduction Prof Robert I McLachlan FRACP, Ph.D. Consultant Andrologist, Monash

More information

Hypogonadism 4/27/2018. Male Hypogonadism -- Definition. Epidemiology. Objectives HYPOGONADISM. Men with Hypogonadism. 95% untreated.

Hypogonadism 4/27/2018. Male Hypogonadism -- Definition. Epidemiology. Objectives HYPOGONADISM. Men with Hypogonadism. 95% untreated. Male Hypogonadism -- Definition - Low T, Low Testosterone Hypogonadism -...a clinical syndrome that results from failure of the testes to produce physiological concentrations of testosterone due to pathology

More information

Hypogonadism in Men. CME Away India & Sri Lanka March 23 - April 7, 2018

Hypogonadism in Men. CME Away India & Sri Lanka March 23 - April 7, 2018 Hypogonadism in Men CME Away India & Sri Lanka March 23 - April 7, 2018 Richard A. Bebb MD, ABIM, FRCPC Consultant Endocrinologist Medical Subspecialty Institute Cleveland Clinic Abu Dhabi Copyright 2017

More information

Androgen deficiency. Dr Rakesh Iyer Staff Specialist in Endocrinology Calvary hospital

Androgen deficiency. Dr Rakesh Iyer Staff Specialist in Endocrinology Calvary hospital Androgen deficiency Dr Rakesh Iyer Staff Specialist in Endocrinology Calvary hospital Outline Pathological androgen deficiency - Background, causes, interpretation - Indications for treatment Androgen

More information

BIOCHEMICAL TESTS FOR THE INVESTIGATION OF COMMON ENDOCRINE PROBLEMS IN THE MALE

BIOCHEMICAL TESTS FOR THE INVESTIGATION OF COMMON ENDOCRINE PROBLEMS IN THE MALE Authoriser: Moya O Doherty Page 1 of 7 BIOCHEMICAL TESTS FOR THE INVESTIGATION OF COMMON ENDOCRINE PROBLEMS IN THE MALE The purpose of this protocol is to describe common tests used for the investigation

More information

PRISM Bruges June Herman Leliefeld Urologist. The Netherlands

PRISM Bruges June Herman Leliefeld Urologist. The Netherlands PRISM Bruges 25-26 June 2015 Herman Leliefeld Urologist The Netherlands Guidelines EAU 2015: a rich source of Knowledge! Epidemiology/ Aetiology / Pathology Diagnostic evaluation Disease management Follow-Up

More information

A dro r gen e R e R p e lac a e c m e e m n e t t T her e a r p a y Androgen Replacement Therapy in the Aging O j b ecti t ve v s Male

A dro r gen e R e R p e lac a e c m e e m n e t t T her e a r p a y Androgen Replacement Therapy in the Aging O j b ecti t ve v s Male Androgen Replacement Therapy in the Aging Male Thomas J. Walsh, MD, MS Department of Urology University of California, San Francisco Objectives 1. List 3 effects of androgens on normal male physiology.

More information

ANDROGEN DEFICIENCY/MALE HYPOGONADISM

ANDROGEN DEFICIENCY/MALE HYPOGONADISM ANDROGEN DEFICIENCY/MALE HYPOGONADISM 1. Medical Condition Hypogonadism in men is a clinical syndrome that results from failure of the testes to produce physiological levels of testosterone (androgen deficiency)

More information

Point-Counterpoint: Late Onset Hypogonadism (LOH)

Point-Counterpoint: Late Onset Hypogonadism (LOH) Point-Counterpoint: Late Onset Hypogonadism (LOH) We are Under-diagnosing and Treating Men with LOH LOH is a Non-existent Disease ~ Robert E. Donohue, MD Late Onset Hypogonadism LOH: underdx. & undertx

More information

Evaluation and Treatment of Primary Androgen Deficiency Syndrome in Male Patients

Evaluation and Treatment of Primary Androgen Deficiency Syndrome in Male Patients Evaluation and Treatment of Primary Androgen Deficiency Syndrome in Male Patients Jeff Unger, MD Director Chino Medical Group Diabetes and Headache Intervention Center Chino, California January 16, 2008

More information

Testosterone Therapy in Men An update

Testosterone Therapy in Men An update Testosterone Therapy in Men An update SANDEEP DHINDSA Associate Professor of Medicine Director, Division of Endocrinology and Metabolism, Saint Louis University, St. Louis, MO Presenter Disclosure None

More information

Contents. At A Glance 04. Male Hormones 06. Androgen Deficiency 10. Symptoms 11. Causes 14. Staying Healthy 20. Diagnosis 22. Treatment 29.

