Polyendocrine Syndromes
Jack L. Leahy, Nathaniel G. Clark, William T. Cefalu in Medical Management of Diabetes Mellitus, 2000
Repeated phlebotomy may reverse the hypogonadism. This primarily occurs in men younger than 40 years. Otherwise, hypogonadism can be treated with testosterone replacement. Testosterone per se cannot be effective administered orally; the testosterone congeners that are administered by mouth are associated with a risk of hepatic dysfunction, and should be avoided in hypogonadal patients in general (and certainly in the patient with hemochromatosis who is likely to have significant liver disease already because of the underlying disorder). Testosterone can be effectively restored by intramuscular injection of long-acting agents, such as testosterone enanthate or testosterone cypionate, either of which can be administered at a dose of 200 mg every 2 weeks. This will result in serum levels in the normal physiological range for men after a steady state is achieved following the initial rise after the injection. Alternatively, testosterone can be administered by transdermal systems (patches), with a typical dose being one 5 mg patch to be replaced daily.
Neuroendocrine disease
Philip E. Harris, Pierre-Marc G. Bouloux in Endocrinology in Clinical Practice, 2014
Some drugs, particularly antipsychotics, may be associated with serum prolactin levels of >4000 mU/L (200 μg/L). There may be associated galactorrhea and hypogonadism. Serum prolactin levels usually return to normal within a few days of stopping the medication. In many patients, however, stopping medication is not possible. Hypogonadism may be treated by estrogen or testosterone supplementation if necessary. If hyperprolactinemia is confirmed and no alternative cause has been identified, hypothalamic–pituitary disease needs to be considered. A serum prolactin of ≥3000 mU/L (150 μg/L) is nearly always indicative of a prolactinoma.8 Serum prolactin levels generally correlate with prolactinoma size, although there are exceptions.75 In a retrospective study of histologically verified nonfunctioning pituitary adenomas with suprasellar extensions, 98.7% of patients had serum prolactin levels <2000 mU/L (100 μg/L), indicating that stalk compression is unlikely to be responsible for hyperprolactinemia in patients with higher serum prolactin levels.76
Neuro-Endocrine Effects of Opioids
Barry Stimmel in Opiate Receptors, Neurotransmitters, & Drug Dependence: Basic Science-Clinical Correlates, 2014
Acutely heroin, morphine, and other opioids produced sharp decreases in blood plasma LH levels in human males.75 This action, well documented by Cicero et al in the male rat,78–80 started with a rapid drop in serum LH after large doses of opioids (20 mg/kg), followed shortly by a decrease in serum testosterone (T). Serum FSH levels fell only slightly. ED 50 studies of LH reduction by acute opioids in rats paralleled the analgesic potency of the agonist, and the effect was blocked by antagonists.80 Manifest hypogonadism ensued, including atrophy of male secondary sex characteristics.79 Blockade by NAL and tolerance to the LH depressing effects of opioid agonists usually occurred with continued opioids.80 In man LH levels in hyperprolactinemic patients may be particularly susceptible to opioid-depressing effects.81
Pharmacological management of late-onset hypogonadism
Published in Expert Review of Clinical Pharmacology, 2018
Giulia Rastrelli, Mario Maggi, Giovanni Corona
When T deficiency orchestrate its effects during early prenatal life (very early onset hypogonadism, VEOH), the associated symptoms can be very severe, ranging from an almost complete feminine body shape (complete androgen insensitivity) to minor defects in virilization, including micropenis, cryptorchidism and hypospadias, as sometimes in the case of congenital hypogonadotropic HG [4–6]. Hence, the resulting phenotype is severely affected. However, the prevalence of VEOH is relatively low (1:10.000–100.000). In the case of the more common (1:500–1000) peripubertal appearance of HG (early-onset hypogonadism, EOH), because of central conditions (e.g., pituitary tumors, as germinoma) or testicular failure (e.g., Klinefelter’s syndrome), there might be a slowing or delaying of puberty progression, with an eunuchoid habitus, including long legs and arms, scant body hair, high-pitched voice, small testis and prostate [4,5].
