This document defines and discusses andropause (also known as male menopause), including its definition, symptoms, epidemiology, pathophysiology, effects of testosterone deficiency, monitoring and risks/benefits of testosterone replacement therapy. Some key points are: andropause is characterized by declining testosterone levels and affects quality of life; symptoms include reduced energy, libido and erectile dysfunction; prevalence increases with age, with 20% of men over 60 and 50% of men over 75 having low testosterone; testosterone replacement can improve symptoms in men with very low levels if administered carefully under medical supervision due to risks like prostate issues.
Polycystic Ovarian Syndrome is heterogeneous, multisystem endocrinopathy in women of reproductive age characterized by chronic anovulation resulting in infertility, irregular bleeding, obesity and hirsutism. Most common, although the least understood, cause of androgen excess. Initially it was described in 1935.Also known as Stein-Leventhal syndrome
The slide includes:
Introduction
Incidence
Pathophysiology
Pathology
Clinical features
Investigation
Treatment
Hypogonadotrophic Hypogonadism
its congenital disease, failure of communication between the hypothalamus and the anterior pituitary gland.
symptom of an altered sense of smell either completely absent (anosmia) or highly reduced (hyposmia).
for diagnosis wait and see" approach applied
female sexual dysfunction
For More Medicine Free PPT - http://playnever.blogspot.com/
For Health benefits and medicine videos Subscribe youtube channel - https://www.youtube.com/playlist?list=PLKg-H-sMh9G01zEg4YpndngXODW2bq92w
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1. Discuss diagnosis of erectile dysfunction
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3. Evaluate penile prosthesis and implant as ED surgical therapy options
Polycystic Ovarian Syndrome is heterogeneous, multisystem endocrinopathy in women of reproductive age characterized by chronic anovulation resulting in infertility, irregular bleeding, obesity and hirsutism. Most common, although the least understood, cause of androgen excess. Initially it was described in 1935.Also known as Stein-Leventhal syndrome
The slide includes:
Introduction
Incidence
Pathophysiology
Pathology
Clinical features
Investigation
Treatment
Hypogonadotrophic Hypogonadism
its congenital disease, failure of communication between the hypothalamus and the anterior pituitary gland.
symptom of an altered sense of smell either completely absent (anosmia) or highly reduced (hyposmia).
for diagnosis wait and see" approach applied
female sexual dysfunction
For More Medicine Free PPT - http://playnever.blogspot.com/
For Health benefits and medicine videos Subscribe youtube channel - https://www.youtube.com/playlist?list=PLKg-H-sMh9G01zEg4YpndngXODW2bq92w
what is endometriosis? Theories in endometriosis, sites of endometriosis. types and clinical presentation. signs and symptoms.
Investigations :TVS, CA125
laparoscopic findings
chocolate cyst and extrapelvic endometriosis.
Classification of endometiosis
Diffential diagnosis
Management :of asymptomatic and symptomatic cases
drugs and minimally invasive surgery
surgey and preventive measures in endometiosis.
Erectile Dysfunction: New Paradigms in Treatment Ranjith Ramasamy
1. Discuss diagnosis of erectile dysfunction
2. Treatments of ED using Viagra, Cialis, Trimix (intracavernosal injections)
3. Evaluate penile prosthesis and implant as ED surgical therapy options
Although typically not thought of as a major medical concern, hormone imbalances affect millions of people all over the world and can dramatically hinder the daily lives of both men and women. As we age, hormone levels such as Testosterone, Estrogen and Thyroid, Progesterone, DHEA, Pregnenolone, Melatonin and Cortisol drop or become imbalanced.
It has been observe that as the man gets old the testosterone level goes down which leads to serious changes in the functions of the body. The patient should be investigated and if testosterone is low and the symptoms are present, such cases need testosterone replacement therapy.
Hormone Repacement Therapy (HRT) for men can be a life changing solution for men who are in their 40's, 50's and 60's and are experiencing low energy levels, low sex drive and have difficulties losing and keeping weight off.
Strategies to prevent depletion of Testosterone and the resulting muscle loss (Sarcopenia ) due to Aging. Stay Young.. Strong and Lively. Andraiz T of Body Satva Essentials on www.bodysatva.com
Testosterone is the key male sex hormone that regulates fertility, muscle mass, fat distribution, and red blood cell production.
When levels of testosterone drop below levels that are healthy, they can lead to conditions like hypogonadism or infertility. There are, however, sources from which people with low testosterone can boost their levels.
Low testosterone is becoming more and more common. The number of prescriptions for testosterone supplements has increased fivefoldTrusted Source since 2012.
This article will explore what testosterone does and whether men should worry about decreasing levels of the hormone as they grow older.
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This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
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June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
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Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
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• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
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June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...
Andropause
1. SPEAKER : DR PARMINDER PAL SINGH
CHAIRPERSON : DR RAGHUVANSH SHARMA
2. DEFINITITION
‘ A CLINICAL AND BIOCHEMICAL SYNDROME
ASSOCIATED WITH ADVANCING AGE AND
CHARACTERISED BY A DEFICIENCY IN SERUM
ANDROGEN LEVELS WITH OR WITHOUT A
DECREASE IN GENOMIC SENSITIVITY TO
ANDROGENS.
