G.Paavan

General management :  Reduce heat around the scrotum ----cold water baths, use of cotton/ loose underwear etc.  Avoidance of alcohol  Cessation of smoking  Control diabetes  Correct other Endocrine Disorders  Antibiotics for any pre existing infections(STDs)  Correction of any surgical anomalies in the MGT  Sexual counseling  Use of antioxidants like Vitamin E

Hypothalamus Secretes GnRH Pituitary LH & FSH Testes Estradiol Testosterone Dihydrotestosterone 5 alpha- reductase Target Tissues Inhibin

 Structure and action similar to LH  Inc testosterone production  Dosage : IU given IM—weekly for 10 weeks or 5000 IU IM twice a week

 Used in pituitary inadequacy  Act on the pituitary and stimulates the production of LH and FSH  Dosage : 150 IU thrice a week for 6 months

 Lower doses induces spermatogenesis and improves testicular function  Higher doses suppress  Dosage : 25 to 50 mg orally  17 alkyl substituted derivatives of testosterone are used : Methyltestosterone and fluoxymesterone  Side effects :Edema, Cholestatic Jaundice, Hepatic carcinoma, Gynaecomastia, Acne.

 Indicated in hypothalamic failure  Low t 1/2  Gonadorelin (synthetic GnRH) injected IV causes prompt release of FSH and LH  Synthetic analogues----Nafraelin

 Pure estrogen antagonist  Induces GnRH secretion by blocking the feedback on the pituitary.  Not useful in pituitary insufficiency  Dosage : 25 mg for 25 days followed by 5 days rest. This is repeated cyclically for 3 to 6 cycles

 Selective estrogen antagonist  Dosage : 10 mg daily for 6 months

 Dexamethasone- 0.5 mg Daily  Prednisolone- 50mg Daily  Cyclosporin A – 5 to 10 mg/kg/ daily for 6 months  Naproxen – 50mg twice daily For 3-6 months

 Selective PDE-5 Inhibitor  Dosage : mg 1 hour before intercourse  Side effx : Fall in BP, Loose Motions, Migraine like headache  Contraindicated in heart pts

Hypothalamus Secretes GnRH Pituitary FSH Ovaries Progesterone Target Tissues Estrogen LH Peripheral Tissues Androstenedione

 Antiestrogenic  Induces GnRH secretion by blocking the feedback on the pituitary.  Dosage : 50 mg per day from day 2 to day 6.  Advise coitus on 7, 9, 11, 13, 15 and 17 th day  Ovulation monitored by ECG.  Complications : 1)> 150mg causes ovarian hyper stimulation 2) Multiple Gestation

 In PCOD  Clomiphene Citrate – mg/day from day 2 to day 6  Inj. hMG- 75 units IM is added on 3, 5, and 7 days

Baseline estradiol assay and U/S hMG 75 IU for 3 days If estradiol doubled monitor hMG dosage If not inc dosage by 50% Inc dosage until estradiol doubles Perform u/s until follicle reaches 16mm Stop hMG and perform PCT 24hr later admin hCG 5000 IU Admin inj hCG 3000 IU 7 days later Await menses

 Dosage: 500mg 3 times a day or 850 mg 2 times a day

 Indicated in hyperprolactinemia  Dosage : 1.25mg at bed time for 7 days  HP gets corrected spontaneously after ovulation

 Alternative to hMG  Administered in pulsatile fashion  Adv : Risk of hyper stimulation reduced

 In women with inc androstenedione  Dosage : 5mg at night mg every morning