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free and weakly protein bound testosterone is a part of what category
bioavalibale testosterone
what is the most important form of estorgen
estradiol (E2)
what kind of estrogen is more prominent when pregnant
E3
what relationship between estrogen and testosterone can cause them to become unbalanced w one another
estrogen can convert into testosterone and vise versa
what are the steps of the menstrual cycle
period day 1-6, proliferative phase day 7-13 (follicular phase for both)
ovulation day 14, secretory phase (luteal phase)
what hormone peaks during ovulation the most
LH
when is progesterone more active in the menstrual cycle
luteal phase
what is the biggest factor affecting hormone levels for men and women
age
diminished functional activity of the gonads (either low estrogen which effects ovulation, or low sperm which effects spermatogenesis
hypogonadism
signs of hypogonadism in women
brain fog, skin problems, acne, facial hair, irritability and mood swings, migraines, food cravings (esp sugar), super heavy menstural cycles, vaginal dryness, suppressed sex drive, endometriosis, fibroids, hot flashes, night sweats, trouble sleeping, breast changes
signs of hypogonadism in men
low mood, depression, HTN, suppressed sex drive, erectile dysfunction, low energy, weight fluctuations, diminished physical strength and endurance, dec bone strength, loss of body hair, diabetes, infections
what is the most common cause of hypogonadism in women
menopause
most common genetic cause of hypogonadism
turner syndrome (X0) or klinefelters syndrome (XXY)
how do we diagnose hypogonadism in men
measure fasting total testosterone at least 2 separate times + present signs/symptoms
why do the testosterone labs have to be done fasting
bc glucose can fuck up results
presence of excess terminal hair in androgen dependent areas (face), most commonly either familial or idiopathic
hirsutism
loss of female sexual characterstics, not common and presentation will depend on level of androgens in the body. no known risk factors and may be “voluntarily induced” (you can say trans bland its not a bad word)
virilization
signs of high estrogen in men (aka androgen insensitivity syndrome)
constant fatigue, high cholesterol, heart disease, loss of muscle tone, inc fat tissue, inc breast size, enlarged prostate and higher prostate cancer risk, erectile dysfunction, low libido
a severe deficit in androgen action with resistance to its masculinizing effects or undescended testes which results in a feminized habitus
androgen insensitivity syndrome
characteristics labs for androgen insensitivity syndrome
normal or high testosterone and high LH and estrogen
absence or abnormal cessation of the menses
amenorrhea
not getting a period by 16/ never menstruated with or without the presence of secondary sex characteristics
primary amenorrhea
women in their reproductive years in whom mensturation was present and then ceased for at least 6 mo (common causes include preg, lactation, menopause, meds, medical conditions)
secondary amenorrhea
the most common hormonal disorder among women of reproductive age
polycystic ovarian syndrome
when high levels of androgens (testosterone or DHEAS) disrupts ovulation, and some ppl develop many small cysts on the ovaries
PCOS
cause and risk factors for PCOS
unknown cause, many pts have insulin resistance, family hx and obesity
PCOS sx
irregular or no periods, hirsutism, acne, weight gain
possible complications of PCOS and tx
infertility, DM, obesity, cardiovascular disease, uterine cancer
tx w meds and weight loss
the persistent inability to ahchieve and maintain an erection enough for sex and ejaculation that becomes more common in pts 40-60s
erectile dysfunction or impotence
erectile dysfunction causes and risk factors
physical/organic, psychogenic, or combo of both (any condition that can dec blood flow to the dick or impair innervation)
risks include smoking, drinking, sedentary lifestyle, obesity, chronic health problems (HTN, DM, cardiovasc, etc)
enlargement of the breast tissue in men with tenderness on the breast and nipples. usually benign and not linked to breast cancer, can be congenital or developed
gynecomastia
gynecomastia causes
dec testosterone most often idiopathic, meds, drugs, secondary to disease
what happens in andropause
testosterone production declines gradually, sperm production doesnt stop (not all men experience andropause), starts around 30
what happens in menopause
estrogen production drops rapidly, egg production stops, all women will experience this, starts around 40
most potent/active form of estrogen, most often tested by immunoassay and used to assess ovarian function and monitoring fertility. has major roles in sexual function, bones, female characteristics and general health. levels will vary throughout the menstrual cycle and preg and will decline w aging with the lowst drop off being menopause when ovaries switch off (present in all bodies not just women)
estradiol (E2)
can we use gel estradiol (E2) specimens that are over 72hrs old
no bs itll bind to the gel and fuck up readings
a hormone produced and stored in anterior pituitary, that stimulates ovarian follicles to produce eggs and controls the menstrual cycle. also regulated production and transportation of sperm and determines sperm count. begins to rise early to prep for repro cycle adn rises w age (might indicate menopause). measured by immunoassay on day 2/3 of your cycle cycle and used to assess egg supply and ovarian function
FSH
made in the anterior pituitary and controls the menstrural cycle and midcycle surge triggers ovulation (linked to ovarian hormone production adn egg maturation). stimulates testosterone and sperm production. measured by immunoassay, peaking day 14 of cycle indicating ovulation and inc w age. used to determine ovulation and infertility and differentiate primary from secondary
LH
made in the gonads and adrenals and in the placenta 9-32wks into preg. prepares body for conception/preg and promotes sex drive. helps produce testosterone and sex drive in men. peaks midluteal phase at day 21. single best immunoassay test to determine ovulation. used to confirm ovulation, evaluate corpus luteum function and assess risk for early spontaneous abortion
progesterone
produced by the ant pit, initiates and maintains lactation and has a gender differentiating role in puberty bc higher estorgen inc this. circadian change in conc marked by episodic fluctuations and sleep. inducedd peak in early morning hrs. used in eval of fertility
prolactin
first line test in evaulating dysfunction of the gonads in adults, measured by immunoassay. represents both bounf and unbound testosterone in circ and used to evaluate fertility and sx of hormone imbalance. rapidly fluctates throughout the day, peaking in the early morning. suppressed by meds, food and glucose so much be taken fasting. lack specificity in patients w low conc of testosterone, recommended tandem mass spec test
total testosterone
immunoassay that measures the free bioavaliable pool of circulating testosterone not bound to proteins. used to dx hypogonadism and more sensitive in cases where total T levels are low or protein levels diminished bc of certain conditions. calculated based on measuremens of total T, SHBG, and albumin by immunoassays. correlates well w clinical presentation and total T level except in SHBG deficiency
free testosterone
a glycoprotein hormone made by the placenta and secreted during preg (peaks at 7-10wks preg). qualitative (piss or serum) tests normally used to determine presence (pos/neg), and quantitative (serum) tests determine total conc. can determine pregnancy, hydatidiform mole, choriocarcinoma, ovarian/testicular cancer. if urine test, best done first thing in the morning to be most concentrated
human chorionic gonadotropin (hCG)
factors influencing fertility
reproductive age, ability to fuck, health of both parents, semen quality, egg quality, ability to be preg
when there are problems with the egg that prevent fertilization
sterility
when there are problems w the egg but fertilization happens but the fetus cant keep growing and you get miscarriages
infertility
causes of infertility in men
pre-testicular causes (ant pit or hypothalamus prob), testicular cause, post testicular cause (dick prob), sperm related factors
what are teh 3 things that can be wrong w sperm
low concentration (low sperm count), low sperm motility (cant swim good), or abnormal form (weird shaped)
specimens for hormone testing
blood and piss
