T2 L1 (CAO)

Determinants of human health? (five)

1. Biology and genetics

2. Individual behavior

3. Social environment

4. Physical environment

5. Health services

Constituents of "men's health" issues? (five)

1. Male intimacy

2. Depression

3. Heart disease

4. Prostate cancer

5. Diabetes

T/F: Men have higher rates of all forms of cardiovascular disease and many forms of cancer.

True

Two hormones which significantly differ in level between men (more) and women (less)?

1. Testosterone

2. Di-hydrotestosterone (DHT)

Difference between "male" and "men's" health?

Male health refers to all males, whereas "Men's" health is associated with aged males and their associated health complications

Steroids, as outlined by the slide, are secreted by what? (two)

Gonads

Adrenal glands

Steroids, derived from cholesterol, include? (eight as outlined by slide)

1. Estrogen

2. Progesterone

3. Testosterone

4. Cortisol

5. Corticosterone

6. Aldosterone

7. DHEA

8. Calcitriol

Polypeptides/proteins are synthesized from what? Secreted by what?

Synthesized from chains of amino acids.

Secreted by pituitary and hypothalamus gland.

Oxytocin is an example of what?

Polypeptide/protein; antidiuretic hormone.

Monoamines are derived from what? Secreted by what?

Derived from amino acids.

Secreted by adrenal, pineal, and thyroid glands.

Monoamine examples? (five)

1. Epinephrine

2. Norepinephrine

3. Melatonin

4. Dopamine

5. Thyroid hormone

General functions of hormones? (three big areas)

1. Help regulate:

- Extracellular fluid

- Metabolism

- Biological clock

- Contraction of cardiac & smooth muscle

- Glandular secretion

- Some immune functions

2. Growth & development

3. Reproduction

Where are androgens produced?

Primarily in the testes and the adrenal cortex

Function of androgens? (six)

1. Virility

2. Spermatogenesis

3. Increased muscle mass

4. Decreased fat deposition

5. Increased libido

6. Increased aggression

T/F: Androgens are otherwise known as anabolic steroids.

True

Where is testosterone converted to DHT?

Inside prostate cells

T/F: 5a-DHT promotes the growth and survival of prostate cells.

True

T/F: Male sexual differentiation fails to occur in the absence of androgens or without functioning androgen receptor (AR).

True

What is the result of a complete loss in androgen receptor (AR) function in males?

Complete androgen insensitivity syndrome

Role of the Y chromosome?

Establishes sexual differentiation.

Establishes formation of the testes, epididymis, accessory sex glands, prostate, seminal vesicles, and the penis.

What is dehydroepiandrosterone (DHEA)?

DHEA is approved in Europe as a fertility drug; it is produced organically in the adrenal glands, the gonads, and the brain. It is considered an anabolic steroid.

Anabolic steroid examples? (four)

1. Nandrolone (Durabolin)

2. Oxymetholone

3. Oxandrolone

4. Stanozolol (Winstrol)

What are anabolic steroids typically indicated for?

To help patients build up muscle mass and to recover from injury.

Adverse effects of androgens (anabolic steroids)?

1. Male balding

2. Increased prostate growth

3. Increased sebaceous gland secretion

Describe the prostate gland

Main function is to help with the production of semen (which is the fluid that transports sperm).

Explain the role of prostate-specific antigen (PSA)?

Liquefy sperm to create semen

Symptoms of benign prostatic hyperplasia (BPH)? (three big ones)

1. Frequent and sudden urgency to urinate

2. Inability to empty bladder

3. Trouble initiating urine flow even with a full bladder

Lifestyle options for the treatment of benign prostatic hyperplasia (BPH)?

Reduce liquid consumption before bed.

Surgery?

Drugs used for the treatment of benign prostatic hyperplasia (BPH)?

Finasteride (Proscar) (1 mg)

Dutasteride (Avodart)

MOA of finasteride, dutasteride?

5a-reductase inhibitor

Effectively reduce conversion of testosterone to DHT

Symptoms of prostatitis? (five)

1. Pelvic pain

2. Testicular pain

3. Pain when urinating

4. Pain when ejaculating semen

5. Pain in the perineum

Typical duration of antibiotic therapy in acute infectious prostatitis?

14 days

Typical duration of antibiotic therapy in chronic infectious prostatitis?

4-12 weeks

What class of medication is typically used to treat chronic prostatitis?

Alpha blockers

Alpha blockers examples? (five)

1. Doxazosin (Cardura)

2. Prazosin (Minipress)

3. Terazosin (Hytrin)

4. Alfuzosin (Uroxatral)

5. Tamsulosin (Flomax)

MOA of alpha blockers?

Block a1 receptor to block the effect of catecholamines on a1-adrenergic receptors.

Main adverse reactions associated with alpha blockers? (two)

Hypotension

Headache

Symptoms of prostate cancer? (two)

1. Needing to urinate more frequently (often during the night)

2. Needing to rush to the toilet difficulty starting to urinate (hesitancy) straining or taking a long time while urinating (weak flow, feeling that bladder isn't fully emptied)

First line treatment for prostate cancer?

Combination of radiation and therapy aimed at blocking the production of or use of testosterone

Term for the surgery used to immediately eliminate testosterone production?

Orchiectomy

Term used to describe prostate cancer which does not go away after castration?

Castration resistant prostate cancer (CRPC)

T/F: Prostate cancer is frequently metastatic.

True

Describe Dendreon (Sipuleucel -T, Provenge)

Vaccine (drug?) recently approved which uses a patient's collected leukocytes and incubation with an antigen to aid the immune system in defending against prostate cancer. About 4-month life extension benefit, costs about $100,000/patient.

T/F: Testosterone has a higher affinity for the AR than does DHT.

False; DHT has a higher affinity.

Non-pharm approaches to help reduce or improve erectile dysfunction (ED)? (five)

1. Quit smoking

2. Limit or stop drinking alcohol

3. Increase physical exercises

4. Healthy habit to reduce body weight

5. No illegal drug use

Drug class typically employed for treatment of ED?

PDE-5 inhibitors

MOA of PDE-5 inhibitors

Inhibits PDE-5 prevent hydrolysis of cGMP -> increased cGMP

cGMP responsible for regulation of some protein-dependent kinases

PDE-5 inhibitor examples (four)

Sildenafil (Viagra)

Vardenafil (Levitra, Staxyn)

Tadalafil (Cialis)

Avanafil (Stendra)

Three drug classes used in the treatment of ED?

PDE5 inhibitors

Vasodilators

Androgen (T supplements)

Common side effects associated with PDE-5 inhibitors? (six)

1. Dizziness

2. Headache

3. Flushing

4. Hypotension

5. Rhinitis

6. Dyspepsia

Describe "male menopause"

Referred to as low-T, andropause, or its medical name, late-onset hypogonadism.

Symptoms can include sexual dysfunction, depression, mood changes, weight gain, and/or fatigue.

Treatment options for male menopause?

Testosterone hormone therapy.

Goal testosterone level in males in andropause?

300-400 ng/dL

T/F: PDE5 inhibitors enhance vasodilation and relaxation of the penile vascular smooth muscle, resulting in improved erectile function.

True

MOA of alprostadil?

Prostaglandin E1 analogue; prostaglandin receptor agonist, resulting in the activation of adenylate cyclase and the subsequent accumulation of 3'5'-cAMP -> vasodilation.