sexual health & testosterone -- dc acp chapter

66 Pages·2013·2 MB·English

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”