Contents. At A Glance 04. Male Hormones 06. Androgen Deficiency 10. Symptoms 11. Causes 14. Staying Healthy 20. Diagnosis 22. Treatment 29. Androgen Deficiency Contents At A Glance 04 Male Hormones 06 Androgen Deficiency 10 Symptoms 11 - DATE REVIEWED: JANUARY 2019 (6TH EDITION) Healthy Male (Andrology Australia) 2003 Causes 14 Staying Healthy

More information

Prof. Dr. Michael Zitzmann Internal Medicine Endocrinology, Diabetology, Andrology University of Muenster, Germany

Prof. Dr. Michael Zitzmann Internal Medicine Endocrinology, Diabetology, Andrology University of Muenster, Germany Induction of fertility in hypogonadal men Prof. Dr. Michael Zitzmann Internal Medicine Endocrinology, Diabetology, Andrology University of Muenster, Germany Induction of fertility in hypogonadal men Prof.

More information

Index. urologic.theclinics.com. Note: Page numbers of article titles are in boldface type.

Index. urologic.theclinics.com. Note: Page numbers of article titles are in boldface type. Note: Page numbers of article titles are in boldface type. A Acquired hypogonadism, prevalence of, 165 167 primary, 165 secondary, 167 Adipose tissue, as an organ, 240 241 Adrenal hyperplasia, congenital,

More information

GUIDELINES ON. Introduction. G.R. Dohle, S. Arver, C. Bettocchi, S. Kliesch, M. Punab, W. de Ronde

GUIDELINES ON. Introduction. G.R. Dohle, S. Arver, C. Bettocchi, S. Kliesch, M. Punab, W. de Ronde GUIDELINES ON Male Hypogonadism G.R. Dohle, S. Arver,. Bettocchi, S. Kliesch, M. Punab, W. de Ronde Introduction Male hypogonadism is a clinical syndrome caused by androgen deficiency. It may adversely

More information

Male History, Clinical Examination and Testing

Male History, Clinical Examination and Testing Male History, Clinical Examination and Testing Dirk Vanderschueren, MD, PhD Case Jan is 29 years old and consults for 1 year primary subfertility partner 28 years old and normal gynaecological investigation

More information

Testosterone Therapy in Men with Hypogonadism

Testosterone Therapy in Men with Hypogonadism Testosterone Therapy in Men with Hypogonadism (Endocrine Society 2018 Guideline) Ngwe Yin, MD Assistant Clinical Professor of Medicine, UCSF Fresno Medical Education Program Disclosures None Objective

More information

Recognizing and Managing Testosterone Deficiency

Recognizing and Managing Testosterone Deficiency Recognizing and Managing Testosterone Deficiency J. Bruce Redmon, M.D. Professor Division of Endocrinology Departments of Medicine and Urologic Surgery Disclosure Information I have no financial relationships

More information

How to treat: TRT modalities and formulations

How to treat: TRT modalities and formulations How to treat: TRT modalities and formulations Paul PIETTE, PharmD Senior Research Fellow Clinique Antoine Depage - Belgium ppiette@besins-healthcare.com Bruges 2014, May 15 th Testosterone-replacement

More information

Corporate Medical Policy Testosterone Pellet Implantation for Androgen Deficiency

Corporate Medical Policy Testosterone Pellet Implantation for Androgen Deficiency Corporate Medical Policy Testosterone Pellet Implantation for Androgen Deficiency File Name: Origination: Last CAP Review: Next CAP Review: Last Review: testosterone_pellet_implantation_for_androgen_deficiency

More information

Endocrine Update Mary T. Korytkowski MD Division of Endocrinology University of Pittsburgh

Endocrine Update Mary T. Korytkowski MD Division of Endocrinology University of Pittsburgh Endocrine Update 2016 Mary T. Korytkowski MD Division of Endocrinology University of Pittsburgh Disclosure of Financial Relationships Mary Korytkowski MD Honoraria British Medical Journal Diabetes Research

More information

EAU GUIDELINES ON MALE HYPOGONADISM

EAU GUIDELINES ON MALE HYPOGONADISM EAU GUIDELINES ON MALE HYPOGONADISM (Limited text update March 2017) G.R. Dohle (Chair), S. Arver, C. Bettocchi, T.H. Jones, S. Kliesch Introduction Male hypogonadism is a clinical syndrome caused by androgen

More information

Testosterone Treatment: Myths Vs Reality. Fadi Al-Khayer, M.D, F.A.C.E

Testosterone Treatment: Myths Vs Reality. Fadi Al-Khayer, M.D, F.A.C.E Testosterone Treatment: Myths Vs Reality Fadi Al-Khayer, M.D, F.A.C.E The Biological Functions of Testosterone in Men Testosterone is essential to the musculoskeletal and metabolic systems throughout a

More information

ANDROGEN DEFICIENCY/MALE HYPOGONADISM

ANDROGEN DEFICIENCY/MALE HYPOGONADISM Medical Information to Support the Decisions of TUE Committees 1. Medical Condition Hypogonadism in men is a clinical syndrome that results from failure of the testes to produce physiological levels of

More information

What Is the Low T Syndrome? Is Testosterone Supplementation Safe?

