sexual health & testosterone -- dc acp chapter PDF
Preview sexual health & testosterone -- dc acp chapter
SEXUAL HEALTH & TESTOSTERONE -- DC ACP CHAPTER -- Michael S. Irwig, M.D. Associate Professor of Medicine, Director, Center for Andrology Division of Endocrinology & Metabolism Disclosures Pharma-Free Presentation Outline of Presentation • Libido and testosterone • “Low T” concept • Testosterone physiology • Measuring testosterone • Diagnosing male hypogonadism • Low testosterone and mortality • Adverse effects of testosterone therapy • Testosterone therapy for women Sexual Desire (Libido) • Dopamine • Norepinephrine • Oxytocin • Serotonin • Opioids • Endocannabinoids Pfaus J. J Sex Med 2009 Sexual Desire (Libido) Dopamine pathways in the brain Pfaus J. J Sex Med 2009 Sexual Function and T and E2 • 16 week trial; N=400 healthy men with a mean age of 33 • Suppressed T and E2 with GnRH agonist (goserelin) • COHORT 1: Randomized to placebo or T gel (4 doses) • COHORT 2: Randomized to placebo or T gel (4 doses) plus anastrazole (aromatase inhibitor) Finkelstein JS, et al. N Engl J Med 2013 Sexual Function and T and E2 FINDINGS • Low T – decreased lean mass, muscle size & strength • Low E2 – increased body fat • Both low T and low E2 – decreased sexual function Finkelstein JS, et al. N Engl J Med 2013 Libido and Testosterone Data from the Massachusetts Male Aging Study Travison TG, et al. J Clin Endocrinol Metab 2006 Current Philosophy in Medicine “Low T”
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