PHRM 825 Lecture 48- Mens Health Part 1

What happens at puberty

bone and muscle growth

body and facial hair

penis growth

testicular growth

spermatogenesis

increased libido

other changes

mens health issues during puberty

delayed sexual maturity (hypogonadism)

testicular cancer

alopecia

at what age is the onset of puberty

9.5-14 years

what is considered delayed puberty

lack of testicular growth at 14 years old

incomplete/ delayed sexual maturity

usually requires testosterone supplementation

hypogonadism

what is the treatment for hypogonadism

IM testosterone esters

50 mg monthly (max 100 mg)

at what age is testicular cancer most common

15-35

prognosis for testicular cancer

5 year survival rate of 95%

80+% cure rate even if stage III

treatment for testicular cancer

surgery, radiation, chemo

most common alopecia

gradual onset by age 40

heredity plays a factor

androgenic alopecia

autoimmune disorder

hair loss in patches

alopecia areata

complete loss of ALL body hair

alopecia universalis

happens over time from tension on hair from braids, buns, etc

traction alopecia

why does androgenic alopecia occur

excessive conversion of testosterone to DHT

treatment for alopecia and its MOA

Finasteride (Propecia)

inhibits type II 5-alpha reductase (conversion of testosterone to DHT)

dose of finasteride for alopecia

1 mg PO once daily

must be used continuously

another treatment for alopecia and MOA

Minoxidil (Rogaine)

enlarging miniaturized hair follicles, increases blood supply

dose and ROA

topical 5% foam, 5% extra-strength solution

apply to scalp twice daily every day- DRY HAIR and SCALP

combination product for alopecia

topical finasteride/ dutasteride and minoxidil (gel, solution spray)

hormonal deficiency (andropause)

hypogonadism

risk factors for hypogonadism

aging

chronic illness (diabetes, AIDS, rheumatoid arthritis)

long term use of corticosteroids

obesity

diagnosis of hypogonadism

low testosterone levels WITH symptoms

what levels of total testosterone and free testosterone confirm low testosterone

total testosterone level: <300 ng/dl

free testosterone level: <5 ng/dl

specific symptoms of low testosterone

reduced libido

gynecomastia

loss of body hair

reduced muscle bulk and strength

diagnosis of low testosterone

specific signs and symptoms

initial test should be done in the morning and measure total testosterone

total testosterone level <300 ng/dl

free testosterone <5 ng/dl

very high concentrations during part of dosing interval

enanthate or cypionate

100 mg weekly or 200 mg every other week

IM injection

most similar to physiologic testosterone levels

5 mg

patch

5-10 grams applied to covered area of skin daily

1.62%

gel

30-120 mg to arm pits daily

apply deodorant first

solution

30 mg q12h

do not chew or swallow

buccal tablet

implanted q3-6 months

delayed onset (3-4 months)

SQ pellet

Jatenzo

158-237 mg BID

take with food

oral capsule

what is the blackbox warning for gel formulation

concerns w secondary exposure to children

contraindications to testosterone supplementation

prostate cancer

breast cancer

Hct>50%

PSA> 3-4 ng/ml

poorly controlled CVD

when should patients be monitored after initiating therapy and what should their goal testosterone levels be

3-6 months after initiating therapy

goal between 400-700 ng/dl

most common type of cancer in men

prostate cancer

how is treatment of prostate cancer determined

patient age and Gleason score

which location of prostate cancer does not have a 100% 5 year survival rate

distant (bone)= 29%

what are PSA levels in most men without prostate cancer

>4 ng/ml

what PSA level means man has a 25% of having prostate cancer

4-10 ng/ml

what PSA level means the chance of having prostate cancer is over 50%

more than 10

men who have PSA levels of what need retested yearly

greater than or equal to 2.5 ng/ml

which demographics should consider baseline screening at age 40-45

black men and men with FH of prostate cancer