Hypogonadism%20in%20males%20-%20late-onset Diagnosis

Diagnosis

If testosterone level is low or at the lower limit of normal, the level should be repeated for confirmation
Follicle stimulating hormone (FSH) & luteinizing hormone (LH) levels should also be measured

Primary Hypogonadism (Testicular Origin)

Low testosterone level w/ increased FSH & LH suggest a testicular failure origin for hypogonadism

Secondary Hypogonadism (Hypothalamic-Pituitary Origin)

Low testosterone level w/ decreased FSH & LH is suggestive of a hypothalamic-pituitary origin of disease
Further endocrinological work-up may be needed

Evaluation

Assessment of androgen deficient related physical manifestations should be noted
Questionnaires may be used to evaluate climacteric symptoms, the patient’s well-being & sexual function
Prostate evaluation should be done including measurement of prostate-specific antigen (PSA) & digital rectal exam (DRE)

History

Full medical history should be undertaken including:
- Investigation for diabetes mellitus (DM), hypertension, smoking, heart disease, sleep apnea
- Medication history (eg use of opioids or high-dose glucocorticoid therapy)

Physical Examination

Measure body weight, heart rate (HR), blood pressure (BP), check complete blood count (CBC), urinalysis & blood chemistry parameters

Laboratory Tests

NOTE:

Serum testosterone level should be obtained between 07:00-11:00 am
Total testosterone level should be compared w/ the normal ranges established by each laboratory

Testosterone Serum Level

Normal Serum Testosterone

There are no specific lower limits of normal serum testosterone in older men
It is generally agreed that total testosterone level >12 nmol/L (345 ng/dL) do not require testosterone substitution

Low Level

Based on measurements taken in younger men, if total testosterone level is <8 nmol/L (231 ng/dL) then testosterone substitution should be considered

Low-Low/Normal Level

In patients w/ the following, testosterone substitution may be considered:
- Total testosterone level between 8-12 nmol/L (231-345 ng/dL)

AND

Presence of above symptoms that are not due to other causes

Lipid profile & liver function tests are also recommended to assess the patient’s risk status

Optimizing metastatic hormone-sensitive prostate cancer treatment in advanced prostate cancer

Assoc Prof. Darren Poon, Assoc Prof. Edmund Chiong, 14 Jan 2021

Metastatic hormone-sensitive prostate cancer (mHSPC) refers to the condition whereby patients have metastatic prostate cancer and no prior hormonal therapy or androgen deprivation therapy (ADT). Typically, patients with mHSPC have been treated with ADT alone, following which, the overwhelming majority develop castration resistance over time and head towards eventual mortality. In recent years, the publication of various landmark trials has prompted dramatic changes in the mHSPC treatment landscape, and had favourably impacted overall survival (OS) in these patients. At a recent webinar, A/Prof Darren Poon, Honorary Consultant in Clinical Oncology, Hong Kong Sanatorium & Hospital, and Honorary Clinical Associate Professor, Department of Clinical Oncology, The Chinese University of Hong Kong, reviewed treatment options in mHSPC, while A/Prof Edmund Chiong, Head and Senior Consultant, Department of Urology, National University Hospital, Singapore, presented a case which was discussed by an esteemed panel of experts. This webinar was jointly organized by the Singapore Society of Oncology and the Singapore Urological Association, and supported by Astellas.

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Antioxidant and micronutrient supplementation on the sperm parameters of male patients with idiopathic infertility: An updated literature review

09 Jun 2020

Infertility is a problem faced by 5-10 percent of couples, with male factor accounting for up to 47 percent of cases. [Int J Androl 1987;7(Suppl):1]. There are many causes for male infertility but up to 15 percent of cases are idiopathic in nature. These cases may be related to unregulated excessive oxidative stress, which may impair spermatogenesis; hence, arousing research into the role of antioxidant supplementation in improving the sperm parameters.