W8 REPLY
Need help to reply three post.
DO NOT JUST REPEAT SAME INFORMATION, DO NOT JUST SAY I AGREE OR THINGS LIKE THAT. YOU NEED TO ADD NEW INFORMATION TO DISCUSSION.
1- Each reply should be at least 200 words.
2- One scholarly reference ( NO MAYO CLINIC/ AHA)
3- APA style needs to be followed.
4- Each response should have reference at the end
5- Reference should be within last 5 years
Need help to reply three post.
DO NOT JUST REPEAT SAME INFORMATION, DO NOT JUST SAY I AGREE OR THINGS LIKE THAT. YOU NEED TO ADD NEW INFORMATION TO DISCUSSION.
1-
Each reply should be at least 200 words.
2- One scholarly reference ( NO MAYO CLINIC/ AHA)
3- APA style needs to be followed.
4- Each response should have reference at the end
5- Reference should be within last 5 years
DQ-1
Hypogonadismin men is classified as the clinical syndrome from the failure of the testicles to produce sufficient and adequate levels of testosterone (Tsametis & Isidori, 2018). This lack of testosterone levels could be the result of two different causes such as lack of production from the testicles, or lack of androgen signaling (Tsametis & Isidori, 2018). There are three types of hypogonadism which result in reduced testosterone levels (Tsametis & Isidori, 2018). The first two types are classical hypogonadism and hypothalamic-pituitary hypogonadism (Tsametis & Isidori, 2018).
The third type that is worth noting is from a genetic-based foundation. Klinefelter syndrome is the most common chromosome disorder in males and is defined as a 47, XXY karyotype (Kanakis & Nieschlag, 2018). This chromosomal disorder also causes hypogonadism and is not usually present until early adulthood and progresses with aging (Kanakis & Nieschlag, 2018). In Klinefelter syndrome, infertility is almost always present, leaving a 17% chance for men who have this to be able to father children (Kanakis & Nieschlag, 2018).
All three types lead to reduced or no production of testosterone from the testicles (Tsametis & Isidori, 2018). The reduced levels of testosterone are not able to elicit the response of sperm production leading to azoospermia (Tsametis & Isidori, 2018). The lower the levels of healthy sperm available decreases the patient’s ability to father children leading to infertility (Kanakis & Nieschlag, 2018).
Treatment of hypogonadism is to give testosterone replacement or boosters (Tsametis & Isidori, 2018). The benefit of testosterone replacement therapy is that testosterone levels will rise and then sperm production will resume in patients with mild to moderate hypogonadism (Tsametis & Isidori, 2018). Other benefits include virilization, an increase in lean body mass, an increase in bone density, and a decrease in bone metabolism (Tsametis & Isidori, 2018). Once sperm levels reach a functional level, the risk of infertility is reduced (Tsametis & Isidori, 2018). Contraindications of testosterone replacement therapy are known prostate cancer, breast cancer, nodules on the prostate, lower urinary tract symptoms, hematocrit >50%, untreated sleep apnea, uncontrolled severe heart failure, and if the patient has an active desire for fertility (Tsametis & Isidori, 2018).
It is important to note that exogenous testosterone actually suppresses luteinizing hormone and decreases spermatogenesis in patients with moderate to severe hypogonadism (Tsametis & Isidori, 2018). If a patient with moderate to severe hypogonadism wishes to be fertile, then other treatment options should be explored to stimulate spermatogenesis (Tsametis & Isidori, 2018).
References:
Kanakis, G. A., & Nieschlag, E. (2018). Klinefelter syndrome: more than hypogonadism. Metabolism, 86, 135–144. https://doi-org.lopes.idm.oclc.org/10.1016/j.metabol.2017.09.017
Tsametis, C. P., & Isidori, A. M. (2018). Testosterone replacement therapy: For whom, when and how? Metabolism, 86, 69–78.
https://doi-org.lopes.idm.oclc.org/10.1016/j.metabol.2018.03.007
DQ-2
Hypogonadism is when the testes do not produce testosterone, sperm, or both resulting in fertility issues along with erectile dysfunction (Woo & Osborn, 2019, pg. 1304). Testosterone is the hormone that affects a man’s appearance and sexual development along with stimulating sperm production. Primary hypogonadism is caused by abnormalities in the testes with testosterone production and secondary is caused by low gonadotropins that affects that hypothalamic-pituitary axis and is unable to produce enough testosterone (Skolnik &Hurchick, 2018). Causes of primary hypogonadism include cancer treatment, klinefelter syndrome, trauma to testes, or congenital defect. Causes of secondary hypogonadism include HIV, inflammatory disease, medications, obesity, and pituitary disorders (Woo & Obsorn, pg. 1306).
