Male reproductive medicines (androgens, sildenafil)

What is pirapism?

Priapism is an erection lasting longer than 4 hours; it is painful and potentially damaging to the tissue. It is considered an emergency in sildenafil use

Four patients of yours are taking sildenafil. Which one is a priority?

A) A pt experiencing flushing
B)A pt experiencing dyspepsia
C) A pt experiencing dizziness
D) A pt experiencing optic neuropathy and loss of hearing

D) Optic neuropathy is a serious side effect

A patient of yours is interested in taking viagra. What are important things to assess for?

Nitrate/alpha blocker use

Penile implant

A new patient would like to start testosterone therapy for hypogonadism. Their bloodwork shows increased levels of AST/ALT. How do you proceed?

Explain to the patient that there is potentially something wrong with their liver and they cannot begin testosterone therapy until that is resolved because liver disease is a contraindication.

A patient of yours would like to begin testosterone therapy for gender reaffirming care (FtM). You noticed they have a hx of breast cancer. How do you proceed?

Explain to that pt that a hx of breast cancer is a contraindication and that they should not start testosterone therapy until it is looked into further.

Four patients of yours are on testosterone/danazol therapy. Which one is the priority?

A)Patient showing signs of jaundice
B)Patient concerned about their weight gain
C) Patient concerned about hair growing in new places
D)Patient with slightly swollen ankles

A) - this is a sign of active liver damage or failure, and medication should be stopped and LFTs initiated

A patient comes in with complaints of headache, vertigo, dizziness, and a reddish/purple discoloration in their face, neck, and hands. You see on their chart that they are on testosterone therapy. What do you do?

Cease the medication and order a CBC to investigate potential polycythemia.

What is the greatest danger to a patient with polycythemia?

Thromboembolic events/clots - stroke, DVT, PE, MI

What important drug interactions should you remember about androgens?

Anticoagulants increase bleeding, glucose is decreased with antidiabetics