Androgens in the Aging Male by rt3463df

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									     Androgens in the Aging Male
    What the world needs is a little more testosterone!




The RxFiles
May-June
 2003
          Hormones and Aging

• Females
  – sudden drop


• Males
  – gradual decline
   Androgen Deficiency Symptoms
ADAM or Morley Questionaire
Do you have a decrease in libido (sex drive)?                        *
Do you have a lack of energy?
Do you have a decrease in strength and/or endurance?
Have you lost height?
Have you noticed a decreased "enjoyment of life?"
Are you sad and/or grumpy?
Are your erections less strong?                              ???     *
Have you noticed a recent deterioration in your ability to play sports?
Are you falling asleep after dinner?
Has there been a recent deterioration in your work performance?
        Morley Questionnaire
• 10 questions every middle aged man is
  afraid to ask
• 88% sensitivity for low BT
  – catches most
• 60% specificity for low BT
  – catches many (~40%) who should not be caught
     • multifactorial nature of symptoms
     • natural course of aging
     • other medical conditions
      Testosterone by System
• Brain
  – libido, depression, irritable,  concentration
• Body
  – abdominal obesity,  muscle & strength, hair
    regression,  BMD, gynecomastia
• Genitourinary
  – smaller, softer, impotence
• General
  – fatigue,  energy
       Testosterone (T) Levels
• SHBG = sex hormone binding globulin
     • tightly BINDS Testosterone making it unavailable
• Total T = free T (unbound T) + bound T
     • ~6-28 nmol/L;
     • AGE adjusted norms?: 40-59y =12.1-30; >60=6.9-25
• Bioavailable T = free T + T bound weakly
                               to albumin
• Free Androgen Index
     • 15-95 U
Males
                        Trials
• Limited - too small, too short
  –   lack good data for large scale treatment of PADAM
  –   some efficacy on some parameters
  –   subjective benefits
  –   safety data lacking
                Benefit vs Risk
•   body                •   prostate
•   strength            •   cardiovascular
•   mood                •   Hct (stroke)
•   libido              •   gynecomastia
•   cognition                  • treated with tamoxifen?

•   function            • inappropriate behavior
                        • cost of treatment
                Monitoring
• Symptoms/side effects
• Prostate
  – DRE, PSA                   *baseline, annual
• Lab
  – Hct, Hgb (stroke); lipids (heart)
  – testosterone
• Other
               Androgens - Oral
• ANDRIOL
  – testosterone
    undecanoate

  – storage
     • refrigerate in pharmacy
     • at room temperature after
       dispensing (Exp. 90 days)
  – take after food
      Androgens - Topical Gel
• ANDROGEL
 – testosterone 1% gel

 – apply daily in AM

 – a shirt prevents sharing
Androgens - Transdermal Patch
• ANDRODERM
 – testosterone

 – apply daily at HS
 – rotate sites weekly
 – skin irritation common
                                 Lower
       Androgens - Injectable   drug cost


• DELATESTRYL
  – Testosterone
    enanthate
     • small volume
       advantage


• DEPO-
  TESTOSTERONE
  – Testosterone
    cypionate

								
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