00:01
So the wrists of androgens
include like these
male physical characteristics
we call that Virilization.
00:06
Most females don't want
those male characteristics.
00:10
That's one of the risks.
00:12
You can also prematurely
close their growth plate
or the epiphyseal plate.
00:17
They liver toxicity,
hepatotoxicity,
remember H-E-P-A-T
we're thinking of liver
and then toxicity tells us
it is bad for the liver.
00:28
And also messes with your salt
and water retention you
end up with extra edema
and it can make
prostate cancer worse.
00:36
Now, that's just a checklist.
Right?
And those are really
hard to remember.
00:40
So let's walk through each one
of these to help them stick
in your brain better.
00:44
Okay, when we talk
about virilization,
that's the first one.
00:47
With women there isn't anything
on that list that I want.
00:50
Look acne,
increased facial and body hair
and increased interest in sex.
00:56
Well, I don't want
any more facial hair
than I have, right?
So that's usually not something
women are interested in.
01:04
It might be irreversible
and you might also develop
male pattern baldness.
01:08
Okay, so stop and picture
this for a minute.
01:10
If you're a girl you're
growing hair here
and you're losing hair here.
01:16
Again not something we're
usually looking for.
01:19
It also affects
other sex organs.
01:21
They have clitoral enlargement
and they go deeper voice.
01:25
Okay.
01:26
This would be really hard to
write, a like in
online dating service for right.
01:32
Here I've got acne,
I have a low voice,
I'm balding and I have a beard
these are not be things I'll be
looking for to make me more attractive.
01:40
Now girls you're going to
see growth of pubic hair
and they're also going to
see the clitoral enlargement.
01:45
And if you see
any of these signs
you need to discontinue
the treatment immediately
because these are
likely irreversible
just like they
would be with women.
01:54
So be very careful with this
if you know so girls
having these experiences
you're seeing these
changes in their bodies.
02:00
The treatment needs
to absolutely stop.
02:03
Remember if a little
girl is accidentally
exposed to these maybe
they have a brother
who's receiving the treatment
and you notice these
things happening.
02:10
You need to figure out
how they're getting
that androgen
transferred to them.
02:14
Now with boys,
they're going to see
their regular changes
that they would see in puberty
they have an increase
in pubic hair
their penile enlargement,
they'll have increased
directions and possibly
even persistent erections.
02:26
That's what you're going
to see in a boy's body.
02:29
So testosterone is a hormone
that can cause significant
changes in the bodies
of women, girls, and boys.
02:37
Now, let's go back to that
premature growth plate closure.
02:40
Now look at the graphic
we made for you here.
02:42
You see the blue points
on the top and the bottom,
that's the epiphyseal plate.
02:47
It's also known as
the growth plate.
02:49
So go ahead and
write growth plate,
right on top of that
epiphyseal plate.
02:54
That just the same name
that we use for that.
02:56
It's located at each
end of the long bones
and it plays a role
in how tall you grow.
03:02
It's an area of growing tissue
and children and adolescents.
03:05
So that's part of your bones
where it gets longer and
longer and longer now,
that's where we
determine the link
and the shape of a mature bone.
03:13
So it tells how tall
I'm going to be.
03:17
Now androgens put you
at risk for a premature.
03:19
That means it's too early.
03:21
That growth plate
closes off early.
03:24
So why is that a problem?
Well, because remember it's
the growth plate the determines
the length and shape
of a mature bone.
03:32
So normally what happens
in puberty is that
cartilage growth slows
down and it stops
at the end of adolescence.
03:38
Normally when those remember the
testosterone level is peeking.
03:43
So then it calcifies
after a calcifies usually
around age 16 to 21.
03:50
There's no further growth.
03:51
So the bone will not get longer
and the child will
not get taller.
03:55
That's it game over
when the growth plate
closes you are done.
04:00
So things that can happen
to that growth plate.
04:02
Maybe they have a break
in the growth plate.
04:04
They have an injury
or premature closure will end
up in the child being shorter.
04:10
Okay.
04:11
So what puts a kid
at risk for this
could be androgens.
04:14
Injury and both of
these could cause
a premature closing
of that bone,
which means they
won't be as tall
as there are normally
intended to be.
04:23
So look at the difference
in those bones there.
04:25
See how they look at adolescents
see how the blue area
it's all calcified.
04:28
It's not changeable now,
the epiphyseal plate
when it's still growing
that growth plate is still
moving and getting bigger
is where you see the
larger blue shaded areas.