IT MAY RESULT IN SIGNIFICANT
ALTERATIONS IN THE QUALITY OF LIFE AND
ADVERSLY AFFECT THE FUNCTION OF MULTIPLE
ORGAN SYSTEMS’
3. SYNONYMS
PADAM : Partial Androgen Deficiency In Ageing
Male
ADAM : Androgen Deficiency In Ageing Male
MALE CLIMACTERIC
VIROPAUSE
RELATIVE HYPOGONADISM
HYPOANDROGENEMIA
MANOPAUSE
LOH : Late Onset Hypogonadism
4.
5.
6.
7.
8.
9.
10. EPIDEMIOLOGY
Prevalence is unknown
Testosterone level decline by 1% per year after the age
of 50
Some studies show 20% of men over age of 60 have
abnormally low level of testosterone
50% have abnormally low level of bioavailable
testosterone
11. EPIDEMIOLOGY cont..
By the age of 75, testosterone level are at 65% of young
adults and 25% of these men have below normal level
of bioavailable testosterone ( Vermeulen , 2000)
Same study showed 25% of 75 year olds, had
testosterone levels in the top quarter of those of young
adults ( Vermeulen , 2000)
12.
13. Variation in serum total testosterone
concentrations
Bremner, WJ, Vitiello, V, Prinz, PN, J Clin Endocrinol Metab 1983; 56:1278
16. Physiological effects cont……
Skin → increases facial and body hair and sebum
production
Blood → increases hematocrit (PCV)
Adipose tissue → increases lipolysis, ↓es abdominal fat
Bone → increases bone mineral density
Muscle mass → increases lean mass and strength
17. PATHOPHYSIOLOGY
Decreasing levels of bioavailable testosterone due to :
Decrease rate of production by testes
Reduction in size and weight of testes
Critical illness
Increassed leval of stress
Testicular trauma
Genetic and metabolic disorder
19. SIGNS AND SYMPTOMS
Reduced energy
Decrease sense of well being
Fatigue
Decreased libido and erectile dysfunction
Changes in ejaculation
Decrease in strength and lean body mass
Loss of height , body hair
Increase in body fat
20. Hot flashes, sweating, insomnia, anxiety
Irritable mood, tiredness, lethargy
Lack of motivation, low mental energy
Depression, low self esteem
Less interest and desire for sex, less sexual activity,
poor erection, reduced quality of orgasm and
ejaculation
21. ERECTILE DYSFUNCTION
Definition : inability to attain or maintain an erection
sufficient to complete intercourse
It is under neurogenic, arteriogenic and vasogenic
control
Atherosclerosis and reduced testosterone play a role in
decreased oxygen saturation to tissues leading to
fibrosis ( TGF-B1)
Prevalence at ages 55, 65, 75, 80 was 8%, 25%, 55% and
75% respectively
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44. Conditions in which testosterone should not be
administered
Very high risk of serious adverse outcomes
Metastatic prostate cancer
Breast Cancer
Moderate to high risk of adverse outcomes
Undiagnosed prostate nodule or induration
Unexplained PSA elevation
Erythrocytosis (hematocrit >50%)
Severe lower urinary tract symptoms associated with benign
prostatic hypertrophy as indicated by AUA/IPSS > 19
Unstable severe congestive heart failure (class III or IV)
Bhasin, S. et al. J Clin Endocrinol Metab 2006;91:1995-2010
45.
46.
47.
48. Monitoring of Testosterone Therapy
Clinical response/adverse effects
After 3 months, then annually
Testosterone levels
After 2- 3months
Hematocrit
Baseline, 3 months, then annually
Bone Mineral density
After 1-2 yrs in men with osteoporosis/fx
Bhasin, S. et al. J Clin Endocrinol Metab 2006;91:1995-2010
49. Monitoring of Testosterone Therapy
DRE/PSA
Baseline, 3 months, then in accordance with guidelines
Urological consult if:
PSA > 4 ng/ml
Increase in PSA > 1.4 ng/dl within 12 months Rx
Abnormal DRE
Increase in IPSS prostate symptom score > 19
Bhasin, S. et al. J Clin Endocrinol Metab 2006;91:1995-2010
50. Summary of Risks and Benefits of
Testosterone Replacement
Decreasing Testosterone levels are associated with
a decline in:
libido and sexual function
Bone Mineral Density
lean body mass, and muscle strength
Replacement studies in elderly men with mildly
low Testosterone levels have not convincingly
shown a benefit or reversal of these changes
51. However, in elderly men with very low T levels (< 200-
300 ng/dl)
improvement in libido and BMD
Possible improvement in sexual function and the perception
of physical well being
Testosterone replacement mildly increases PSA levels
and may exacerbate androgen dependent diseases
(BPH and prostate cancer) which increase with age
However, clinical studies to date are too small to
determine an adverse effect
Summary of Risks and Benefits of
Testosterone Replacement
52. CONCLUSION
THUS IT MAY BE STATED THAT THE MALE
ANDROPAUSE DOES EXISTS. IT AFFECTS THE MEN
OVER 40 YEARS OF AGE ( SOMETIMES EARLIER)
EARLY DIAGNOSIS AND HORMONE
REPLACEMENT THERAPY CAN IMPROVE
SYMPTOMS.
TESTERONE REPLACEMENT THHERAPY MUST BE
ALWAYS ADMINISTERED ONLY BY VERY
RESPONSIBLE PHYSICIANS AND UNDER STRICT
CASE SELECTION CRITERION AND SUPERVISION.