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Keith T. Chumley, M.D. Men’s Sexual Health-It’s Not Just a Pill Low Testosterone
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Keith T. Chumley, M.D.
• Board Certified Family Practitioner • M.S. Human Physiology – Georgetown University • M.D. Georgetown University
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Goals
• Understand that there are secondary causes of low testosterone
• Testosterone treatment requires monitoring • The best way to maintain normal sexual health is to stay
in shape!
Normal Sexual Func1on
Hormones
Psychology Cardiovascular
Func1on
Neurologic Func1on
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“Doc, Our sex life is not what it used to be. Must be my testosterone”
HYPOGONADISM DEFINITION
• Failure of the testes to produce androgen (testosterone) or sperm or both
• TMMC 240 ng/dl - 950 ng/dl
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Primary vs Secondary Hypogonadism(Low T) • Primary is loss of testicular function
• NORMAL to lose 1-2% testosterone production/year after age 30
• Secondary is loss of pituitary or hypothalamic function
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Testosterone function
• Secondary male sex characteristics • Changes in muscle/fat distribution • Bone growth • Laryngeal enlargement (Adam’s apple/voice) • Testicular growth • #PUBERTY
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Testosterone function
• Homeostatic functions • Libido • Bone density • Erythropoiesis • Prostate health
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Hypogonadism Causes
• Loss of Leydig cells over time is normal but by itself does not usually cause low testosterone
• COPD • Diabetes • Hemochromatosis • HIV • Medication (e.g. Lupron)
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Hypogonadism Causes
• Obesity • Pituitary Mass • Psychological stress • Kidney Failure • ?Chronic Marijuana use • ?Obstructive Sleep Apnea
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Clinical Presentation
• Mood Changes (depression/fatigue/anger) • Decreased Body Hair • Decreased Bone Density • Decreased Muscle Mass/Strength • Increased Visceral Fat • Infertility • Decreased libido/Erectile dysfunction
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ADAM Questionnaire
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Laboratory Diagnosis
• Total Testosterone • Bioavailable Testosterone • Free Testosterone
• Drawn between 8-11 AM • LH • Prolactin • Sex Hormone Binding Globulin 11/19/15 Name of Presenta1on 17
Controversy
• Most labs do not provide age based results • What are the target levels?
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Treatment
• Treat Primary causes first! • Contraindications
• Prostate Cancer • Male breast Cancer • Obstructive Uropathy
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Treatment
• Testosterone Injections • Upside-most cost effective • Downside-Not physiologic & OUCH!
• Patch • Upside-physiologic • Downside-expensive, rash
• Transdermal/gel • Upside-physiologic • Downside-expensive, risk of transfer to close contact
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Risks
• Fluid Retention • Polycythemia • Prostate disease • Sleep Apnea • Personality changes • ?Coronary Artery Disease • ?Breast Development • ?Suppression of Natural testosterone Production
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Monitoring
• Voiding history • Blood Pressure • Prostate Exam • Obstructive Sleep Apnea symptoms • Prostate Specific Antigen • Lipid Profile • CBC • Liver Enzymes
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Monitoring
• Check levels in 2-3 weeks if gel/patch or 8 weeks if injectable
• Check level halfway in between doses • Recheck in 3 months • Every 6 months thereafter
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Other Treatments
• PDE5 inhibitors • Viagra • Levitra • Cialis
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Other Treatments
• External Constriction Devices
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Other Treatments
• Vacuum Pump
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Other Treatments
• MUSE (Medicated Urethral System for Erections) • PDE1 inhibitor
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Other Treatments
• Penile Implants
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Other Treatments
• Intracavernosal Injections
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The End
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