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

Size: px
Start display at page:

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

Transcription

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

2 Late onset hypogonadism(loh) Definition LOH age associated testoteronedeficiency syndrome (TDS) Male menopause, andropause, ADAM (androgen deficiency of the aging male), PADAM (partial androgen deficiency in aging male)

3 Late onset hypogonadism(loh) 1. Recommendation 1: Definition LOH Clinicaland biochemical syndrome associated with advancing age and characterized by symptoms and a deficiency in serum testosterone levels( below young healthy adult male reference range). This condition may result in significant detriment in the QoLand adversely affect the function of multiple organs

4 Pathophysiology: Reasons for declining serum testosterone in aging male Reduced testicular response to gonadotrophins (vascular supply to testis; reduced leydigcells; testis less responsive to LH) Decline in hypothalamic pituitary function (pulse freq and amplitude of gonadotropinssecretion reduces ) Age related SHBG : less free serum T on target tissue 1% annual decline after age 30

5 2. Recommendation 2 : Clinical diagnosis opresence of symptoms and signs suggestive of testosterone deficiency:- Low libido (most common) ED Decreased muscle mass and strength Increased body fat Decreased bone mineral density and osteoporosis Decreased vitality Depressed mood oone or more of these must be corroborated with low serum testosterone

6

7 Questionnaires e.g. Aging Male Symptom Score (AMS), Androgen Deficiency in Adult Males (ADAM) are NOT to be used for Dx. (Low specificity)

8 3. LabarotoryDiagnosis exclude transient cause of low T determine primary or secondary cause (serum LH, prolactin) serum T level taken at 0700 and 1100 (peak 0800) serum total T measured no accepted lower limit of normal total T > 12nmol/l (350ng/dl) no substitution Rx total T < 8nmol/l (230ng/dl) need substitution Rx between 8-12 nmol/l (measure free T level)

9 4. Assessment of treatment outcome and decision on cont therapy improvement in s&s discont therapy if failure of clinical benefit 5. Body composition 5. Body composition testosterone administration improves body composition (decrease fat mass, increase lean body mass level 1b) secondary benefits : strength, muscle fn, metabolic and CVS

10 6. Bone density and fracture rate T substitution increase bone density BMD assessment 2 yrs interval Fracture reduction not proven 7. Testosterone and sexual function Might be related to co morbidities (DM, PVD, BOO) ED with low libido and documented low T should be given testosterone therapy (level 2a) Therapeutic synergism of PDE5I with T therapy (level lb) Unclear which one to start first (PDE5I or T) or combination

11 8. Obesity, Type 2 DM, metabolic syndrome obesity, HPT, dyslipidemia, impaired glucose regulation, insulin resistance obese men 20-64% low T testosterone therapy may have benefit to metabolic status

12 9. BPH and Prostate Ca No evidence No conclusive evidence T increase risk of BPH/Pca No evidence T will convert subclinical PCa to clinically detectable Pca (level 4) Evidence Evidence suggest T stimulate growth and aggravate symptoms in locally advanced PCa and metastatic PCa(level 2a) Asses PCarisk (age, DRE, PSA, family Hx) before starting T therapy If risk is high while on T perform TRUS Bx Those treated for PCawith LOH, T therapy possible after prudent interval, no clinical or lab evidence of residual Ca, and follow up Uncertain No long term data on prostate ca risk related to T replacement

13 Testosterone Replacement Goals: Maintain QoL Reduce disability Maintain physiologic concentration of T Reduce side effects Target: Mid-range to lower young adult levels Contraindications: Active prostate or breast cancer or unexplained raised PSA Significant erythrocytosis(hct> 52%), untreated sleep apnoea, untreated CCF Relative: High IPSS Age is not a contraindication

14 Treatment and Delivery Systems Oral T undecanoate(andriol) commonly used Raises T to mid range level Taken daily with meals >20g fat for T to be absorbed Intramuscular T undecanoate Long acting 3 monthly Stable T level within normal range T enanthate Shorter acting 2-3 weeks; maintain normal average T level First few days results in supraphysioogical peaks and hypogonadal troughs hence roller coaster effects on symptoms

15 Treatment and Delivery Systems Transdermal Patch (scrotal/non scrotal) or gels form Sustain delivery of T over 24 hrs Normal T level Skin irritation (not with gel) Difficult adjust dose Lower incidence erytrocystosis compare to IM Sublingual/ buccal Subdermalimplants T pellets ; subcutaneous tissue Sustain released about 4-6 mths

16 Adverse effect and monitoring Contraindications men with PCa, breast cancer high risk of CaP(relative) Low grade PCaGleason <7 ( relative / absolute) erythrocytosis(hct >52%) untreated OSA untreated CCF

17 Side effects Breast tenderness Gynecomastia Compromised fertility Change in testicle size Skin reactions Fluid retention Acne/oily skin Increased body hair