What Is the Low T Syndrome? Is Testosterone Supplementation Safe? What Is the Low T Syndrome? Is Testosterone Supplementation Safe? UCSF Osher Mini Medical School March 7, 2018 Dolores Shoback, MD Staff Physician SF-VAMC Professor of Medicine, UCSF No disclosures or

More information

Men Getting Older Will Testosterone Keep Him Young?

Men Getting Older Will Testosterone Keep Him Young? Men Getting Older Will Testosterone Keep Him Young? Alvin M. Matsumoto, M.D. Associate Director, GRECC V.A. Puget Sound Health Care System Professor, Department of Medicine Division of Gerontology and

More information

6/14/2010. GnRH=Gonadotropin-Releasing Hormone.

6/14/2010. GnRH=Gonadotropin-Releasing Hormone. Male Androgen Replacement Mitchell Sorsby, MD June 19, 2010. QUESTION # 1 Which of the following is not a symptom associated with low T levels? a) decreased libido b) erectile dysfunction c) depression

More information

Late onset Hypogonadism. Dr KhooSay Chuan Department of Urology Penang General Hospital

Late onset Hypogonadism. Dr KhooSay Chuan Department of Urology Penang General Hospital Late onset Hypogonadism Dr KhooSay Chuan Department of Urology Penang General Hospital Late onset hypogonadism(loh) Definition LOH age associated testoteronedeficiency syndrome (TDS) Male menopause, andropause,

More information

ANDROGEN DEFICIENCY A GUIDE TO MALE HORMONES A BOOKLET IN THE SERIES OF CONSUMER GUIDES ON MALE REPRODUCTIVE HEALTH FROM

ANDROGEN DEFICIENCY A GUIDE TO MALE HORMONES A BOOKLET IN THE SERIES OF CONSUMER GUIDES ON MALE REPRODUCTIVE HEALTH FROM ANDROGEN DEFICIENCY A GUIDE TO MALE HORMONES A BOOKLET IN THE SERIES OF CONSUMER GUIDES ON MALE REPRODUCTIVE HEALTH FROM First published in July 2003 by Andrology Australia 5th Edition, December 2015 Copyright

More information

GUIDELINES ON MALE HYPOGONADISM

GUIDELINES ON MALE HYPOGONADISM GUIDELINES ON MALE HYPOGONADISM (Text update March 2015) G.R. Dohle (Chair), S. Arver, C. Bettocchi, T.H. Jones, S. Kliesch, M. Punab Introduction Male hypogonadism is a clinical syndrome caused by androgen

More information

TESTOSTERONE DEFINITION

TESTOSTERONE DEFINITION DEFINITION A hormone that is a hydroxyl steroid ketone (C19H28O2) produced especially by the testes or made synthetically and that is responsible for inducing and maintaining male secondary sex characteristics.

More information

EAU GUIDELINES ON MALE HYPOGONADISM

EAU GUIDELINES ON MALE HYPOGONADISM EAU GUIDELINES ON MALE HYPOGONADISM (Text update March 2015) G.R. Dohle (Chair), S. Arver, C. Bettocchi, T.H. Jones, S. Kliesch, M. Punab Introduction Male hypogonadism is a clinical syndrome caused by

More information

Late Onset Hypogonadism. Toh Charng Chee Hospital Selayang

Late Onset Hypogonadism. Toh Charng Chee Hospital Selayang Late Onset Hypogonadism Toh Charng Chee Hospital Selayang Introduction Although suppressed serum testosterone (T) is common in ageing men, only a small proportion of them develop the genuine syndrome of

More information

Update on diagnosis and complications of adult and elderly male hypogonadism

Update on diagnosis and complications of adult and elderly male hypogonadism Hypoandrogenism in the elderly: to treat or not to treat? 12 th Italian AME Meeting; 6 th joint Meeting with AAC Bari november 10th Update on diagnosis and complications of adult and elderly male hypogonadism

More information

Prof Dato Dr TAN Hui Meng University of Malaya, Kuala Lumpur University of Pennsylvania, USA

