Additional Information
Book Details
Abstract
The relationship between testosterone and prostate cancer physiology resulted in a Nobel Prize almost 5 decades ago; scientists have been studying testosterone and its relationship to heart health, diabetes, bone density, and muscle development throughout the subsequent 50 years. Included in this issue is the clinical experience and research expertise of many of the leaders in this field.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Hypogonadism\r | i | ||
| Copyright\r | ii | ||
| CME Accreditation Page | iii | ||
| PROGRAM OBJECTIVE | iii | ||
| TARGET AUDIENCE | iii | ||
| LEARNING OBJECTIVES | iii | ||
| ACCREDITATION | iii | ||
| DISCLOSURE OF CONFLICTS OF INTEREST | iii | ||
| UNAPPROVED/OFF-LABEL USE DISCLOSURE | iv | ||
| TO ENROLL | iv | ||
| METHOD OF PARTICIPATION | iv | ||
| CME INQUIRIES/SPECIAL NEEDS | iv | ||
| Contributors | v | ||
| CONSULTING EDITOR | v | ||
| EDITOR | v | ||
| AUTHORS | v | ||
| Contents | ix | ||
| Foreword: Hypogonadism\r | ix | ||
| Preface: Hypogonadism\r | ix | ||
| Physiology of the Hypothalamic Pituitary Gonadal Axis in the Male\r | ix | ||
| Hypogonadism: Its Prevalence and Diagnosis\r | ix | ||
| Assays of Serum Testosterone\r | ix | ||
| Testosterone Therapies\r | x | ||
| Testosterone and Male Infertility\r | x | ||
| Testosterone Deficiency and the Prostate\r | x | ||
| Testosterone Therapy and Prostate Cancer\r | x | ||
| Testosterone and Sexual Function\r | x | ||
| Testosterone and Varicocele\r | xi | ||
| Testosterone Deficiency and Sleep Apnea\r | xi | ||
| Obesity and Hypogonadism\r | xi | ||
| Management of Hypogonadism in Cardiovascular Patients: What Are the Implications\rof Testosterone Therapy on Cardiovascular Morbidity?\r | xi | ||
| Trends in Testosterone Prescription and Public Health Concerns\r | xii | ||
| UROLOGIC CLINICS OF NORTH AMERICA\r | xiii | ||
| FORTHCOMING ISSUES | xiii | ||
| August 2016 | xiii | ||
| November 2016 | xiii | ||
| February 2017 | xiii | ||
| RECENT ISSUES | xiii | ||
| February 2016 | xiii | ||
| November 2015 | xiii | ||
| August 2015 | xiii | ||
| Foreword: Hypogonadism\r | xv | ||
| Preface: Hypogonadism\r | xvii | ||
| Physiology of the Hypothalamic Pituitary Gonadal Axis in the Male | 151 | ||
| Key points | 151 | ||
| INTRODUCTION | 151 | ||
| ANATOMIC OVERVIEW OF THE HYPOTHALAMUS AND PITUITARY | 152 | ||
| CONTROL OF HYPOTHALAMIC SECRETION | 152 | ||
| NORMAL HYPOTHALAMIC REGULATION OF GONADOTROPINS | 152 | ||
| FOLLICLE-STIMULATING HORMONE, LUTEINIZING HORMONE, AND TESTICULAR FUNCTION | 152 | ||
| PERIPHERAL METABOLISM OF TESTOSTERONE | 153 | ||
