Androgens; Erectile Dysfunction + BPH

Androgens

Produced by the testes, ovaries, and adrenal cortex. Have significant physiologic and pharmacologic effects unrelated to sex. Promote expression of male sex characteristics testosterone.

Testosterone

Male Sex Characteristics: pubertal transformation

Female Sex Characteristics: clitoral growth, maintenance of normal libido, overproduction of androgens = virilization.

Anabolic effects - skeletal muscle. Erythropoietic effects - synthesis of erythropoietin, men have higher hematocrit than women.

Therapeutic Uses: male hypogonadism, replacement therapy, delayed puberty, gender affirming treatment

Adverse Effects: virilization in women, girls, and boys; premature epiphyseal closure; hepatotoxicity; effects on cholesterol levels; use in pregnancy; prostate cancer; edema

Hypogonadism Preparations

Oral Androgens: Fluoxymesterone and methyltestosterone

Intramuscular testosterone esters; transdermal testosterone patches; transdermal testosterone gels; implantable subcutaneous testosterone pellets

Erectile Dysfunction

ED also known as impotence. Persistent inability to achieve or sustain an erection suitable for sexual intercourse. Affects up to 30 million men commonly associated with chronic illnesses. Risk for ED increases with advancing age.

Treatment: Lifestyle measure (increased exercise, smoking cessation), drug regimens (remove the drugs that may cause ED), Drug therapy (PDE5 inhibitors, sildenafil, tadalafil)

Sildenafil (Viagra)

PDE5 Inhibitor - plasma levels peak in 1 hour; high fat meals slow absorption; hypotension; priapism

Do not give with Nitrates - 24hrs in between meds for safety.

Caution in pts w/ MI, stroke, and life-threatening dysrythmia within the past 6 months

Tadalafil (Cialis)

PDE5 Inhibitor - effects last up to 36 hours, headache, dyspepsia, back pain, myalgia, limb pain, flushing, and nasal congestion. NO NITRATES

Benign Prostatic Hyperplasia

Nonmalignant Prostate enlargement:

S/Sx: urinary hesitancy, urinary urgency, increased frequency or urination, dysuria, nocturia, sensation of incomplete bladder emptying.

5 - Alpha - Reductase Inhibitors

Mechanical Obstruction

Dutasteride and Finasteride

Finasteride (Proscar)

Decrease in ejaculate volume and libido, Gynecomastia, decreased levels of prostate specific antigen (PSA)

Alpha 1 - Adrenergic Antagonists

Dynamic Obstruction

Terazosin, Doxazosin, Tamsulosin, Alfuzosin, Silodosin