Testosterone levels decrease as a man ages starting in the 40’s and the best time to draw a serum level should be in the morning when they are at its highest. Testosterone replacement therapy is the treatment for low testosterone but needs to be done safely. It should not be done in patients planning fertility treatments, those with prostate or breast cancer, prostate nodule, or high PSA level with high risk for prostate cancer (Skolnik &Hurchick, 2018). The most common issue is erythrocytosis and H&H should be checked regularly. There are 5 high-risk medications that interact with testosterone which include, anisindione, dicumarol, leflunomide, teriflunomide, and warfarin (Woo & Obsorn, pg. 1311). There are different forms that person can take such as buccal, intramuscular, subcutaneous pellets, gel, patch, or topical liquid. Typically, the IM is given every 2 weeks at 200 mg; the pellet is 75mg that covers the patient 3-6 months. The patches are applied daily and need to be rotated to different sites and is 5mg- 90mg daily depending on the topical routes. The goal is to get testosterone levels between 400-600 and needs to be monitored 3-6 months after initiation to see if it is helping and to check any adverse reactions (Woo & Osborn, pg. 1312).
Skolnik, N., & Hurchick, M. (2018, January 18). Clinical Guidelines: Testosterone therapy in men with hypogonadism. Retrieved February 20, 2020, from https://www.mdedge.com/familymedicine/article/163830/mens-health/clinical-guidelines-testosterone-therapy-men-hypogonadism
Woo, T. M. & Osborn, K. (2019). Men as Patients. In T. M. Woo & M. V. Robinson (Eds.), Pharmacotherapeutics for advanced practice nurse prescribers (pp. 1303-1319). Philadelphia, PA: F. A. Davis Company.
DQ-3
Genetic differences would include the sensitivity and efficacy of progesterone and its comparative effectiveness that may need closer monitoring and altered dosage to achieve the desired effects for women (Wollum, 2017).
Over the counter birth control has been a topic of late with a lot of cultural differences that are presently making this a complicated issue (Wollum, 2017). Some cultural differences include religious bases citing that contraceptives are against “God’s will” (Blank & Olmstead, 2016). Also, the proposal of this medication also includes the ability of teenagers to obtain this medication over the counter which raises concerns such as, if the teenager is not a legal adult, how can they be of the right mind to purchase this medication (Blank & Olmstead, 2016). Another issue is from pharmacists who state that “there is no healthcare provider assessing the patient’s ability to take this medication and monitor or counsel on severe side effects” (Blank & Olmstead, 2016).
Some benefits of over the counter birth control would include the effective cost of the medication would be minimal, avoidance of unintended pregnancies would total approximately 450,000, decrease in signs and symptoms of endometriosis and regulation of the menstrual cycle (Wollum, 2017).
The mechanism of action of over the counter progesterone only is to prevent ovulation by inhibiting follicular development and preventing ovulation (Cooper & Mahdy, 2019). Progesterone acts on the negative feedback loop at the hypothalamus to decrease the pulse frequency of the gonadotropin-releasing hormone (Cooper & Mahdy, 2019). With the decrease of gonadotropin-releasing hormone, there is a decrease of luteinizing hormone, leading to a lack of development of the follicle and no increase in estradiol level leading to the prevention of ovulation (Cooper & Mahdy, 2019).
Contraindications include smoking due to increased risk for DVTs, ischemic heart disease, migraines with auras, and breast or endometrial cancer (Cooper & Mahdy, 2019).
Drug interactions include aminoglutethimide, antibiotics or antifungal medications, and barbiturate medications (Cooper & Mahdy, 2019). Interactions with these drugs include a decreased effect of progesterone so it is recommended for back up options and usage of other contraceptive means (Cooper & Mahdy, 2019).
References:
Blank, C., & Olmstead, S. C. (2016). Should birth control be OTC? Contemporary OB/GYN, 61(8), 40–41.
Cooper, D.B., & Mahdy H. (2019). Oral Contraceptive Pills. In: StatPearls Treasure Island StatPearls Publishing. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK430882/
Wollum, A. (2017). Willingness to pay for an over-the-counter progestin-only birth control pill: potential users and averted unintended pregnancies in the United States. Contraception, 4. https://doi-org.lopes.idm.oclc.org/10.1016/j.contraception.2017.07.092