Normal testosterone level is influencing all the steps of the male psychosexual development: intrauterine neonatal and final psychosexual development.. At pubertal stage, the quality of testosterone secretion is conditioning the development of the mature male phenotype. In adult life, eugonadism sustains desire, arousal, determines spontaneous erections, facilitates stimulated erection, influencing the response rate to medication. Moreover, eugonadism sustain daydreaming and phantasies, both needed for a normal sexual life. The pathogenic mechanism of all these actions is presented. Talking about hypogonadism means not only the classical types of hypogonadism: due to classical testicular disease of central, hypothalamic and hypophysis disease, but also the partial testosterone deficiency induces by aging (late onset hypogonadism), weight increase (up to 30% of males with metabolic syndrome and 50% of males with diabetes) or secondary hypogonadism described in chronic use of steroids or after long exposure to stress, especially in young males. All these types of hypogonadism, that affect young, middle aged or old males will be presented separately. A therapeutic approach that is individualized for each type of hypogonadism, should consider positive and possible negative effects and all alternatives will be presented: life style changes, sustained weight loss, increase exercise, supplemental therapy, pro fertility treatment.
Part of the book: Sexual Dysfunction
The most precise evaluation of thyroid masses is by high-sensitive ultrasound. Complementary to B-mode ultrasound, elastography can add valuable information by determining tissue stiffness—an important predictor for malignancy. All major guidelines recommend nodules with high suspicious ultrasound characteristics larger than 1 cm to be addressed to ultrasound-guided fine needle aspiration biopsy (FNAB) to rule out malignancy. The main limitation of this procedure is represented by indeterminate cytology, which accounts for up to 20–25% of biopsy results. Molecular markers imply elevated costs and their performance needs further study. Elastography may be helpful in establishing the optimal therapeutic attitude for this cytological category. Currently, there are two ultrasound elastography methods available for assessing tissue stiffness using the parallel deformation to the applied force direction (strain) or the perpendicular deformation to the force direction (shear wave). These methods will be presented and compared in this chapter, with their indications and limitations for a better understanding of their application in nodular thyroid pathology.
Part of the book: Knowledges on Thyroid Cancer