Low Testosterone
HPMI Update 2024 / Chris Rowe
When
Measure at peak of health
Good sleep,
Fasting
No illness
Need a good reason
Risk of pituitary or testicular disorder
Need hot flushes
Big change in libido
Premature OP
Androtest questionnaire
What
Free Testosterone
If low
Repeat
Think
Examine
SHBG
50% of T bound to SHBG + Albumin
Low in obestiy = functional hypogonadism
Framework
Transient
Acute Illness
Management - Expectant, Recovery over 3 to 6 months
2/3 of hospitalised men had low testosterone = probably marker of severity of illness
Secondary
OSA
Opioids - suppresses LH / FSH / ACTH
Gym Supplements - Anabolics
Management - Find cause + treat
Functional
Obesity
Metabolic Syndrome
Chronic illness
Ageing
Management - Treat metabolic syndrome
Optimise chronic illness
Idiopathic
Mildly low T
Organic
Low T and High FSH / LF
Hypogonadotrophic hypogonadism
Structural pituitary
PRLanoma
Primary pituitary
Check PRL
Pituitary profile
MRI
Screen haemochromatosis
Primary testicular
Small testes
Testicular damage
Benefits
Improve anaemia
Improve libido
Improve bone architecture
No clear benefit of QoL
No clear exercise benefit
Downsides
Shrinks testes
Feel lousy once stopping as induces dependence
e.g. If takes for 5 years then stops = likely 5 years of feeling lousy until recovery
Suppresses spermrows prostate
Behaviour changes
Polycythaemia
Kleinfelter’s
1 in 450
Tall
Inferttility
Androgen defiency
Testosterone
Reandron injection
Full dose at once, peaks first 4 weeks, 3 monthly
Testogel / Testovan = 50mcg aim (arm, chest, back)
Easy dose titration, easy to stop if SE, daily use, can’t put on partner / kids
Androforte 5% (scrotum)
Lower risk skin contact, fiddly application
Monitoring
Trough level = lower half of normal range
Gel / Cream - 2/4 hours after dose
Long-term
Haematocrit
Vascular risk factors
Consider prostate screening