Androgens in the Aging Male

1
Androgens in the Aging Male
What the world needs is a little more
testosterone!
The RxFiles May-June 2003
2
Hormones and Aging

• Females
• sudden drop
• Males
• gradual decline

3
Androgen Deficiency Symptoms
ADAM or Morley Questionaire
Do you have a decrease in libido (sex drive)?
Do you have a lack of energy? Do you have a
decrease in strength and/or endurance? Have you
lost height? Have you noticed a decreased
"enjoyment of life?" Are you sad and/or grumpy?
Are your erections less strong? Have you
noticed a recent deterioration in your ability to
play sports? Are you falling asleep after
dinner? Has there been a recent deterioration in
your work performance?
???
4
Morley Questionnaire

• 10 questions every middle aged man is afraid to
  ask
• 88 sensitivity for low BT
• catches most
• 60 specificity for low BT
• catches many (40) who should not be caught
• multifactorial nature of symptoms
• natural course of aging
• other medical conditions

5
? Testosterone by System

• Brain
• libido, depression, irritable, ? concentration
• Body
• abdominal obesity, ? muscle strength, hair
  regression, ? BMD, gynecomastia
• Genitourinary
• smaller, softer, impotence
• General
• fatigue, ? energy

6
Testosterone (T) Levels

• SHBG sex hormone binding globulin
• tightly BINDS Testosterone making it unavailable
• Total T free T (unbound T) bound T
• 6-28 nmol/L
• AGE adjusted norms? 40-59y 12.1-30 gt606.9-25
• Bioavailable T free T T bound weakly
• to albumin
• Free Androgen Index
• 15-95 U

Early AM
7
Males
8
Trials

• Limited - too small, too short
• lack good data for large scale treatment of PADAM
• some efficacy on some parameters
• subjective benefits
• safety data lacking

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Benefit vs Risk

• body
• strength
• mood
• libido
• cognition
• function

• prostate
• cardiovascular
• Hct (stroke)
• gynecomastia
• treated with tamoxifen?
• inappropriate behavior
• cost of treatment

10
Monitoring

• Symptoms/side effects
• Prostate
• DRE, PSA baseline, annual
• Lab
• Hct, Hgb (stroke) lipids (heart)
• testosterone
• Other

11
Androgens - Oral

• ANDRIOL
• testosterone undecanoate
• storage
• refrigerate in pharmacy
• at room temperature after dispensing (Exp. 90
  days)
• take after food

12
Androgens - Topical Gel

• ANDROGEL
• testosterone 1 gel
• apply daily in AM
• a shirt prevents sharing

13
Androgens - Transdermal Patch

• ANDRODERM
• testosterone
• apply daily at HS
• rotate sites weekly
• skin irritation common

14
Androgens - Injectable
Lower drug cost

• DELATESTRYL
• Testosterone enanthate
• small volume advantage
• DEPO-TESTOSTERONE
• Testosterone cypionate