| SEXUAL DEVELOPMENT IN MALES | 155 | ||
| HYPOGONADOTROPIC HYPOGONADISM | 155 | ||
| ANDROGEN INSENSITIVITY SYNDROME | 157 | ||
| ABNORMALITIES IN TESTICULAR FUNCTION | 158 | ||
| DIAGNOSIS | 158 | ||
| TREATMENT | 159 | ||
| NOVEL THERAPEUTICS | 159 | ||
| SUMMARY | 161 | ||
| REFERENCES | 161 | ||
| Hypogonadism | 163 | ||
| Key points | 163 | ||
| INTRODUCTION | 163 | ||
| PRIMARY HYPOGONADISM | 164 | ||
| Primary Congenital Hypogonadism | 164 | ||
| Primary Acquired Hypogonadism | 165 | ||
| SECONDARY HYPOGONADISM | 165 | ||
| Secondary Congenital Hypogonadism | 165 | ||
| Secondary Acquired Hypogonadism | 167 | ||
| EPIDEMIOLOGY OF HYPOGONADISM | 167 | ||
| Testosterone and Metabolic Disorders | 168 | ||
| DIAGNOSIS OF ANDROGEN DEFICIENCY SYNDROMES IN MEN | 168 | ||
| Who Should Be Screened for Androgen Deficiency? | 168 | ||
| Patient History | 168 | ||
| Physical Examination | 169 | ||
| LABORATORY TESTING | 170 | ||
| Semen Analysis | 173 | ||
| SUMMARY/DISCUSSION | 173 | ||
| REFERENCES | 173 | ||
| Assays of Serum Testosterone | 177 | ||
| Key points | 177 | ||
| INTRODUCTION | 177 | ||
| PREVALENCE | 178 | ||
| DIAGNOSING HYPOGONADISM | 178 | ||
| REFERENCE RANGES OF TESTOSTERONE | 179 | ||
| VARIATION IN TESTOSTERONE | 179 | ||
| INTRAINDIVIDUAL VARIATION | 179 | ||
| METHODS FOR MEASURING TOTAL TESTOSTERONE | 180 | ||
| Immunoassays | 180 | ||
| Mass Spectrometry | 181 | ||
| SUMMARY | 182 | ||
| REFERENCES | 182 | ||
| Testosterone Therapies | 185 | ||
| Key points | 185 | ||
| INTRODUCTION | 185 | ||
| HISTORY | 185 | ||
| PRETREATMENT CONSIDERATIONS | 186 | ||
| CONTRAINDICATIONS TO TESTOSTERONE THERAPY | 186 | ||
| TREATMENT OPTIONS | 186 | ||
| TESTOSTERONE GELS AND SOLUTIONS | 187 | ||
| BUCCAL FORMULATIONS | 187 | ||
| ORAL TESTOSTERONE PREPARATIONS | 189 | ||
| SUBCUTANEOUS TESTOSTERONE PELLETS | 189 | ||
| SHORT-ACTING TESTOSTERONE INJECTIONS | 189 | ||
| LONG-ACTING TESTOSTERONE INJECTIONS | 189 | ||
| TESTOSTERONE PATCHES | 189 | ||
| ALTERNATIVES TO TESTOSTERONE THERAPY | 190 | ||
| EFFECTS OF LIFESTYLE INTERVENTIONS TO RAISE ENDOGENOUS TESTOSTERONE | 190 | ||
| ADVERSE EVENTS WITH TESTOSTERONE THERAPY | 190 | ||
| FOLLOW-UP AND MONITORING | 191 | ||
| SUMMARY | 191 | ||
| REFERENCES | 191 | ||
| Testosterone and Male Infertility | 195 | ||
| Key points | 195 | ||
| INTRODUCTION | 195 | ||
| CAUSES OF HYPOGONADISM | 195 | ||
| Hypogonadotropic Hypogonadism | 196 | ||
| Kallmann syndrome | 196 | ||
| Prader–Willi syndrome | 196 | ||
| Other genetic causes | 197 | ||
| Hyperprolactinemia | 197 | ||
| Congenital Adrenal Hyperplasia | 197 | ||
