Oleh: Muhammad Nur Hanief Pembimbing: Dr. Pugud Samodro SP - PD

oleh:
Muhammad Nur Hanief

Pembimbing:
dr. Pugud Samodro Sp.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 cant 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

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



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

Pertanyaan

Oleh: Muhammad Nur Hanief Pembimbing: Dr. Pugud Samodro SP - PD

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