{"id":1483,"date":"2017-07-20T18:10:17","date_gmt":"2017-07-20T18:10:17","guid":{"rendered":"http:\/\/papergp.com\/index.php\/data-interpretation\/testosterone\/"},"modified":"2023-01-24T11:25:25","modified_gmt":"2023-01-24T11:25:25","slug":"testosterone","status":"publish","type":"page","link":"https:\/\/papergp.com\/index.php\/data-interpretation\/endocrine\/testosterone\/","title":{"rendered":"Testosterone"},"content":{"rendered":"<div class=\"content-box-blue\">\n<h4>Background<\/h4>\n<ul>\n<li>\u00a0Presentation\n<ul>\n<li>Loss of morning erections, erectile dysfunction<\/li>\n<li>Decreased libido<\/li>\n<li>Lethargy, low mood, irritability<\/li>\n<\/ul>\n<\/li>\n<li>Diurnal variation of levels &#8211; testosterone should be measured as early morning sample and repeated 6 weeks after first test<\/li>\n<li>Causes\n<ul>\n<li>Primary hypogonadism (failure of testes to produce testosterone)\n<ul>\n<li>Ageing<\/li>\n<li>Undescended testes<\/li>\n<li>Mumps orchitis<\/li>\n<li>Testicular trauma<\/li>\n<li>Klinefelter syndrome<\/li>\n<\/ul>\n<\/li>\n<li>Secondary hypogonadism (lack of pituitary signal &#8211; low LH)\n<ul>\n<li>Medications &#8211; opiates, glucocorticoids<\/li>\n<li>Pituitary disease &#8211; adenomas, hyperprolactinaemia<\/li>\n<li>Kallmann&#8217;s syndrome<\/li>\n<li>Haemochromatosis<\/li>\n<li>Hypothalamic disorders e.g. sarcoidosis, histiocytosis<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"content-box-blue\">\n<h4>Clinical management<\/h4>\n<ul>\n<li>Investigation\n<ul>\n<li>Morning testosterone, LH, FSH, oestradiol, prolactin, FBC, U+E, LFTs, HbA1c, PSA (if &gt; 40yo)<\/li>\n<\/ul>\n<\/li>\n<li>When to treat\n<ul>\n<li>&lt; 8 nmol\/L &#8211; treat<\/li>\n<li>8-12 nmol\/L &#8211; offer treatment if the calculated free testosterone level is &lt; 0.225nmol\/l and there are symptoms<\/li>\n<li>&gt; 12 nmol\/L &#8211; does not need replacement<\/li>\n<li>Treatment in patients with classical hypogonadism is effective and safe and usually long term<\/li>\n<li>Treatment for patients with few symptoms &#8211; trial for 6 months can be commenced but should be stopped if no symptomatic benefit<\/li>\n<\/ul>\n<\/li>\n<li>Testoterone therapy contraindications\n<ul>\n<li>Prostate cancer<\/li>\n<li>Severe LUTS<\/li>\n<li>Haematocrit &gt; 50%<\/li>\n<li>Untreated severe sleep apnoea<\/li>\n<li>Untreated severe heart failure<\/li>\n<li>Liver cancer<\/li>\n<li>Serious liver or kidney disease<\/li>\n<li>Breast cancer<\/li>\n<li>Fertility considerations<\/li>\n<\/ul>\n<\/li>\n<li>Treatment\n<ul>\n<li>Before starting treatment\n<ul>\n<li>Check for prostatic symptoms<\/li>\n<li>Measure PSA<\/li>\n<li>Perform PR<\/li>\n<li>Measure FBC &#8211; testosterone can cause polycythaemia &#8211; Hct &gt; 53% requires prompt haematological review<\/li>\n<\/ul>\n<\/li>\n<li>Target\n<ul>\n<li>testosterone level 15-18 nmol\/l<\/li>\n<\/ul>\n<\/li>\n<li>Formulations\n<ul>\n<li>Testogel (1% gel) &#8211; 5g (50mg) OD in the mornings (titrate up to 10g in 2.5g steps)<\/li>\n<li>Tostran (2% gel) &#8211; max 4g (80mg)<\/li>\n<li>Nebido (IM injection) &#8211; injected every 10-14 weeks &#8211; needs deep IM injection and there is risk of pulmonary oil microembolism &#8211; cough\/SOB\/sweats\/chest pain\/lightheadedness<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Monitoring\n<ul>\n<li>Bloods &#8211; FBC, lipids, PSA, testosterone<\/li>\n<li>PSA &#8211; a rise should be monitored carefully (even within normal range)<\/li>\n<li>DEXA &#8211; if bone density is low<\/li>\n<li>Check testosterone 6-12 hours post gel application or 2 weeks prior to next Nebido depot<\/li>\n<\/ul>\n<\/li>\n<li>Length of treatment\n<ul>\n<li>Can be used long term if beneficial and being monitored annually<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Background \u00a0Presentation Loss of morning erections, erectile dysfunction Decreased libido Lethargy, low mood, irritability Diurnal variation of levels &#8211; testosterone should be measured as early morning sample and repeated 6 weeks after first test Causes Primary hypogonadism (failure of testes to produce testosterone) Ageing Undescended testes Mumps orchitis Testicular trauma Klinefelter syndrome Secondary hypogonadism (lack &hellip; <a href=\"https:\/\/papergp.com\/index.php\/data-interpretation\/endocrine\/testosterone\/\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">Testosterone<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":2365,"menu_order":33,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1483","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/1483","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/comments?post=1483"}],"version-history":[{"count":4,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/1483\/revisions"}],"predecessor-version":[{"id":2091,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/1483\/revisions\/2091"}],"up":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/2365"}],"wp:attachment":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/media?parent=1483"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}