Prof Dato Dr TAN Hui Meng University of Malaya, Kuala Lumpur University of Pennsylvania, USA Prof Dato Dr TAN Hui Meng University of Malaya, Kuala Lumpur University of Pennsylvania, USA Prevailing context Increase number of men who are potential candidates for Testosterone Replacement Therapy

More information

Disclosures. Learning Objectives. Effects of Hormone Therapy on the Metabolic Syndrome and Cardiovascular Disease. None

Disclosures. Learning Objectives. Effects of Hormone Therapy on the Metabolic Syndrome and Cardiovascular Disease. None Effects of Hormone Therapy on the Metabolic Syndrome and Cardiovascular Disease Micol S. Rothman, MD Associate Professor of Medicine Endocrinology, Diabetes and Metabolism Clinical Director Metabolic Bone

More information

Managing Testosterone Deficiency: A Practical Guide. John Grantmyre MD Professor of Urology Dalhousie University

Managing Testosterone Deficiency: A Practical Guide. John Grantmyre MD Professor of Urology Dalhousie University Managing Testosterone Deficiency: A Practical Guide John Grantmyre MD Professor of Urology Dalhousie University 1 2 Case Study #1 A 59-Year-Old Man with Erectile Dysfunction 3 Case History Robert is a

More information

Implantable Hormone Pellets

Implantable Hormone Pellets Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the Company ), unless otherwise provided

More information

HYPOGONADISM DEFINITION: PRODUCTION OF SEX HORMONES AND GERM CELLS IS INADEQUATE (ENDOCRINE SOCIETY)

HYPOGONADISM DEFINITION: PRODUCTION OF SEX HORMONES AND GERM CELLS IS INADEQUATE (ENDOCRINE SOCIETY) HYPOGONADISM DEFINITION: PRODUCTION OF SEX HORMONES AND GERM CELLS IS INADEQUATE (ENDOCRINE SOCIETY) DEFECT OF THE REPRODUCTIVE SYSTEM THAT RESULTS IN LACK OF FUNCTION OF THE GONADS (Wikipedia) REDUCTION

More information

Hormone Replacement Therapy

Hormone Replacement Therapy Hormone Replacement Therapy What Role Should It Play With Our Patients? Noel R. Williams MD, FACOG TESTOSTERONE FOR MEN: SALVATION OR SNAKE OIL? Definition Male hypogonadism means the testicles don't produce

More information

Assessment and management of male androgen disorders: an update

Assessment and management of male androgen disorders: an update Irene Chan Mark Ng Tang Fui Jeffrey D Zajac Mathis Grossmann Assessment and management of male androgen disorders: an update Background Male hypogonadism, caused by intrinsic pathology of the hypothalamic

More information

More than meets the eye

More than meets the eye More than meets the eye Ana Paula Abreu, MD, PhD American Association of Clinical Endocrinologists New England Chapter Annual Meeting September 8, 2018 Disclosures No conflict of interest or significant

More information

Laboratory Investigation of Male Gonadal Function. Dr N Oosthuizen Dept of Chemical Pathology UP 2010

Laboratory Investigation of Male Gonadal Function. Dr N Oosthuizen Dept of Chemical Pathology UP 2010 Laboratory Investigation of Male Gonadal Function Dr N Oosthuizen Dept of Chemical Pathology UP 2010 1 Figure 1. Hypothalamic-pituitary pituitary-testicular testicular axis 2 Testosterone (T) measurement

More information

Consent for Testosterone Therapy-Men Revised 4/10/18

Consent for Testosterone Therapy-Men Revised 4/10/18 Consent for Testosterone Therapy in Men You have been diagnosed with or have an increased risk of having a hormone deficiency and your provider has recommended treatment with bio-identical hormone replacement

More information

TUE Physician Guidelines Medical Information to Support the Decisions of TUE Committees MALE HYPOGONADISM MALE HYPOGONADISM

TUE Physician Guidelines Medical Information to Support the Decisions of TUE Committees MALE HYPOGONADISM MALE HYPOGONADISM 1. Medical Condition Hypogonadism in men is a clinical syndrome that results from failure of the testes to produce physiological levels of testosterone (testosterone deficiency) and in some instances normal

More information

Hormones of brain-testicular axis

Hormones of brain-testicular axis (Hormone Function) Hormones of brain-testicular axis anterior pituitary drives changes during puberty controlled by GnRH from hypothalamus begins to secrete FSH, LH LH targets interstitial endocrinocytes

