Chairs: Dr Peter Savill
Speakers: Professor Mike Kirby, Dr Louise Newson
Professor Mike Kirby
Testosterone Deficiency TD is defined in recent guidance from the British Society for Sexual Medicine as a clinical and biochemical syndrome associated with advancing age and comorbidities, characterised by a deficiency in serum androgen levels and relevant signs and symptoms.
Due to its numerous effects on multiple systems in the body, deficiency of testosterone can lead to significant reductions in quality of life and also increased mortality risk.
The link between ED and TD is of course well established. The 4th International Consultation for Sexual Medicine made recommendations for clinically diagnosing TD. It described sexual function symptoms (low sexual desire, decreased morning and night-time erections, and erectile dysfunction) as prominent, commonly presenting symptoms that are particularly suggestive of TD when associated with each other . It has been reported that ED becomes more prominent when total testosterone levels fall to around 8mmol/L – a lower level than that at which other symptoms of TD tend to appear.
This strong correlation between ED and CVD has now been recognised in the latest version of QRISK3, and a 25% increased CVD risk has been incorporated into the calculation.
Similarly to ED, there is a significant correlation between the number of Metabolic Syndrome components and low testosterone levels
There have been several studies linking TD to CVD risk. Testosterone levels have been shown to be negatively correlated to Framingham risk scores in patients with sexual dysfunction. It has been shown that TD in men with established coronary artery disease is associated with increased all-cause and vascular mortality. High quality reviews have shown a protective effect of increased testosterone levels on all-cause and cardiovascular mortality.
Dr Louise Newson
Around 25% of menopausal women have severe symptoms affecting their quality of lives at home and at work. Many healthcare professionals are still not confident in managing the menopause. This presentation will highlight various ways the menopause can present in clinical practice and summarise optimal management based on the current menopause guidelines. Safe prescribing of HRT with body identical hormones will be discussed for young women with early menopause and POI as well as for older menopausal women.
Key learning points:
- Individualised approach is needed based on the guidelines
- Diagnosis of menopause is clinical
- Risk of breast cancer is not for all patients
- Young women with POI need to have hormones
- Benefits of HRT usually outweigh risks is starting under 60 years