Controversies in Testosterone Deficiency

✍ Scribed by John P. Mulhall; Mario Maggi; Landon Trost

• Publisher: Springer
• Year: 2021
• Tongue: English
• Leaves: 143
• Edition: 1
• Category: Library

✦ Synopsis

This book aims to address a number of controversies concerning the use of testosterone treatment. It explains topics that clinicians regularly encounter such as whether to use free or total testosterone in the evaluation of the patient with testosterone deficiency; what factors actually impact testosterone levels, polycythemia, gynecomastia, bone density, and hyperprolactinemia in the testosterone deficient patient; critical analysis of the numerous questionnaires that are available to clinicians; and the impact of testosterone therapy on male fertility, cardiovascular disease, and prostate events including prostate cancer. Guiding the reader in both evaluation and management, the book also illuminates novel concepts in the T space such as testosterone use in the transgender population, T therapy as an endothelial modulator, bipolar testosterone therapy in the patient with advanced prostate cancer, and testosterone therapy as a performance enhancer. Controversies in Testosterone Deficiency is intended for any clinician involved in the care of patients with testosterone deficiency, exploring hot topics and correcting existent misinformation in the routine care of patients.

✦ Table of Contents

Contents
Contributors
Chapter 1: What to Measure: Testosterone or Free Testosterone?
1.1 Why Serum Testosterone Is Necessary for the Diagnosis of Testosterone Deficiency?
1.2 What Methods Should Be Used for Serum Testosterone Measurements?
1.3 What Is the Reference Range for Serum Total Testosterone in Adult Men?
1.4 What Are the Precautions to Reduce the Variability in Serum Testosterone Concentrations?
1.5 What Is Free Testosterone?
1.6 Are There Reliable Methods to Estimate Free Testosterone Concentrations?
1.6.1 Free Testosterone by Equilibrium Dialysis
1.6.2 Bioavailable Testosterone
1.6.3 Salivary Testosterone
1.6.4 Calculated Free and Bioavailable Testosterone
1.6.5 Analog-Based Immunoassays and Why They Are Not Recommended by Most Experts in the Field
1.7 Does Measurement of Free Testosterone Provide Additional Information for Clinical Diagnosis?
References
Uncategorized References
Chapter 2: Erythrocytosis in Patients on Testosterone Therapy
2.1 Introduction
2.2 Definition of Erythrocytosis
2.3 Rates of Erythrocytosis During Testosterone Therapy
2.3.1 Risk of Thrombosis and Cardiovascular Disease in Testosterone-Induced Erythrocytosis
2.3.2 Monitoring and Management of Erythrocytosis
2.4 Conclusion
References
Chapter 3: Role of Gonadotropins in Adult-Onset Functional Hypogonadism
3.1 Introduction
3.2 Gonadotropin Measurements
3.2.1 Gonadotropin Assays
3.2.2 Gonadotropin Bioactivity, Polymorphisms, and Microheterogeneity
3.2.3 Interpretation of the Findings
3.3 Pathogenesis of Functional Hypogonadism (FH)
3.3.1 Primary (Hypergonadotropic) Hypogonadism
3.3.2 Secondary (Hypogonadotropic) Hypogonadism
3.3.3 Mixed Primary/Secondary Hypogonadism
3.3.4 Compensated Hypogonadism
3.4 Gonadotropins in the Treatment of Functional Hypogonadism
References
Chapter 4: Hyperprolactinemia in Men with Testosterone Deficiency
4.1 Introduction