04:38
Now, let's look at the third
possible adverse effect
of androgens or
testosterone specifically,
so it's hepatotoxicity.
04:46
Now, we always try
to break words down
and help you remember those.
04:49
Toxicities definitely bad right?
And hepatic refers
to your liver.
04:54
So this is hepatotoxic.
04:56
Now, it's certain form of
androgens are testosterone.
04:59
Now I've got it there
17-alpha-alkylated, right?
That's just to let you know
It's only specific androgen
testosterone hormones
that cause this effect.
05:07
It's a cholestatic hepatitis.
05:10
Now itis means inflammation
just underline I-T-I-S
and right inflammation
under that.
05:15
We can help you learn
some medical terminology
as we go through this.
05:19
But this means
cholestatic hepatitis
because that isn't
flowing anymore.
05:24
The bile isn't flowing.
05:25
It's just like if you had a
gallstone in the bile duct,
the bile doesn't flow well,
and that's why you end up with
inflammation of the liver.
05:33
See the liver makes the bile
and it's meant to flow
down that common bile duct
into the small intestine.
05:39
If it can't flow
down through there.
05:42
It's going to start
irritating that liver
because it backs up.
05:45
That's what cholestatic
meaning still hepatitis is.
05:50
So you want to make sure
that you're kind of
monitoring liver function text
on a periodically on a
pretty regular basis.
05:57
So watch how their livers doing
because we know that especially
with this 17-alpha-alkylated
androgen or testosterone
they can have some
hepatotoxicity.
06:07
Also another risk
It might increase
LDL and decrease HDL.
06:11
That's a bad deal
because remember LDL
is the bad cholesterol
and HDL is the good cholesterol,
so he'd wanted the opposite
but people on androgens
or testosterone have
an increased risk
of their LDL levels shooting up
and their HDL levels going down.
06:29
Another possible adverse
effect for taking an androgen
like testosterone
is that androgens promote sodium
and water retention.
06:38
Well that kind of
goes without saying,
if you promote anything
that causes your body
to hang onto sodium,
water is going to follow.
06:45
So once you hang on a sodium,
you're going to have an
increased water retention,
so I'm going to have lots
of extra fluid on board.
06:51
So you want to watch closely
if the patient is any
cardiovascular problems.
06:55
If there are any kind
of walking that balance
of fluid volume overload.
06:59
This could be
something that cause
further fluid volume overload.
07:03
So remember,
androgens like testosterone
promote sodium retention.
07:08
They're going to have more
water and more volume.
07:11
So watch your patients
closely for signs of overload.
07:15
Now prostate cancer isn't
caused by testosterone,
but it can make it worse.
07:22
So it's really important
that you educate your
patients about this risk.
07:26
Also you want to make sure that
they might have
undiagnosed prostate cancer
so you'll want to screen them
before you start this therapy.
07:34
So just to be clear
testosterone and androgen
like testosterone
does not cause prostate cancer
but if they have prostate cancer
that may not even
be aware of it,
It will make it worse.
07:46
So you definitely
want to make sure
that they have screening
before they start this therapy.
07:50
Now androgen should not be
used with pregnant women
with obvious with men
with prostate cancer
that we just talked
about or breast cancer
because remember that
men can also have cancer.
08:01
And you shouldn't use androgens
like testosterone for athletic
performance enhancement.
08:06
Let's go back over
those categories.
08:09
Not for pregnant women
because it's going to cause
some significant changes
to the fetus particularly
of female fetus,
men with prostate
or breast cancer
or for athletic
performance enhancement.
08:20
The risk far outweigh the
benefits of the improvement
in performance enhancement.
08:25
Okay.
08:26
I really want to go
back and emphasize
the risk of accidental exposure.
08:30
Now, you know that we can
use transdermal methods
of getting androgens
or testosterone gel.
08:35
You put it on your skin,
but if it brushes
up against clothing
or another individual you
could accidentally expose
them to testosterone.
08:43
So be very careful about
handling the close of patients
who use androgen gels
and also touching
patients who have this gel
you don't want to
accidentally expose them
to virillization and
all the other things
that could happen
from testosterone.
08:58
Now hypogonadism is
the only FDA approved
therapeutic use of
androgen therapy.
09:05
So I want you to underline that
hypogonadism is the
only FDA approved.
09:11
We talked about
some off-label uses.
09:13
But this is the only
one approved by the FDA.
09:16
So that means I have
lower absence secretion
of testosterone from the testes.
09:21
So for now this is only
approved by the FDA in males
who have low or absent secretion
of testosterone from the gonads.