More information

A USER S GUIDE WHAT EVERY MAN NEEDS TO KNOW

A USER S GUIDE WHAT EVERY MAN NEEDS TO KNOW A USER S GUIDE WHAT EVERY MAN NEEDS TO KNOW 1. Why men need to know more Good health is vital for a happy and full life. But, with work and family responsibilities, men often overlook their own health

More information

Sexual dysfunction of chronic kidney disease. Razieh salehian.md psychiatrist

Sexual dysfunction of chronic kidney disease. Razieh salehian.md psychiatrist Sexual dysfunction of chronic kidney disease Razieh salehian.md psychiatrist Disturbances in sexual function are a common feature of chronic renal failure. Sexual dysfunction is inversely associated with

More information

HORMONE THERAPY IN AGING MALE ATHLETES

HORMONE THERAPY IN AGING MALE ATHLETES DISCLOSURES HORMONE THERAPY IN AGING MALE ATHLETES No relevant affiliations or financial interests When, Why and is it Safe? OBJECTIVES Summarize the benefits of optimizing hormone balance Examine the

More information

Male Hypogonadism. Types and causes of hypogonadism. What is male hypogonadism? Symptoms. Testosterone production. Patient Information.

Male Hypogonadism. Types and causes of hypogonadism. What is male hypogonadism? Symptoms. Testosterone production. Patient Information. Patient Information English 31 Male Hypogonadism The underlined terms are listed in the glossary. What is male hypogonadism? Male hypogonadism means the testicles do not produce enough of the male sex

More information

ISSM QUICK REFERENCE GUIDE ON TESTOSTERONE DEFICIENCY FOR MEN

ISSM QUICK REFERENCE GUIDE ON TESTOSTERONE DEFICIENCY FOR MEN International Society for Sexual Medicine - www.issm.info ISSM QUICK REFERENCE GUIDE ON TESTOSTERONE DEFICIENCY FOR MEN Version: September 2015 What is testosterone deficiency? Testosterone deficiency

More information

Clinical evaluation of infertility

Clinical evaluation of infertility Clinical evaluation of infertility DR. FARIBA KHANIPOUYANI OBSTETRICIAN & GYNECOLOGIST PRENATOLOGIST Definition: inability to achieve conception despite one year of frequent unprotected intercourse. Male

More information

Diagnosis and Clinical Evaluation of Hypogonadism in Adult Patients with Obesity and Diabetes

Diagnosis and Clinical Evaluation of Hypogonadism in Adult Patients with Obesity and Diabetes Diagnosis and Clinical Evaluation of Hypogonadism in Adult Patients with Obesity and Diabetes Adrian Dobs, M.D., M.H.S. Professor of Medicine and Oncology The Johns Hopkins University School of Medicine

More information

MALE HYPOGONADISM: CHOOSING THE APPROPRIATE THERAPY. Michael S. Irwig, M.D. Director, Center for Andrology Division of Endocrinology & Metabolism

MALE HYPOGONADISM: CHOOSING THE APPROPRIATE THERAPY. Michael S. Irwig, M.D. Director, Center for Andrology Division of Endocrinology & Metabolism MALE HYPOGONADISM: CHOOSING THE APPROPRIATE THERAPY Michael S. Irwig, M.D. Director, Center for Andrology Division of Endocrinology & Metabolism Disclosures Aromatase inhibitors & clomiphene citrate are

More information

Diseases / conditions affecting the steroid profile in blood

Diseases / conditions affecting the steroid profile in blood Athlete Biological Passport Symposion Rome, Nov. 5 7, 2018 Diseases / conditions affecting the steroid profile in blood Eberhard Nieschlag Centre of Reproductive Medicine & Andrology University Hospital

More information

An Idea Whose Time Has Come-Male Health Programs: An Opportunity For Clinical Expansion and Better Health

An Idea Whose Time Has Come-Male Health Programs: An Opportunity For Clinical Expansion and Better Health An Idea Whose Time Has Come-Male Health Programs: An Opportunity For Clinical Expansion and Better Health KEVIN R. LOUGHLIN MD,MBA Harvard Medical School Boston, MA THE WEAKER SEX-MALES LIFE EXPECTANCY

More information

11: Androgen deficiency and replacement therapy in men

11: Androgen deficiency and replacement therapy in men 11: Androgen deficiency and replacement therapy in men While androgen replacement therapy is essential and effective in overt deficiency, it is no anti-ageing elixir David J Handelsman and Jeffrey D Zajac

More information

Testosterone deficiency in men Diagnosis and management

Testosterone deficiency in men Diagnosis and management THEME: Men s health Testosterone deficiency in men Diagnosis and management Carolyn A Allan, Robert I McLachlan Carolyn A Allan, MBBS, FRACP, is Research Fellow, Prince Henry s Institute of Medical Research,