18 Summary Diagnosis of LOH = presence of hypogonadal symptoms/ signs + persistent low serum testosterone Before Rx discuss risks/benefits assessment of prostate cancer and other risks Response to Rx must be assessed (no response -withdraw) Goalis to keep T in mid normal range

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

TRT and localized protate cancer

TRT and localized protate cancer TRT and localized protate cancer Frans M. J. Debruyne Professor of Urology PRISM BRUGES Increased risk of prostate cancer with TRT? Prostate cancer Testosterone and Prostate Cancer There appears to be

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

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

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

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 ANDROID (methyltestosterone) oral capsule ANDROXY (fluoxymesterone) oral tablet AXIRON transdermal

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

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

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

Peter J. Burrows MD FACS

Peter J. Burrows MD FACS Testosterone Supplementation, Prostate Cancer Screening and Vitamins Peter J. Burrows MD FACS Clinical Assistant Professor of Urology University of Arizona, College of Medicine Adjunct Assistant Professor

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 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

Recommendations on the diagnosis, treatment and monitoring of Testosterone deficiency (TD) in adult men

Recommendations on the diagnosis, treatment and monitoring of Testosterone deficiency (TD) in adult men Recommendations on the diagnosis, treatment and monitoring of Testosterone deficiency (TD) in adult men Bruno Lunenfeld, George Mskhalaya, Svetlana Kalinchenko, Yulia Tishova, Michael Zitzmann, Stefan

More information

presents with Ken Sekine, MD

presents with Ken Sekine, MD presents Pioneering Technologies For Pellet Hormone Therapy Lifestyle Based Medicine A Primer for Clinicians with Ken Sekine, MD Dr. Sekine is a board certified OB-GYN who has been in private practice

More information

Where are the injections given? They are given in the upper outer hip.

Where are the injections given? They are given in the upper outer hip. 1 How do you diagnose low Testosterone in men? Low Testosterone can be diagnosed if you have 3 or more of the following symptoms: lack of libido fatigue insomnia erectile dysfunction (ED) depression loss

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

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

Hormone Balance - Female Report SAMPLE. result graph based on Luteal Phase. result graph based on Luteal Phase

Hormone Balance - Female Report SAMPLE. result graph based on Luteal Phase. result graph based on Luteal Phase Patient Name: Patient DOB: Gender: Physician: Test Hormone Balance - Female Report SAMPLE Grote, Mary Jane Batch Number: B6437 2/16/1954 Accession Number: N52281 F Date Received: 2/3/2015 Any Lab Test

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

GA KS KY LA MD NJ NV NY TN TX WA Applicable X X N/A N/A X N/A X X X X X X N/A N/A NA *FHK- Florida Healthy Kids. Androgens

GA KS KY LA MD NJ NV NY TN TX WA Applicable X X N/A N/A X N/A X X X X X X N/A N/A NA *FHK- Florida Healthy Kids. Androgens Androgens Override(s) Prior Authorization Quantity Limit Approval Duration Varies upon diagnosis Medication Strengths Quantity Limit Comments Generic Androgel 1% (2.5 g) packet 2 packets per day (testosterone

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

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

Clinical Policy: Testosterone Pellet (Testopel) Reference Number: CP.CPA.## [Pre-P&T approval] Effective Date:

Clinical Policy: Testosterone Pellet (Testopel) Reference Number: CP.CPA.## [Pre-P&T approval] Effective Date: Clinical Policy: (Testopel) Reference Number: CP.CPA.## [Pre-P&T approval] Effective Date: 07.25.17 Last Review Date: 11.17 Line of Business: Commercial Coding Implications Revision Log See Important Reminder

More information

Basics of Male Libido: Dysfunction & Treatment. Ripu Hundal MD FACE First State Endocrinology Newark, DE

Basics of Male Libido: Dysfunction & Treatment. Ripu Hundal MD FACE First State Endocrinology Newark, DE Basics of Male Libido: Dysfunction & Treatment Ripu Hundal MD FACE First State Endocrinology Newark, DE Sexual Hormones Steroid hormones Commonly referred to as male sex hormones and female sex hormones,

More information

Prior Authorization Criteria Update: Androgens, Topical and Parenteral

Prior Authorization Criteria Update: Androgens, Topical and Parenteral Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119

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

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

Therapeutic Cohort Results

Therapeutic Cohort Results Patient: JANE DOE DOB: December 31, 1968 Sex: F MRN: Order Number: Completed: February 26, 2016 Received: February 26, 2016 Collected: February 26, 2016 One Day Hormone Check - Salivary Profile Therapeutic

More information

Best Practices to Improve Patient Outcomes

Best Practices to Improve Patient Outcomes Best Practices Pearls Practical Primary Care Strategies for Diagnosing and Managing Hypogonadism in Men Utilize lab testing in appropriate patients who have complaints consistent with the often subtle

