Transcript Appendix 17 (Androgen_Presentation

Androgens in the Aging Male
What the world needs is a little more testosterone!
The RxFiles
May-June
2003
Hormones and Aging
• Females
– sudden drop
• Males
– gradual decline
Androgen Deficiency Symptoms
ADAM or Morley Questionaire
Do you have a decrease in libido (sex drive)?
*
Do you have a lack of energy?
Do you have a decrease in strength and/or endurance?
Have you lost height?
Have you noticed a decreased "enjoyment of life?"
Are you sad and/or grumpy?
Are your erections less strong?
???
*
Have you noticed a recent deterioration in your ability to play sports?
Are you falling asleep after dinner?
Has there been a recent deterioration in your work performance?
Morley Questionnaire
• 10 questions every middle aged man is
afraid to ask
• 88% sensitivity for low BT
– catches most
• 60% specificity for low BT
– catches many (~40%) who should not be caught
• multifactorial nature of symptoms
• natural course of aging
• other medical conditions
 Testosterone by System
• Brain
– libido, depression, irritable,  concentration
• Body
– abdominal obesity,  muscle & strength, hair
regression,  BMD, gynecomastia
• Genitourinary
– smaller, softer, impotence
• General
– fatigue,  energy
Testosterone (T) Levels
• SHBG = sex hormone binding globulin
• tightly BINDS Testosterone making it unavailable
• Total T = free T (unbound T) + bound T
• ~6-28 nmol/L;
• AGE adjusted norms?: 40-59y =12.1-30; >60=6.9-25
• Bioavailable T = free T + T bound weakly
to albumin
• Free Androgen Index
• 15-95 U
Males
Trials
• Limited - too small, too short
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–
–
–
lack good data for large scale treatment of PADAM
some efficacy on some parameters
subjective benefits
safety data lacking
Benefit vs Risk
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body
strength
mood
libido
cognition
function
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prostate
cardiovascular
Hct (stroke)
gynecomastia
• treated with tamoxifen?
• inappropriate behavior
• cost of treatment
Monitoring
• Symptoms/side effects
• Prostate
– DRE, PSA
*baseline, annual
• Lab
– Hct, Hgb (stroke); lipids (heart)
– testosterone
• Other
Androgens - Oral
• ANDRIOL
– testosterone
undecanoate
– storage
• refrigerate in pharmacy
• at room temperature after
dispensing (Exp. 90 days)
– take after food
Androgens - Topical Gel
• ANDROGEL
– testosterone 1% gel
– apply daily in AM
– a shirt prevents sharing
Androgens - Transdermal Patch
• ANDRODERM
– testosterone
– apply daily at HS
– rotate sites weekly
– skin irritation common
Androgens - Injectable
• DELATESTRYL
– Testosterone
enanthate
• small volume
advantage
• DEPOTESTOSTERONE
– Testosterone
cypionate
Lower
drug cost