More information

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

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

More information

ANDROGEN DEFICIENCY Update on Evaluation and Management

ANDROGEN DEFICIENCY Update on Evaluation and Management ANDROGEN DEFICIENCY Update on Evaluation and Management Kristen Gill Hairston, MD, MPH Associate Professor of Internal Medicine Section of Endocrinology and Metabolism Wake Forest University School of

More information

Evaluation and Management of Pituitary Failure. Dr S. Ali Imran MBBS, FRCP (Edin), FRCPC Professor of Medicine Dalhousie University, Halifax, NS

Evaluation and Management of Pituitary Failure. Dr S. Ali Imran MBBS, FRCP (Edin), FRCPC Professor of Medicine Dalhousie University, Halifax, NS Evaluation and Management of Pituitary Failure Dr S. Ali Imran MBBS, FRCP (Edin), FRCPC Professor of Medicine Dalhousie University, Halifax, NS Conflict of Interest None Objectives Diagnostic approach

More information

Low Testosterone Consultation Information

Low Testosterone Consultation Information T Low Testosterone Consultation Information www.urologyaustin.com Andropause or Male Menopause This syndrome has been nicknamed ADAM, which stands for androgen deficiency of the aging male. It differs

More information

Male reproductive physiology

Male reproductive physiology START Lecture Series Crown Conference Centre, Melbourne Feb 18 th 2017 Male reproductive physiology Prof Robert I McLachlan FRACP, Ph.D., AM Director, Clinical Research, Hudson Institute Consultant Andrologist,

More information

Implantable Hormone Pellets

Implantable Hormone Pellets Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the Company ), unless otherwise provided

More information

Androderm patch, AndroGel packets and pump, Axiron solution, First- Testosterone, First-Testosterone MC, Fortesta gel, Testim gel, Vogelxo

Androderm patch, AndroGel packets and pump, Axiron solution, First- Testosterone, First-Testosterone MC, Fortesta gel, Testim gel, Vogelxo Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.30.31 Subject: Testosterone Topical Page: 1 of 9 Last Review Date: September 23, 2016 Testosterone topical

More information

Pharmacy Coverage Guidelines are subject to change as new information becomes available.

Pharmacy Coverage Guidelines are subject to change as new information becomes available. TESTOSTERONE REPLACEMENT THERAPY: ANDRODERM transdermal patch ANDROGEL pump transdermal gel and transdermal gel AXIRON transdermal solution FORTESTA transdermal gel NATESTO nasal gel STRIANT buccal mucoadhesive

More information

Late onset hypogonadism

Late onset hypogonadism Late onset hypogonadism Farrukh Javid Male Menopause Clinical AND biochemical syndrome Testosterone levels decline by 0.4-3% per year after the age of 30, as opposed to the more rapid decline that occurs

More information

Retrospective Study of Klinefelter Syndrome in Chinese Boys

Retrospective Study of Klinefelter Syndrome in Chinese Boys HK J Paediatr (new series) 2010;15:111-115 Retrospective Study of Klinefelter Syndrome in Chinese Boys KM BELARAMANI, LM WONG, NS KWONG Abstract Key words Background: Klinefelter syndrome (KS) is a common

More information

TUE Application for Testosterone Physician Worksheet

TUE Application for Testosterone Physician Worksheet TUE Application for Testosterone Physician Worksheet Attention Physicians - USADA will not process Therapeutic Use Exemptions (TUE) for the use of testosterone unless all of the requirements for documentation

More information

REPRODUCTIVE ENDOCRINOLOGY

REPRODUCTIVE ENDOCRINOLOGY Overview REPRODUCTIVE ENDOCRINOLOGY Specialist Portfolio Seminar 23 rd June 2014 Katie Jones Sandwell and West Birmingham Hospitals NHS Trust Hypothalamic pituitary gonadal axis Females Males Overview

More information

REPRODUCTIVE ENDOCRINOLOGY OF THE MALE

REPRODUCTIVE ENDOCRINOLOGY OF THE MALE Reproductive Biotechnologies Andrology I REPRODUCTIVE ENDOCRINOLOGY OF THE MALE Prof. Alberto Contri REPRODUCTIVE ENDOCRINOLOGY OF THE MALE SPERMATOGENESIS AND REPRODUCTIVE BEHAVIOR RELATED TO THE ACTIVITY

More information

Biology of Reproduction-Biol 326

Biology of Reproduction-Biol 326 Biology of Reproduction-Biol 326 READ ALL INSTRUCTIONS CAREFULLY. ANSWER ALL THE QUESTIONS ON THE ANSWER SHEET. THE ANSWER ON THE ANSWER SHEET IS YOUR OFFICIAL ANSWER REGARDLESS OF WHAT YOU MARK ON THE

More information

The Male Andropause. What are the symptoms? What are the risks of hormone deficiencies?