| Hyperestrogenemia | 197 | ||
| Klinefelter Syndrome | 197 | ||
| HYPOGONADISM AND EXOGENOUS TESTOSTERONE | 198 | ||
| PRESERVATION OF SPERMATOGENESIS | 198 | ||
| RECOVERY OF SPERMATOGENESIS | 199 | ||
| SUMMARY | 200 | ||
| REFERENCES | 200 | ||
| Testosterone Deficiency and the Prostate | 203 | ||
| Key points | 203 | ||
| INTRODUCTION | 203 | ||
| EMBRYOLOGY OF THE PROSTATE | 203 | ||
| TESTOSTERONE AND PROSTATE GROWTH (PUBERTY, MIDDLE AGE, OLD AGE) | 204 | ||
| TESTOSTERONE AND BENIGN PROSTATIC HYPERPLASIA | 205 | ||
| TESTOSTERONE AND PROSTATE CANCER | 205 | ||
| FUTURE DIRECTIONS | 206 | ||
| SUMMARY | 207 | ||
| REFERENCES | 207 | ||
| Testosterone Therapy and Prostate Cancer | 209 | ||
| Key points | 209 | ||
| INTRODUCTION | 209 | ||
| The Modern Era of Testosterone Therapy | 210 | ||
| The Androgen Hypothesis | 210 | ||
| The Saturation Model | 210 | ||
| Association of Low Serum Testosterone with Prostate Cancer | 211 | ||
| Testosterone Therapy in Men with a History of Prostate Cancer | 212 | ||
| Discussion | 213 | ||
| SUMMARY | 214 | ||
| REFERENCES | 214 | ||
| Testosterone and Sexual Function | 217 | ||
| Key points | 217 | ||
| INTRODUCTION | 217 | ||
| PATHOPHYSIOLOGY | 218 | ||
| ERECTILE FUNCTION | 218 | ||
| LIBIDO | 219 | ||
| EJACULATORY FUNCTION/ORGASM | 220 | ||
| TESTOSTERONE SUPPLEMENTATION AND OTHER SEXUAL OUTCOMES | 220 | ||
| TESTOSTERONE SUPPLEMENTATION AND PHOSPHODIESTERASE TYPE 5 INHIBITORS | 220 | ||
| NONTESTOSTERONE SUPPLEMENTATION AND SEXUAL FUNCTION | 220 | ||
| SUMMARY | 221 | ||
| REFERENCES | 221 | ||
| Testosterone and Varicocele | 223 | ||
| Key points | 223 | ||
| INTRODUCTION | 223 | ||
| CLINICAL DATA | 223 | ||
| Early Evidence | 223 | ||
| Contemporary Evidence | 224 | ||
| PATHOPHYSIOLOGY OF LEYDIG CELL DYSFUNCTION | 226 | ||
| Human Studies | 226 | ||
| Animal Studies | 228 | ||
| VARICOCELECTOMY FOR HYPOGONADISM—CLINICAL SIGNIFICANCE | 228 | ||
| SUMMARY | 229 | ||
| REFERENCES | 229 | ||
| Testosterone Deficiency and Sleep Apnea | 233 | ||
| Key points | 233 | ||
| INTRODUCTION | 233 | ||
| LOW TESTOSTERONE AND SLEEP APNEA: ROLES OF AGE, BODY MASS INDEX, AND SEVERITY OF SLEEP APNEA | 233 | ||
| LOW TESTOSTERONE AND SLEEP APNEA: ROLE OF FATIGUE | 234 | ||
| EFFECT OF TESTOSTERONE SUPPLEMENTATION ON OBSTRUCTIVE SLEEP APNEA | 234 | ||
| MEN WITH OBSTRUCTIVE SLEEP APNEA AND SEXUAL DYSFUNCTION | 234 | ||
| EFFECT OF OBSTRUCTIVE SLEEP APNEA TREATMENT ON TESTOSTERONE LEVEL | 235 | ||
| OBSTRUCTIVE SLEEP APNEA AND POLYCYTHEMIA | 235 | ||
| SUMMARY | 236 | ||
| REFERENCES | 236 | ||
| Obesity and Hypogonadism | 239 | ||
