Hvem skal ha testosteronbehandling? Martina Moter Erichsen spesialist endokrinologi, PhD Haukeland universitetssykehus

Transkript

1 Hvem skal ha testosteronbehandling? Martina Moter Erichsen spesialist endokrinologi, PhD Haukeland universitetssykehus

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3 Epidemiologi hypogonadisme (the HIM study) Menn > 45 år : 40 % med hypogonadisme (T<10,4!) 5 % blir diagnostisert og behandlet Int J Clin Pract., 2006, Mulligan et al Prevalence of hypogonadism in males aged at least 45 years: the HIM

4 Longitudinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore longitudinal study of aging. Harman et al 2001 JCEM..by the criteria of total T < 11.3 nmol/l (325 ng/dl) (shaded bars), or T/SHBG (free T index) < nmol/nmol (striped bars). More men are hypogonadal by free T index than by total T after age 50, and there seems to be a progressively greater difference, with increasing age, between the two criteria.

5 Hypothalamic-Pituitary-Testicular Axis Disruptions in Older Men Are Differentially Linked to Age and Modifiable Risk Factors: The European Male Aging Study

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8 «Verktøy» for identifisering ADAM AMS MMAS Q Adrogen Deficiency in MAles Aging Males Symptoms Massachusets Male Aging Study Quest Dagbladet

9 At Risk? TAKE THE QUIZ To see if you are at risk for low testosterone, answer yes or no to the following questions. If you answer yes to question 1 or 7, or at least three of the other questions, you may have low testosterone. Be sure to discuss the results of this quiz with your doctor. 1. Do you have a decrease in libido (sex drive)? Yes No 2. Do you have a lack of energy? Yes No 3. Do you have a decrease in strength and/or endurance? Yes No 4. Have you lost height? Yes No 5. Have you noticed a decreased enjoyment of life? Yes No 6. Are you sad and/or grumpy? Yes No 7. Are your erections less strong? Yes No 8. Have you noticed a recent deterioration in your ability to play sports? Yes No 9. Are you falling asleep after dinner? Yes No 10. Has there been a recent deterioration in your work performance? Yes No Source: Saint Louis University Androgen Deficiency in Aging Men (ADAM) Questionnaire. John Morley, M.D., Saint Louis University School of Medicine, June 1997.

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12 The causes of low libido include: Medications (SSRIs, anti-androgens, 5-alpha reductase inhibitors, opioid analgesics) Alcoholism Depression Fatigue Hypoactive sexual disorder Recreational drugs Relationship problems Other sexual dysfunction (fear of humiliation) Sexual aversion disorder Systemic illness Testosterone deficiency

13 Ingen generell T screening

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15 Laboratorieprøver Testosteron (T) fastende morgen Hvis lav/ under ref.grenser; gjenta T sammen med LH, FSH og SHBG Prolaktin Evt. andre prøver når du vurderer årsaken Ingen T-diagnostikk ved akutt eller subakutt sykdom

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17 Testosteron fungerer både som et målhormon og et prohormon Daglig testosteronproduksjon hos menn: 7 mg

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19 Underdiagnostisert: XXY

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21 Klinefelter syndrom Obs. ved testis < 6 ml Obs. ved mosaikk 46, XY/47, XXY kan blodprøve (lymfocytter) vise normal karyotype XY

22 Klinefelter syndrome in clinical practice the most common sex-chromosome disorder; one in every 660 men. The 'prototypic' man with Klinefelter syndrome has traditionally been described as tall, with narrow shoulders, broad hips, sparse body hair, gynecomastia, small testicles, androgen deficiency, azoospermia and decreased verbal intelligence. A less distinct phenotype has, however, been described. Patients should be treated with lifelong testosterone supplementation that begins at puberty however, the optimal testosterone regimen for patients with Klinefelter syndrome remains to be established. Nat Clin Pract Urol Apr;4(4): Department of Clinical Genetics, Vejle Hospital, Aarhus University Hospital, Denmark. anders.bojesen@dadlnet.dk

23 Orchidometer

24 Klinefelter f-1964 med «ny» diagnose, LH og testosteron fra behandlingsstart

25 KONTRAINDIKASJONER T-substitusjon Prostatakreft, brystkreft Palpasjonsfunn for prostata eller PSA>4 ng/ml (3 ng/ml) EVF > 0,50 Ubehandlet søvnapnoe Dårlig regulert hjertesvikt

26 Testosteronsubstitusjon Til hvem: Menn med åpenbar klinisk testomangel og gjentatte lave testosteronmålinger Mål, biokjemisk: Bringe teststeronnivået til middels normale verdier Krever kontroll av effekt og bivirkninger: Dosevurdering, uønskete anabole effekter på prostata og beinmarg. => årlig prostatasjekk og hematokrit

27 Testosteronsubstitusjon forts. Administrasjonsformer : Langtidsvirkende injeksjonstestosteron (Nebido ) 1000mg (10-12 uker) er mest brukt Transdermal gel 50mg, mindre hudirritasjoner enn plaster (Testogel dosepose/ Tostran dosepumpe) Transdermal testosteron; plaster 2,5-7,5 mg, skiftes daglig Oral testosteron er lite brukt pga multippel dlg.adm., leverbivirkninger, dårligere androgen effekt, mer lipidforandringer Buccal administrasjon som en heftende snuspose 30 mg, 2 x daglig