The Male Andropause. What are the symptoms? What are the risks of hormone deficiencies? The Male Andropause By: Dr. Sangeeta Pati MD, FACOG Although, the male andropause has not been widely recognized, increased medical research has turned attention to the gradual hormone decline in males

More information

Alternative management of hypogonadism Tamoxifen. Emmanuele A. Jannini, MD Tor Vergata University of Rome ITALY

Alternative management of hypogonadism Tamoxifen. Emmanuele A. Jannini, MD Tor Vergata University of Rome ITALY Alternative management of hypogonadism Tamoxifen Emmanuele A. Jannini, MD Tor Vergata University of Rome ITALY eajannini@gmail.com What hypogonadism is? What hypogonadism is? It is an empty glass The two

More information

Androgens. Medication Strengths Quantity Limit Comments Androderm (testosterone patch) 1% pump 2 pump bottles per Non-Preferred

Androgens. Medication Strengths Quantity Limit Comments Androderm (testosterone patch) 1% pump 2 pump bottles per Non-Preferred Market DC Androgens Override(s) Prior Authorization Quantity Limit Approval Duration Varies upon diagnosis Medication Strengths Quantity Limit Comments Androderm (testosterone patch) AndroGel (testosterone

More information

in Primary Care (Part 2) Jonathan R. Anolik, MD, FACP, FACE Lewis Katz School of Medicine at Temple University

in Primary Care (Part 2) Jonathan R. Anolik, MD, FACP, FACE Lewis Katz School of Medicine at Temple University Common Endocrine Problems Seen in Primary Care (Part 2) Lecture #34 Jonathan R. Anolik, MD, FACP, FACE Lewis Katz School of Medicine at Temple University None Conflict of Interest Topics to be Covered

More information

BAD TO THE BONE. Peter Jones, Rheumatologist QE Health, Rotorua. GP CME Conference Rotorua, June 2008

BAD TO THE BONE. Peter Jones, Rheumatologist QE Health, Rotorua. GP CME Conference Rotorua, June 2008 BAD TO THE BONE Peter Jones, Rheumatologist QE Health, Rotorua GP CME Conference Rotorua, June 2008 Agenda Osteoporosis in Men Vitamin D and Calcium Long-term treatment with Bisphosphonates Pathophysiology

More information

Prescribing Guidelines

Prescribing Guidelines Porterbrook Clinic Sheffield Gender Identity Clinic Michael Carlisle Centre 75 Osborne Road Sheffield S11 9BF Version V10 22-01-18 Tel: 0114 271 6671 Fax: 0114 271 8693 Email: Porterbrook@shsc.nhs.uk Website:

More information

GONADAL FUNCTION: An Overview

GONADAL FUNCTION: An Overview GONADAL FUNCTION: An Overview University of PNG School of Medicine & Health Sciences Division of Basic Medical Sciences Clinical Biochemistry BMLS III & BDS IV VJ Temple 1 What are the Steroid hormones?

More information

The reality of LOH-symptoms

The reality of LOH-symptoms The reality of LOH-symptoms PRISM IV Bruges, Belgium September 25-26, 2014 Dr. Herman Leliefeld Androsmannenkliniek The Netherlands The reality of LOH symptoms male external & internal genitalia Testosterone

More information

Hormone Replacement Therapy For Men Consultation Information

Hormone Replacement Therapy For Men Consultation Information Hormone Replacement Therapy For Men Consultation Information www.urologyaustin.com Biological Aging and Hormones As we age, a natural degeneration and aging of organs causes the levels of our hormones

More information

OVERVIEW OF PRESENTATION

OVERVIEW OF PRESENTATION Thanh D. Hoang, DO, FACP, FACE Division of Endocrinology Department of Internal Medicine WRNMMC 13 Aug 2018 OVERVIEW OF PRESENTATION Take Home Points Definition of Hypogonadism Clinical Manifestations

More information

What You Need to Know

What You Need to Know UW MEDICINE PATIENT EDUCATION What You Need to Know Facts about male infertility This handout explains what causes male infertility, how it is diagnosed, and possible treatments. Infertility is defined

More information

Testosterone Therapy and the Prostate. Frans M.J. Debruyne Professor of Urology The Netherlands