| Key points | 239 | ||
| INTRODUCTION | 239 | ||
| ADIPOSE TISSUE AS AN ORGAN | 240 | ||
| HYPOGONADISM AS AN ENDOCRINE DISEASE | 241 | ||
| INTERPLAY BETWEEN OBESITY AND LOW TESTOSTERONE | 241 | ||
| Effects of Fat on Androgens | 241 | ||
| Effects of Androgens on Fat | 242 | ||
| EFFECTS OF TREATMENT OF OBESITY ON TESTOSTERONE | 242 | ||
| EFFECTS OF TREATMENT OF TESTOSTERONE ON OBESITY | 243 | ||
| SUMMARY | 243 | ||
| REFERENCES | 244 | ||
| Management of Hypogonadism in Cardiovascular Patients | 247 | ||
| Key points | 247 | ||
| INTRODUCTION | 247 | ||
| NATURAL HISTORY OF TESTOSTERONE LEVELS | 248 | ||
| CLINICAL DIAGNOSIS AND MANAGEMENT OF HYPOGONADISM | 248 | ||
| WHAT ARE THE CLINICAL MANIFESTATIONS OF TESTOSTERONE DEFICIENCY? | 249 | ||
| Adverse Symptoms and Physiologic Consequences | 249 | ||
| Increase in Metabolic Syndrome and Other Cardiovascular Risk Factors | 249 | ||
| Increased All-Cause and Cardiovascular Mortality | 249 | ||
| EFFECTS OF TESTOSTERONE REPLACEMENT THERAPY: PROSPECTIVE DATA | 250 | ||
| Improvement in Symptoms and Components of the Metabolic Syndrome | 250 | ||
| Improvement in Cardiac Functional Capacity | 250 | ||
| Progression of Atherosclerotic Risk Factors | 250 | ||
| Signal Toward Increased Cardiovascular Events | 251 | ||
| Studies Showing No Effect on Cardiovascular Events | 251 | ||
| Reduction in Mortality | 252 | ||
| EFFECTS OF TESTOSTERONE REPLACEMENT THERAPY: RETROSPECTIVE DATA | 252 | ||
| Potential Increase in Cardiovascular Events and Mortality | 252 | ||
| Reduction in Mortality | 253 | ||
| WHAT ROLE DOES TESTOSTERONE PLAY IN CARDIOVASCULAR DISEASE AND ITS RISK FACTORS AND WHAT ARE THE POTENTIAL MECHANISMS? | 254 | ||
| WHAT ARE OTHER THERAPEUTIC OPTIONS FOR CLINICAL ANDROGEN DEFICIENCY? | 255 | ||
| SUMMARY | 255 | ||
| REFERENCES | 256 | ||
| Trends in Testosterone Prescription and Public Health Concerns | 261 | ||
| Key points | 261 | ||
| TRENDS IN THE PRESCRIPTION OF TESTOSTERONE | 262 | ||
| Commercial Insurance Claims Data | 262 | ||
| Pharmacy Sales | 262 | ||
| Veterans Administration Health Care System Data | 263 | ||
| International Trends | 263 | ||
| PREFERENCES IN PRESCRIBED TESTOSTERONE FORMULATIONS | 263 | ||
| TESTOSTERONE PRESCRIBER DEMOGRAPHICS | 264 | ||
| TESTOSTERONE USER DEMOGRAPHICS | 264 | ||
| PRACTICE PATTERNS INCONSISTENT WITH MEDICAL ORGANIZATION GUIDELINES | 265 | ||
| TESTOSTERONE PRESCRIPTION ADHERENCE | 266 | ||
| DIRECT-TO-CONSUMER PRODUCT ADVERTISING | 267 | ||
| FOOD AND DRUG ADMINISTRATION ACTIONS | 268 | ||
| SUMMARY | 269 | ||
| REFERENCES | 269 | ||
| Index | 273 |