Standards of Care for the Health of Transgender and Gender Diverse People, Version 8
Published in International Journal of Transgender Health, 2022
E. Coleman, A. E. Radix, W. P. Bouman, G. R. Brown, A. L. C. de Vries, M. B. Deutsch, R. Ettner, L. Fraser, M. Goodman, J. Green, A. B. Hancock, T. W. Johnson, D. H. Karasic, G. A. Knudson, S. F. Leibowitz, H. F. L. Meyer-Bahlburg, S. J. Monstrey, J. Motmans, L. Nahata, T. O. Nieder, S. L. Reisner, C. Richards, L. S. Schechter, V. Tangpricha, A. C. Tishelman, M. A. A. Van Trotsenburg, S. Winter, K. Ducheny, N. J. Adams, T. M. Adrián, L. R. Allen, D. Azul, H. Bagga, K. Başar, D. S. Bathory, J. J. Belinky, D. R. Berg, J. U. Berli, R. O. Bluebond-Langner, M.-B. Bouman, M. L. Bowers, P. J. Brassard, J. Byrne, L. Capitán, C. J. Cargill, J. M. Carswell, S. C. Chang, G. Chelvakumar, T. Corneil, K. B. Dalke, G. De Cuypere, E. de Vries, M. Den Heijer, A. H. Devor, C. Dhejne, A. D’Marco, E. K. Edmiston, L. Edwards-Leeper, R. Ehrbar, D. Ehrensaft, J. Eisfeld, E. Elaut, L. Erickson-Schroth, J. L. Feldman, A. D. Fisher, M. M. Garcia, L. Gijs, S. E. Green, B. P. Hall, T. L. D. Hardy, M. S. Irwig, L. A. Jacobs, A. C. Janssen, K. Johnson, D. T. Klink, B. P. C. Kreukels, L. E. Kuper, E. J. Kvach, M. A. Malouf, R. Massey, T. Mazur, C. McLachlan, S. D. Morrison, S. W. Mosser, P. M. Neira, U. Nygren, J. M. Oates, J. Obedin-Maliver, G. Pagkalos, J. Patton, N. Phanuphak, K. Rachlin, T. Reed, G. N. Rider, J. Ristori, S. Robbins-Cherry, S. A. Roberts, K. A. Rodriguez-Wallberg, S. M. Rosenthal, K. Sabir, J. D. Safer, A. I. Scheim, L. J. Seal, T. J. Sehoole, K. Spencer, C. St. Amand, T. D. Steensma, J. F. Strang, G. B. Taylor, K. Tilleman, G. G. T’Sjoen, L. N. Vala, N. M. Van Mello, J. F. Veale, J. A. Vencill, B. Vincent, L. M. Wesp, M. A. West, J. Arcelus
The current set of recommendations is directed at professionals working with individuals who identify as eunuchs (Johnson & Wassersug, 2016; Vale et al., 2010) requesting medically necessary gender-affirming medical and/or surgical treatments (GAMSTs). Although not a specific diagnostic category in the ICD or DSM, eunuch is a useful construct as it speaks to the specifics of eunuch experience while also connecting it to the experience of gender incongruence more broadly. Eunuch individuals will present themselves clinically in various ways. They wish for a body that is compatible with their eunuch identity—a body that does not have fully functional male genitalia. Some other eunuch individuals feel acute discomfort with their male genitals and need to have them removed to feel comfortable in their bodies (Johnson et al., 2007; Roberts et al., 2008). Others are indifferent to having male external genitalia as long as they are only physically present and do not function to produce androgens and male secondary sexual features (Brett et al., 2007). Hormonal means may be used to suppress the production of androgens, although orchiectomy provides a permanent solution for those not wishing genital functioning (Wibowo et al., 2016). Some eunuch individuals desire lower testosterone levels achieved with orchiectomy, but many will elect some form of hormone replacement to prevent adverse effects associated with hypogonadism. Most who elect hormone therapy choose either a full or partial replacement dose of testosterone. A smaller number elect estrogen.
Effectiveness of testosterone therapy in hypogonadal patients and its controversial adverse impact on the cardiovascular system
Published in Critical Reviews in Toxicology, 2020
Zelal Jaber Kharaba, Manal Ali Buabeid, Yaseen Abd Alfoteih
T is the major male hormone produced by testicles which are directly associated with man’s appearance and secondary sexual developments. It also regulates fertility in males. Hypogonadism in males is a condition when sex hormones are not produced by sex glands. Thus, hypogonadism can be categorized into two types. Primary hypogonadism in which testes does not produce enough sex hormones while secondary hypogonadism is the condition in which hypothalamus and pituitary glands are not working correctly (Snyder and Lawrence 1980). Testosterone replacement therapy is considered harmless in youngsters with hypogonadism in which serum testosterone level is deficient (Seftel 2019). However, ageing is also a contributing factor of decreasing testosterone level in males (Wu et al. 2008; Bhasin et al. 2011) even in the absence of pituitary or testicular disease (Harman et al. 2001; Shores et al. 2006). From studies, it was evident that prevalence of lower level of testosterone was seen more deliberately in the ages between 50 and 80 years come up with different percentages of 12–49%, respectively (Harman et al. 2001).
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