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Andropause

Andropause. By Shedeed Ashour, MD. Assist. Prof. of Andrology & Reproductive Medicine Cairo University Cairo – EGYPT 2009. ب سم الله الرحمن الرحيم. قَالُوا سُبْحَانَكَ لاَ عِلْمَ لَنَا إِلاَّ مَا عَلَّمْتَنَا إِنَّكَ أَنتَ الْعَلِيم ُ الْحَكِيم. صدق الله العظيم.

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Andropause

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  1. Andropause By Shedeed Ashour, MD. Assist. Prof. of Andrology & Reproductive Medicine Cairo University Cairo – EGYPT 2009

  2. بسم الله الرحمن الرحيم قَالُوا سُبْحَانَكَ لاَ عِلْمَ لَنَا إِلاَّ مَا عَلَّمْتَنَا إِنَّكَ أَنتَ الْعَلِيم ُ الْحَكِيم صدق الله العظيم سورة البقرة الآية 32

  3. Andropause

  4. Andropause has received significant attention in recent years. It results in a variety of symptoms experienced by eldery. Many of these symptoms are non specific and vague.

  5. partial deficiency of androgens in blood genomic sensitivity to testosterone or its active metabolites in target tissues. physical energy, an altered state of well-being , a sexual dysfunction and various metabolic alterations. Clinical condition characterized by:

  6. Androgen production and aging 1-Normal metabolism Testosterone (synthesised and secreted by leydig cells of the testes) is regulated by a negative feedback system involving the hypothalamus and the pituitary. The testes produce 0.24 µ mol/day of testosterone.

  7. 5  reductase • Testosterone Dihydro testosteron (DHT)

  8. 2- Changes in hormone levels with age  Serum total testosterone levels Serum sex hormone binding globulin (SHBG)  Free testosterone.

  9. Decline of testosteron levels with age in men older than 70 y due to : • Level of SHBG • Estrodiol production due to adiposity with age

  10. 3-Mechanism of age-related changes in hormone levels Decline in testosterone levels with age is primarily testicular in origin • number and volume of leydig cells • Impaired testicular perfusion • Impaired steroid biosynthesis

  11. Several alterations in the hypothalamic pituitary gonadal axis • Loss of nycthemeral variations in testosterone levels • frequency of large amplitude LH pulses •  Sensitivity of the gonadotrophs to sex hormone feed back.

  12. Testosterone: target organs Skin Hair growth, balding, Sebum production Muscle Increase in strength And volume Liver Synthesis of serum Proteins Kidney Stimulation of Erythropoietin production Bone marrow Stimulation of stem cells Bone Accelerated linear growth, Closure of epiphyses Brain Libido,mood Synovial tissue Modulation of the Immune response Male sexual organs Penile growth Spermatogenesis, Prostate growth & function

  13. Clinical symptoms of andropause

  14. Nervousness , hot flashes which is seen in 10-15% of patients as well as sleep disorders; • Signs of  masculinity such as a reduced muscle mass with or without concomitant obesity , a loss of vigor and of sexual hair; • A general propensity to fatigue , lethargy, blunted libido and erectile dysfunction; • Moderate symptoms of depression, anxiety, lack of mental energy, personal and social drive, loss of productivity at work and at home,  memory and loss of self-esteem.

  15. Diagnosis of andropause

  16. Diagnosis is made based on the presence of signs or symptoms with confirmation by laboratory testing as: 1-morning , non fasting , plasma total testosterone level. 2-Free, plus protein-bound (Albumin and SHBG) testosterone . 3-Additional laboratory testing. (A) LH which often  in testosterone defeciency (B) Other test, that can confuse the D.D. (1)CBC (anemia) (2) Blood glucose level (Diabetes) (3) TSH and prolactin (pituitary dysfunction).

  17. For older men, if the serum total testosterone level is less than 7.0 nM/L, the man is clearly hypogonadal and replacement therapy should be considered.

  18. Treatment of andropause

  19. COMMERCIALLY TESTOSTERONEPREPARATIONS (Moralse et al., 1996)

  20. Monitoring During Therapy

  21. Preparations of testosterone for therapy carry the potential for significant adverse effects on liver, prostate, lipid profile and cardiovascular system, sleep patterns, and social behavior and emotional states.

  22. To monitor for adverse effect , all men undergoing androgen therapy should be seen within the first 3 to 4 months after the initiation of treatment . At that time,one should evaluate the patient for : * weight gain * peripheral edema * Gynecomastia or breast tenderness * problems with sleep * Hemoglobin / hematocrit levles *Prostate specific antigen (PSA) levle.

  23. Any  of PSA by more than 0.75 ng/ml in two consecutive controls or a PSA level abnormal for age (>4 ng / ml ) requires further examination and eventually biopsy, whereas any  of the hematocrite above 51% requires reduction of the dose or temporarily arrest of the treatment.

  24. Thank you

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