More information

Metastatic prostate carcinoma. Lee Say Bob July 2017

Metastatic prostate carcinoma. Lee Say Bob July 2017 Metastatic prostate carcinoma Lee Say Bob July 2017 Scenario A 58 year old gentleman presents with PSA 200 ng/ml with hard prostate and bone mets. LUTS but upper tracts are normal with normal RP. history

More information

Diagnosis and management of testosterone deficiency syndrome in adult men: clinical practice guideline (CMAJ)

Diagnosis and management of testosterone deficiency syndrome in adult men: clinical practice guideline (CMAJ) Diagnosis and management of testosterone deficiency syndrome in adult men: clinical practice guideline (CMAJ) Alvaro Morales CM MD, Richard A. Bebb MD, Priya Manjoo MD MSc, Peter Assimakopoulos MD, John

More information

State of California, California Health and Human Services Agency, Department of Managed Health Care 2013:

State of California, California Health and Human Services Agency, Department of Managed Health Care 2013: This policy has been developed through review of medical literature, consideration of medical necessity, generally accepted medical practice standards, and approved by the IEHP Pharmacy and Therapeutics

More information

One Day Hormone Check

One Day Hormone Check One Day Hormone Check Patient: EMILY TEST DOB: January 18, 1948 Sex: F MRN: 0000000004 Order Number: J5070009 Completed: March 07, 2014 Received: March 07, 2014 Collected: March 07, 2014 Alec Smart, ND

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

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

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

One Day Hormone Check

One Day Hormone Check One Day Hormone Check DOB: Sex: F MRN: Order Number: Completed: Received: Collected: Salivary Hormone Results Estradiol pmol/l >3330.0 Testosterone pmol/l

More information

Testim 1 Gel: Review of Clinical Data

Testim 1 Gel: Review of Clinical Data European Urology Supplements European Urology Supplements 4 (2005) 24 30 Testim 1 Gel: Review of Clinical Data Tom A. McNicholas* Department of Urology, Lister Hospital, Corey s Mill Lane, Stevenage, Hertfordshire

More information

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

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

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

Testosterone Therapy in Men with Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline

Testosterone Therapy in Men with Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline SPECIAL FEATURE Clinical Practice Guideline Testosterone Therapy in Men with Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline Shalender Bhasin, Glenn R. Cunningham, Frances

More information

Therapeutic Cohort Results

Therapeutic Cohort Results Patient: SAMPLE PATIENT DOB: Sex: MRN: Menopause Plus - Salivary Profile Therapeutic Cohort Results Hormone Average Result QUINTILE DISTRIBUTION 1st 2nd 3rd 4th 5th Therapeutic Range* Estradiol (E2) 8.7

More information

GP guide to testosterone replacement therapy in men

GP guide to testosterone replacement therapy in men GP guide to testosterone replacement therapy in men SPL Mike Kirby FRCP Professor Mike Kirby describes how the diagnosis and treatment of test - osterone deficiency in primary care can lead to improved

More information

Male Patient Questionnaire & History

Male Patient Questionnaire & History Male Patient Questionnaire & History Name: Today s Date: (Last) (First) (Middle) Date of Birth: Age: Weight: Occupation: Home Address: City: State: Zip: E-Mail Address: May we contact you via E-Mail? (

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

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

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

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

Oestrogen, progestogens and assessing risks of hormones. Dr Naomi Achong BSc MBBS(Hons) FRACP Endocrinologist

Oestrogen, progestogens and assessing risks of hormones. Dr Naomi Achong BSc MBBS(Hons) FRACP Endocrinologist Oestrogen, progestogens and assessing risks of hormones Dr Naomi Achong BSc MBBS(Hons) FRACP Endocrinologist My interest Minimal exposure during training Unmet need within endocrinology (private/public)

More information

Therapeutic Cohort Results

Therapeutic Cohort Results Patient: PAGE LOVE DOB: January 11, 1983 Sex: F MRN: 1232704193 Order Number: J9020008 Completed: July 08, 2016 Received: July 02, 2016 Collected: July 01, 2016 Aum Healing Center Sarika Arora MD 332 Newbury

More information

Male Menopause: Disease or Pseudoscience? March 4, 2015 story: FDA to require warning on labels of testosterone products.

