Testosterone replacement for hypogonadism (Dr.Lewis)

failure of testes to produce physiological levels of testosterone… due to disruption of ≥1 levels of the hypothalamic-pituitary-testicular axis is what

males >40

male menopause

andropause

hypogonadism

•Low T; elevated gonadotropin is what kind of gonadotropin

primary

Low T; low-normal gonadotropin is what kind of gonadotropin

secondary

diagnosis of testosterone deficiency is only made when patients have low total testosterone levels combined with symptoms and/or signs

true

•“use a total testosterone level below 300 ng/dL as a reasonable cut-off in support of the diagnosis of low testosterone”

true

In men with hypogonadism and preexisting or a high risk of cardiovascular disease, testosterone-replacement therapy was noninferior to placebo with respect to the incidence of major adverse cardiac events.

true

what are the testosterone products

oral

topical

nasal

SQ

IM

SQ implant

•Kyzatrex®

•Jatenzo®

•Tlando®

•Undecatrex®

are what type of formulation

testosterone capsules (oral)

Supraphysiologic serum concentrations of testosterone are produced during a portion of the dosing interval. This has been linked to mood swings

•Undecanoate carries BBW for pulmonary oil microembolism (POME) reactions (cough, SOB, chest pain, anaphylaxis)

•Only available by REMS

•Monitor patients for ≥30 minutes after injection

intramuscular testosterone injections

once weekly SQ injection

SQ testosterone

1.Ensure patient has hypogonadism by assessing testosterone

1.If hypogonadism confirmed, assess for contraindications to testosterone replacement therapy

1.If no contraindications, begin testosterone replacement and monitor patient within 1-3 months, assessing for indications to withhold or modify treatment

approach to treating hypogonadism

diagnosis of hypogonadism

• requires symptoms + confirmed hypogonadism

  • two total testosterone levels required (different days)

what are the baseline for testosterone replacement

Testosterone level

PSA

CBC