4.2 Prolactin and Hypothalamic-Pituitary-Gonadal Axis
4.3 Clinical Symptoms and Prevalence of Hyperprolactinemia in Men
4.4 Etiologies for Hyperprolactinemia
4.5 When to Obtain Prolactin Testing
4.6 Management of Hyperprolactinemia
4.7 Summary
References
Chapter 5: Testosterone and Disordered Sleep
5.1 Introduction
5.2 Insufficient Sleep
5.2.1 Effect on Reproductive Health
5.3 Misaligned Sleep
5.3.1 Effect on Reproductive Health
5.4 Disrupted Sleep
5.4.1 Effects on Reproductive Health
5.4.2 Testosterone Replacement Therapy and Obstructive Sleep Apnea
5.5 Conclusion
References
Chapter 6: Testosterone Therapy and Male Fertility
6.1 Introduction
6.2 Male Reproduction
6.3 Testosterone Deficiency and Male Infertility
6.4 Adverse Effects of Exogenous Androgens and Spermatogenesis
6.5 Alternative Therapies for the Treatment of Testosterone Deficiency
6.5.1 Aromatase Inhibitors
6.5.2 Human Chorionic Gonadotropin (hCG)
6.5.3 Selective Estrogen Receptor Modulators (SERMs)
6.6 Treatment of Testosterone Deficiency in “Special Populations”
6.6.1 The Aging Male
6.6.2 The Male Who Abuses Anabolic Steroids
6.6.3 The Male with Hypogonadotropic Hypogonadism
6.6.4 The Male with Klinefelter Syndrome
6.7 Conclusions
References
Chapter 7: Testosterone and Prostate Effects
7.1 Introduction
7.2 Prostate-Specific Antigen (PSA) Changes
7.3 Prostate Volume Changes
7.4 Lower Urinary Tract Symptoms (LUTS)
7.5 Prostate Cancer (CaP) Development
7.6 Conclusion
References
Chapter 8: Testosterone in Females
8.1 Introduction
8.2 Physiology of Androgens in Women
8.2.1 Production and Signaling
8.2.2 Androgens’ Levels in Menopause and Aging
8.3 The Role of Androgens in Women
8.4 Neurobiology of Testosterone
8.5 Testosterone and Vaginal Health
8.6 Testosterone and Cardiometabolic Health
8.7 Controversies in Testosterone Deficiency in Women – Causes and Diagnosis
8.7.1 Causes
8.7.2 Diagnostic Controversies
8.7.3 Role of Testosterone Measurement Assays
8.8 Controversies in Testosterone Deficiency in Women – Therapy
8.8.1 Systemic Testosterone Therapy for HSDD in Postmenopausal Women
8.8.2 Other Effects of Testosterone Therapy
8.8.2.1 Mood and Well-Being
8.8.2.2 Cardiovascular Health
8.8.2.3 Bone and Body Composition
8.8.3 Local Androgen Therapy
8.8.4 Management and Safety
8.8.5 Recommendations for Premenopausal Women
8.8.6 Other Androgenic Preparations
8.9 Conclusions
References
Chapter 9: Testosterone in Transgender Population
9.1 Introduction
9.2 Gender Affirming Hormones in Transgender Men
9.3 Desirable Effects
9.3.1 Voice
9.3.2 Dermatologic Effects
9.3.3 Reproductive Organs
9.3.4 Sexual Well-Being
9.3.5 Body Composition
9.4 Side Effects
9.4.1 Dermatologic Effects
9.4.2 Reproductive Organs
9.4.3 Cardiovascular Safety
9.4.4 Hepatologic and Renal Safety
9.4.5 Bone Health
9.4.6 Oncological Risk
9.4.7 Psychological Monitoring
9.4.8 Mortality
9.5 Monitoring During Testosterone Treatment
9.6 Conclusions
References
Chapter 10: Testosterone as a Performance Enhancer
10.1 Introduction
10.2 Historical Context of Steroids/Hormone Replacement for Performance
10.3 Current Trends in Steroid Abuse
10.4 Mechanism of Performance Enhancement
10.5 Anecdotal Revelations of a Steroid Abuse Expert
10.6 Review of Literature on Supraphysiologic Testosterone Side Effects
10.7 Future Trends in Steroid Abuse
10.8 Conclusions
References
Index