Androgen deficiency in aging male Dicky Moch Rizal

Testosteron is the man, male is testosterone..

How important its functions in male

ANDROPAUSE

SOMATOPAUSE

VIRILIPAUSE

P.A.D.A.M

A.D.A.M

Synthesis of AndrogensCholesterol serves as the substrate for P5 biosynthesis in the Leydig cells.

Conversion of P5 to 17-hydroxylated steroids provides the steroidogenic predominant pathway in testicular tissue.

The 17-hydroxysteroids are converted by side chain cleavage to 17 ketosteroids and these in turn are converted to testosterone.

Synthesis of AndrogensAlthough some androgens are 17-ketosteroids not all 17-ketosteroids are androgens and not all androgens are 17-ketosteroids.In some tissues, testosterone is converted to either dihydrotestosterone (DHT) or E2 which are the biologically active steroids in these tissues.

Testosterone is the principal steroid produced by Leydig cells.

Androstenedione and dehyrdorepiandrosterone are also produced but the physiological potencies are very low.

Male Sex Steroid Synthesis

Major Testicular Steroids

Almost 100% of the testosterone in the blood is bound to protein; ~ 40% bound to SBG about 40% bound to albumin and 17% to other proteins.

Roles of AndrogensTesticular androgens play a role in differentiation and development of male urogential system, accessory sex organs and external genitalia.Many tissues respond directly to testosterone, but this must be converted to either DHT or E2 to mediate its actions.

After the initial actions of T in early fetal development, the gonads remain quiescent until puberty, when gonadotropins increase for spermatogenesis and 2o sex characteristics.

Regulation of T

Testosterone from birth..

Testosterone level

DHEA and testosterone level

PHYSIOLOGICAL EFFECTS OF TESTOSTERONE (non reproductive)Nervous systemSkinMuscleBoneCardiovascularbloodMetabolism

ADAM SCORELoss of libidoDecrease of erectionDecrease of concentrationSwinging moodDecrease of heightWeaknessSleepy after meal

Loss of tunica albuginiaDecrease of penile sizeLoss of sensationLoss of nocturnal and morning erectionsLack of ejaculation volumeIncrease of refracter phase

ManagementDiagnosis

History

Physical examination

Laboratory finding

LABORATORY FINDING

FREE TESTOSTERONE

TOTAL TESTOSTERONE

PROLACTIN

Treatment

Prohormone

Hormonal replacement therapyTEnanthate, TUndecanoate, T Oral, gel/transdermal, injection depo

EVALUATIONPre and post examination of PSA

Blood count

BPH symptom