Androgen deficiency in aging male

Dicky Moch Rizal

 Testosteron is the man, male is testosterone.. How important its functions in male

 ANDROPAUSE SOMATOPAUSE

VIRILIPAUSE
P.A.D.A.M A.D.A.M

Synthesis of Androgens
Cholesterol serves as the substrate for P5 biosynthesis in the Leydig cells.
Conversion of P5 to 17-hydroxylated steroids provides the steroidogenic predominant pathway in testicular tissue. The 17-hydroxysteroids are converted by side chain cleavage to 17 ketosteroids and these in turn are converted to testosterone.

Synthesis of Androgens
Although some androgens are 17ketosteroids not all 17ketosteroids are androgens and not all androgens are 17ketosteroids. In some tissues, testosterone is converted to either dihydrotestosterone (DHT) or E2 which are the biologically active steroids in these tissues.

 Testosterone is the principal steroid produced by Leydig cells. Androstenedione and dehyrdorepiandrosterone are also produced but the physiological potencies are very low.

Male Sex Steroid Synthesis

Major Testicular Steroids

 Almost 100% of the testosterone in the blood is bound to protein; ~ 40% bound to SBG about 40% bound to albumin and 17% to other proteins.

Roles of Androgens
Testicular androgens play a role in differentiation and development of male urogential system, accessory sex organs and external genitalia. Many tissues respond directly to testosterone, but this must be converted to either DHT or E2 to mediate its actions.

 After the initial actions of T in early fetal development, the gonads remain quiescent until puberty, when gonadotropins increase for spermatogenesis and 2o sex characteristics.

Regulation of T

Testosterone from birth..

Testosterone level

DHEA and testosterone level

 PHYSIOLOGICAL EFFECTS OF TESTOSTERONE (non reproductive)

Nervous system Skin Muscle Bone Cardiovascular blood Metabolism

 ADAM SCORE
Loss of libido Decrease of erection Decrease of concentration Swinging mood Decrease of height Weakness Sleepy after meal

20
YO

30
YO

40
YO

50
YO

60

YO

Loss of tunica albuginia Decrease of penile size Loss of sensation Loss of nocturnal and morning erections Lack of ejaculation volume Increase of refracter phase

Management
Diagnosis
History Physical examination

Laboratory finding

 LABORATORY FINDING
FREE TESTOSTERONE TOTAL TESTOSTERONE PROLACTIN

 Treatment
Prohormone Hormonal replacement therapy
TEnanthate, TUndecanoate, T Oral, gel/transdermal, injection depo

 EVALUATION
Pre and post examination of PSA Blood count BPH symptom