Malady Wise

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Low Testosterone

Maladywise

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