Testosterone Therapy and the Prostate. Frans M.J. Debruyne Professor of Urology The Netherlands Testosterone Therapy and the Prostate Frans M.J. Debruyne Professor of Urology The Netherlands TRT- Risks Prostate ( Cancer, BPH )? Cardiac? Lipids? Polycythemia Sleep apnea Gynecomastia Edema Testosterone

More information

Testosterone: Current Opinion and Controversy

Testosterone: Current Opinion and Controversy Testosterone: Current Opinion and Controversy Ravi Kacker, MD Metrowest Urology (508) 655 4422 Medical Office Building at Leonard Morse Hospital Disclosures MHB Labs President and CEO of Drug Development

More information

Polycystic Ovary Syndrome HEATHER BURKS, MD OU PHYSICIANS REPRODUCTIVE MEDICINE SEPTEMBER 21, 2018

Polycystic Ovary Syndrome HEATHER BURKS, MD OU PHYSICIANS REPRODUCTIVE MEDICINE SEPTEMBER 21, 2018 Polycystic Ovary Syndrome HEATHER BURKS, MD OU PHYSICIANS REPRODUCTIVE MEDICINE SEPTEMBER 21, 2018 Learning Objectives At the conclusion of this lecture, learners should: 1) Know the various diagnostic

More information

Developing clinical stage small molecule therapeutics to treat hormonal and reproductive system disorders

Developing clinical stage small molecule therapeutics to treat hormonal and reproductive system disorders Developing clinical stage small molecule therapeutics to treat hormonal and reproductive system disorders Repros Disclaimer Any statements made by the Company that are not historical facts contained in

More information

Patient education for transgender feminizing hormone therapy

Patient education for transgender feminizing hormone therapy Date name DOB Patient education for transgender feminizing hormone therapy o Some transsexual, transgender, and gender non-conforming people choose to take hormone therapy to treat gender dysphoria and

More information

Over the past decade, androgen replacement

Over the past decade, androgen replacement J. Andrew Hoover, MD; Jeffrey T. Kirchner, DO, FAAFP Department of Family and Community Medicine, Lancaster General Hospital, Pa jhoover4@lghealth.org The authors reported no potential conflict of interest

More information

Naviga2ng the Adverse Effects of ADT: Improving Pa2ent Outcomes

Naviga2ng the Adverse Effects of ADT: Improving Pa2ent Outcomes Naviga2ng the Adverse Effects of ADT: Improving Pa2ent Outcomes E. David Crawford, M.D. Professor of Surgery/ Urology/ Radiation Oncology University of Colorado Greetings from Colorado Disclosures Consultant:

More information

Definition of Andropause

Definition of Andropause HORMONE REPLACEMENT THERAPY FOR MEN Thomas C. Reed R.Ph., F.A.C.A. Reed s Compounding Pharmacy 2729 E. Speedway 318-4421 reedsrx.com 7/7/2010 1 Definition of Andropause A gradual decline in sex hormone

More information

PITUITARY: JUST THE BASICS PART 2 THE PATIENT

PITUITARY: JUST THE BASICS PART 2 THE PATIENT PITUITARY: JUST THE BASICS PART 2 THE PATIENT DISCLOSURE Relevant relationships with commercial entities none Potential for conflicts of interest within this presentation none Steps taken to review and

More information

Dr Stella Milsom. Endocrinologist Fertility Associates Auckland. 12:30-12:40 When Puberty is PCO

Dr Stella Milsom. Endocrinologist Fertility Associates Auckland. 12:30-12:40 When Puberty is PCO Dr Stella Milsom Endocrinologist Fertility Associates Auckland 12:30-12:40 When Puberty is PCO Puberty or Polycystic Ovary Syndrome? Stella Milsom Endocrinologist Auckland DHB, University of Auckland,

More information

Hormonal Control of Male Sexual Function

Hormonal Control of Male Sexual Function Hormonal Control of Male Sexual Function A majority of the control of sexual functions in the male (and the female) begins with secretions of gonadotropin-releasing hormone (GnRH) by the hypothalamus.

More information

Male New Patient Package

Male New Patient Package Male New Patient Package The contents of this package are your first step to restore your vitality. Please take time to read this carefully and answer all the questions as completely as possible. Thank

More information

PCOS-Understanding the Science and Practice. Inositols. Maurizio Nordio, University Sapienza, Rome, Italy Mumbai, June 18th, 2016

PCOS-Understanding the Science and Practice. Inositols. Maurizio Nordio, University Sapienza, Rome, Italy Mumbai, June 18th, 2016 PCOS-Understanding the Science and Practice Inositols Maurizio Nordio, University Sapienza, Rome, Italy Mumbai, June 18th, 2016 maurizionordio1@gmail.com PCOS and insulin It is well known that a strong

More information