oleh:oleh:Muhammad Nur Muhammad Nur

HaniefHanief

Pembimbing:Pembimbing:dr.dr. Pugud Samodro Pugud Samodro

Sp.PDSp.PD

Introduction Androgen deficiency in men with metabolic disorders Low testosterone in men with metabolic disorders : cause

or consequence ? The evidence : low testosterone leads to insulin resistance The evidence : low testosterone is consequence of

dysglicaemia and associated clinical factors Testosterone and insulin : a bilateral relationships Therapeutic approach to treatment of lowered testosterone

levels in men with metabolic disorders The treatment for men with metabolic disorders Potential risks of testosterone therapy Summary Conclusion

OVERVIEW

Around 50% of ageing, obese men presenting to the diabetes clinic have lowered testosterone levels relative to reference ranges based on healthy young men.

Only few proportion have a symptoms refer to hypo androgenism (or been overlaped by its underlying disease)

Lack of strong evidence providing the reason why testosterone treatment useful for this topic and show the association between testosterone level and glucose metabolism

Endocrinologist society lack of high –level evidence We should making distinction between androgen

replacement therapy and pharmacological testosterone therapy

INTRODUCTION

Almost research still can’t answer three key points about this topic;1.first, is low testosterone is a causal factor or a biomarker for metabolic disorders and associated clinical features? 2.Second, even if low testosterone is pathogenic, we do not know whether testosterone treatment meaningfully improves patient important health outcomes. 3.Third, even if testosterone treatment improves outcomes, we do not know whether we should we use this treatment, because this depends on additional factors, such as long-term risks, cost and inconvenience of treatment, and comparisons to established therapies.

INTRODUCTION

INTRODUCTION

Endocrine society Androgen deficiency is a clinical

syndrome, diagnosed by the presence of both consistent symptoms and signs and unequivocally low serum testosterone levels

Consist of androgen deficiency and spermatogenic failure

Androgen deficiency in men with metabolic

disorders

Symptom of androgen deficiency• Confounded by the comorbidities• A research, comparing men with low TT and normal TT

specific sexual symptom high in men with normal TT• 55 -70% men with normal TT have such symptoms• The presence of symptoms may be caused by increasing

age Diagnosis of androgen deficiency in mien with metabolic

disorder remains challenging due to high prevalence of non-specific symptom in modest reduction of TT

NO GOLDEN STNDARD for diagnosis

Androgen deficiency in men with metabolic

disorders

Cause or consequence ?

Low testosterone leads to insulin resistance

In kohort prospective metabolic syndrome predicts low

TT 30% respondents showed lower TT compared with lean

men TT decrease in age 40-80

Low testosterone is consequence of dysglicaemia and associated clinical factors

Testosterone and insulin : a bilateral relationships

Testosterone treatment is potential Concept of weight lose is potential as well as

testosterone treatment Obesity and dysglicaemia, contribute to the suppression

of HPT axis life style modification and weight reduction are most logical approach

2 way for lossing weight (non-surgical weight loss and surgical weight loss). both of them increase TT level

Therapeutic approach

Testosterone treatment in men with metabolic

disorders

Testosterone treatment in men with metabolic

disorders

Testosterone treatment in men with metabolic

disorders

Long-term risk still remain UNKNOWN A meta-analysis showed that the risk of prostate cancer

increased Increase hematocrit and decrease HDL Increase a cardiovascular events The risk may be increased with older -obese men

Potential risks of testosterone therapy

Summary

Need research to provide identification due to diagnosis

of low TT Men with metabolic disorder have functional gonadal

axis supression reduce TT level Need more RCT to determine risk-benefit of tetosterone

therapy. Include testosterone therapy for succeeding weight loss in men with metabolic disorder

Testosterone effects on visceral fat mass as well as potential insulin sensitisers such as adiponectin, SHBG and uncarboxylated osteocalcin

Conclusion

THANKYOU..

1. Pada laki-laki, kadar testosteron tidak ada

gejala? Kenapa?2. Mengapa ekstradiol

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