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  <head>
    <title>052-02 Androgen physiology, sexual function, fertility, and male genital emergencies</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Androgens, sexual function, fertility, emergencies">
      <outline text="Integrated assessment">
        <outline text="Libido, erection, ejaculation, fertility are separable">
          <outline text="Normal erections with impaired spermatogenesis"/>
        </outline>
        <outline text="Establish anatomy, goals, satisfactory function"/>
      </outline>
      <outline text="Androgen axis and diagnosis">
        <outline text="Pulsatile releasing hormone; continuous suppresses"/>
        <outline text="Testosterone mostly protein-bound">
          <outline text="Binding globulin altered by age, obesity, liver"/>
          <outline text="Total level can misrepresent available hormone"/>
        </outline>
        <outline text="Symptoms plus consistently low timed testosterone">
          <outline text="Morning sample, repeated when well"/>
        </outline>
        <outline text="High gonadotropins: primary testicular failure"/>
        <outline text="Low or normal gonadotropins: central suppression">
          <outline text="Check prolactin, iron, opioids, steroids, obesity"/>
        </outline>
      </outline>
      <outline text="Testosterone therapy and fertility">
        <outline text="Only when deficiency established"/>
        <outline text="Erythrocytosis, acne, oedema, sperm suppression"/>
        <outline text="Anabolic steroids: prolonged secondary hypogonadism"/>
        <outline text="Fertility wish: restore endogenous drive">
          <outline text="Correct weight, sleep, opioids, prolactin"/>
          <outline text="Specialist gonadotropins or receptor modulation"/>
          <outline text="Spermatogenesis takes months to recover"/>
        </outline>
        <outline text="Ask about children before treatment begins"/>
      </outline>
      <outline text="Erectile function">
        <outline text="Nitric oxide raises cyclic guanosine monophosphate">
          <outline text="Cavernosal smooth muscle relaxes"/>
          <outline text="Sinusoids compress subtunical veins, trapping blood"/>
        </outline>
        <outline text="Sympathetic tone: detumescence and emission"/>
        <outline text="Early vascular marker: small penile arteries"/>
        <outline text="Morning erections do not prove psychogenic cause"/>
        <outline text="Phosphodiesterase five inhibitors need stimulation">
          <outline text="Nitrates absolutely incompatible"/>
          <outline text="Failure: review, not unsafe escalation"/>
        </outline>
        <outline text="Injections and intraurethral therapy"/>
        <outline text="Vacuum ring must not remain indefinitely"/>
        <outline text="Psychological therapy does not mean symptoms unreal"/>
      </outline>
      <outline text="Ejaculation">
        <outline text="Sympathetic emission, bladder-neck closure"/>
        <outline text="Serotonergic drugs delay ejaculation"/>
        <outline text="Alpha blockade or pelvic surgery impairs closure">
          <outline text="Retrograde: dry orgasm, sperm in urine"/>
        </outline>
        <outline text="Premature: pattern, poor control, distress"/>
      </outline>
      <outline text="Priapism">
        <outline text="Ischaemic: rigid corpora, soft glans">
          <outline text="Stagnant hypoxic blood in a closed compartment"/>
          <outline text="Necrosis then fibrosis with time"/>
          <outline text="Aspiration, alpha-agonist, surgical escalation"/>
        </outline>
        <outline text="Systemic care must not delay decompression"/>
        <outline text="Non-ischaemic: perineal arterial injury"/>
        <outline text="Stuttering priapism needs prevention plan"/>
        <outline text="Seek help once erection persists, not at four hours"/>
      </outline>
      <outline text="Acute scrotum">
        <outline text="Treat as torsion until proven otherwise">
          <outline text="Venous then arterial block, infarction in hours"/>
          <outline text="No single sign or feature excludes it"/>
          <outline text="Explore without imaging delay, fix both testes"/>
        </outline>
        <outline text="Epididymitis: gradual, overlaps with torsion">
          <outline text="Nucleic-acid tests, culture, partner treatment"/>
          <outline text="Persistent swelling may be tumour"/>
        </outline>
        <outline text="After torsion: viability, atrophy, fertility">
          <outline text="One normal testis often suffices, not guaranteed"/>
        </outline>
      </outline>
      <outline text="Fournier gangrene and testicular mass">
        <outline text="Necrotising perineal and genital fascial infection">
          <outline text="Pain beyond visible change, crepitus, shock"/>
          <outline text="Immediate surgery; CT must not delay"/>
        </outline>
        <outline text="Solid intratesticular mass is malignant">
          <outline text="Trans-scrotal biopsy disrupts lymphatic staging"/>
          <outline text="Inguinal orchidectomy diagnoses and treats"/>
          <outline text="Sperm cryopreservation before gonadotoxic therapy"/>
        </outline>
      </outline>
      <outline text="Prostate">
        <outline text="Bulk, dynamic tone, bladder adaptation"/>
        <outline text="Alpha blockers act quickly on tone"/>
        <outline text="Reductase inhibitors lower antigen levels">
          <outline text="Reinterpret during cancer assessment"/>
        </outline>
        <outline text="Retention, infection, high residual: procedures"/>
        <outline text="Screening is a preference-sensitive sequence">
          <outline text="Mortality benefit versus overdiagnosis"/>
        </outline>
      </outline>
      <outline text="Male infertility">
        <outline text="Evaluate in parallel with partner"/>
        <outline text="Semen varies: abstinence, fever, collection"/>
        <outline text="Low volume: collection error, obstruction, retrograde"/>
        <outline text="Azoospermia: absent production or obstruction"/>
        <outline text="Absent vas: cystic-fibrosis implications"/>
        <outline text="Targeted, non-moralising lifestyle advice">
          <outline text="Stop exogenous testosterone and steroids"/>
        </outline>
        <outline text="Insemination, in-vitro fertilisation, donor, adoption"/>
      </outline>
    </outline>
  </body>
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