Male Menopause: Disease or Pseudoscience? March 4, 2015 story: FDA to require warning on labels of testosterone products. Male Menopause: Disease or Pseudoscience? March 4, 2015 story: FDA to require warning on labels of testosterone products. 3-30-2015; web William E. Winter, MD University of Florida Departments of Pathology

More information

Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes:

Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes: The Endocrine Society s CLINICAL GUIDELINES Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline Authors: Shalender Bhasin, Glenn R. Cunningham,

More information

Hypogonadism and Testosterone Replacement Therapy: Pharmacist

Hypogonadism and Testosterone Replacement Therapy: Pharmacist Hypogonadism and Testosterone Replacement Therapy: Practical Insights for the Pharmacist Roger G. Hefflinger, PharmD Associate Professor of Pharmacy Practice and Administrative Services Idaho State University,

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

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

Testosterone Injection / Implant

Testosterone Injection / Implant Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Testosterone Injection / Implant Page: 1 of 9 Last Review Date: December 5, 2014 Testosterone

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

Metastatic disease. 80% will die of prostate cancer 5 year survival only 25% No major advances in cure since 1942

Metastatic disease. 80% will die of prostate cancer 5 year survival only 25% No major advances in cure since 1942 Prostate cancer Metastatic disease 80% will die of prostate cancer 5 year survival only 25% No major advances in cure since 1942 Impact of early prostate cancer 12 10 8 6 4 2 0 70-80 years 60-70 years

More information

Prescribing Framework for Testosterone in Adults

Prescribing Framework for Testosterone in Adults Prescribing Framework for Testosterone in Adults Patient s Name:.. NHS Number: Patient s Address:... (Use addressograph sticker) GP s Name:... Communication We agree to treat this patient within this Prescribing

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

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

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

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

Disclosures. Dr. Swerdloff and/or Dr. Wang have served as. o Consultants: Abbvie, Novartis, Clarus, AEZ, Lipocine, Antares Pharma

Disclosures. Dr. Swerdloff and/or Dr. Wang have served as. o Consultants: Abbvie, Novartis, Clarus, AEZ, Lipocine, Antares Pharma Safety and Efficacy Results From the Phase-3, Double-Blind, Multicenter STEADY Trial of a Novel, Pre-Filled, Subcutaneous Auto-Injector For Testosterone Replacement Therapy Ronald Swerdloff, MD Harbor

More information

Current Data and Considerations Novel Testosterone Formulations

Current Data and Considerations Novel Testosterone Formulations Current Data and Considerations Novel Testosterone Formulations 1 Hypogonadism: Treatment Safety and Prostate Health 2 Monitoring for Testosterone Therapy DRE 1,2 PSA Parameter Voiding/IPSS 1,2 Hemoglobin

More information

Testosterone Injection and Implant

Testosterone Injection and Implant Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.30.33 Subject: Testosterone Injection Implant Page: 1 of 10 Last Review Date: December 8, 2017 Testosterone

More information

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

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

More information

FAILURE IS NOT AN OPTION HOPE IS NOT A PLAN

FAILURE IS NOT AN OPTION HOPE IS NOT A PLAN FAILURE IS NOT AN OPTION HOPE IS NOT A PLAN Doctors' Secrets What Men Want - Testosterone - Sharing the Secrets of Men s Health Donald M. McLeod M.D. and Philip A White M.D. CONTENTS SECTION I Introduction

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

CERTIFIED MEN S HEALTH COUNSELOR ONLINE COURSE: SESSION 7 Male Menopause and Testosterone

CERTIFIED MEN S HEALTH COUNSELOR ONLINE COURSE: SESSION 7 Male Menopause and Testosterone CERTIFIED MEN S HEALTH COUNSELOR ONLINE COURSE: SESSION 7 Male Menopause and Testosterone Andropause: Dealing With Male Menopause Hormonal changes that occur as a result of aging are generally associated

More information

HIGHLIGHTS. From Testosterone Update Disease State Theater. American Urological Association and Endocrine Society Annual Meetings

HIGHLIGHTS. From Testosterone Update Disease State Theater. American Urological Association and Endocrine Society Annual Meetings HIGHLIGHTS From Testosterone Update Disease State Theater Presentations held at the 2008 American Urological Association and Endocrine Society Annual Meetings Jointly sponsored by the Annenberg Center

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

Early or late childhood? Age driven. LH driven Start testosterone when LH begins to rise Indicates that the pituitary is trying and failing

Early or late childhood? Age driven. LH driven Start testosterone when LH begins to rise Indicates that the pituitary is trying and failing Philip S. Zeitler MD. PhD Division of Endocrinology Children s Hospital Colorado Aurora, Colorado Primary testicular failure Central hormones responsible for onset of puberty are normal The testis itself

More information

Testosterone Injection and Implant

Testosterone Injection and Implant Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.30.33 Subject: Testosterone Injection Implant Page: 1 of 10 Last Review Date: March 17, 2017 Testosterone

More information

Testosterone Replacement in Adults. John A. Seibel, MD, FACP, MACE

Testosterone Replacement in Adults. John A. Seibel, MD, FACP, MACE Testosterone Replacement in Adults John A. Seibel, MD, FACP, MACE Disclosures None! *Privately Authenticated Definition of Male Hypogonadism inadequate gonadal function, as manifested by deficiencies in

More information