SEARCH RESULTS FOR: Androgen-Deficiency

Clinical Findings of Androgen Deficiency

Yu, Yan - Androgen Deficiency - FINAL.pptx Hypogonadism in Males:Clinical Findings of Androgen Deficiency? secretion volume from seminal vesicle and prostateAuthor: Yan YuReviewers:Peter VetereGillian GoobieHanan Bassyouni** MD at time of publicationLegend:Published June 18, 2013 on www.thecalgaryguide.comMechanismPathophysiologySign/Symptom/Lab FindingComplications? effect of testosterone on the brain? Libido(sensitive, but less specific)? [testosterone] : [estrogen] ratio at the male breast? ejaculate volume(a sensitive and specific sign)Gynecomastia (palpable breast tissue, not fat, directly under nipple)Fatigue,low mood, irrtabilityHot flashes, sweats(Can be nocturnal; occur only when hypogonadism is severe)Vasomotor neural response of unknown causeFewer spontaneous erections (i.e. in the morning)Lack of androgens (i.e. testosterone, DHT) in men past the age of pubertyIn advanced stages of the disease, after years of hypogonadism:(thus, less commonly seen)Low Bone Mass Density (BMD)Less testosterone to be converted into estrogen in bone? muscle bulk and strengthSmall, soft testicles(<4cm long on orchidometer)Lack of hormones to stimulate and maintain testicular hyperplasia/growthLoss of androgenic hair (on face, midline, and pubic area)Vertebral fracture (height loss), or other fragility fracturesIf sexual development is incomplete from puberty:Note: These clinical findings apply to many disorders, including:-Andropause-Hypopituitarism (suspect if other hormone abnormalities & Sx of mass lesion like visual field loss, diplopia, and headache exist)-Testicular Failure (if Hx of chemo, radiation, excess alcohol, and chronic liver disease)-Klinefelter's (if assoc. tall and eunuchoid stature, breast enlargement and cognitive deficiency - XXY)-Kallman's (if assoc. anosmia, and tall/eunuchoid stature)-Drugs (e.g. ketoconazole, anabolic steroids, spironolactone, digoxin, marijuana)Testosterone's inhibitory effect on estrogen is not enough to prevent breast growthDeficiency in testosterone during puberty delays fusion of epiphysesTall, eunuchoid statureNote: any disease involving an increase in aromatase activity (hyperthyroidism, cirrhosis, HCG-secreting tumors) will also cause relative estrogen excess & subsequent gynecomastia. 111 kB / 272 words

Androgen Deficiency

Hypogonadism in Males (Androgen Deficiency): Pathogenesis and clinical findings Klinefelter syndrome (extra X: XXY) Kallman syndrome (hypo- gonadotropic hypogonadism Testicular failure (hyper- gonadotropic hypogonadism) Hypopituitarism Andropause (testosterone decline) Drugs (e.g., ketoconazole, anabolic steroids, spironolactone, digoxin, marijuana) Authors: Mitchell Chorney Yan Yu Catherine R Jarvis Reviewers: Peter Vetere Gillian Goobie Jessica Revington Hanan Bassyouni* Karin Winston* *MD at time of publication Legend: If sexual development is incomplete from puberty: ↓ Androgens in males during age of puberty (~9-14 years) ↓ Testosterone in skeletal muscle cells ↓ Testosterone converted into estrogen in bone ↓ Androgen receptor (AR) activation in skeletal muscle ↓ AR-induced suppression of muscle breakdown pathways & ↓ activation of protein synthesis pathways ↑ Muscle breakdown & ↓ muscle synthesis ↓ Muscle bulk & strength ↓ Estrogen at bone epiphyses (ends of bone adjacent to growth plates) Insufficient estrogen to initiate fusion (closure) of epiphyses causes extended period of limb growth Eunuchoid stature (tall, long limbs relative to trunk) ↓ Estrogen in osteoblasts (bone- forming cells) & osteoclasts (bone- breakdown cells) ↓ Estrogen- induced osteoblast stimulation & ↓ osteoclast suppression ↓ Bone formation & ↑ breakdown Vertebral fractures (e.g., height loss) ↓ Bone mass density Fragility fractures ↓ Androgens à ↓ stimulation & maintenance of testicular growth Small soft testicles (<4mL on orchidometer) ↓ Androgens at androgenic hair follicle sites (face, midline, pubic area) Hair follicles do not receive signal to transition from vellus hair (thin fine hair) to terminal hair (thick pigmented hair) ↓ Terminal hair at face, midline, & pubic areas ↓ Androgens in males onset after age of puberty ↓ Androgens at the seminal vesicle ↓ AR activation at the seminal vesicle ↓ AR-induced seminal vesicle glandular secretions ↓ Ejaculate volume ↓ Androgens at the prostate ↓ AR activation at the prostate ↓ AR-induced prostate glandular secretions ↓ Testosterone at the male breast area ↓ Testosterone available to inhibit estrogen receptors ↑ Estrogen binding to estrogen receptors ↑ breast glandular growth Gynecomastia (↑ palpable breast tissue directly under nipple) ↓ Androgens in corpus cavernosum (penile erectile tissue) ↓ AR activation in corpus cavernosum ↓ nitric oxide (NO) production ↓ NO-mediated smooth muscle relaxation in corpus cavernosum impairs penile vasodilation ↓ Spontaneous erections ↓ Testosterone in hypothalamus ↓ AR activation in the hypothalamus ↓ dopamine release ↓ Sexual motivation signaling ↓ Testosterone ↓ Testosterone ↓ AR activation in the amygdala in the brain ↓ Libido in amygdala ↓ emotional sexual cue processing ↓ Erotic stimulus recognition ↓ Testosterone in prefrontal cortex ↓ AR activation in the prefrontal cortex ↓ initiating goal-directed sexual behavior Vasomotor neural response of unknown cause is induced Hot flashes & sweats (can be nocturnal; occur only when hypogonadism is severe) Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published June 18, 2013, updated May 26, 2026 www.thecalgaryguide.com