Testosterone Replacement for Men and Women www.freelivedoctor.com
Presenting from the Premises of Port Power www.freelivedoctor.com
www.freelivedoctor.com While testosterone replacement is being used in women with good  effect… it is   used without the a...
The human ovary produces more testosterone than oestrogen- weight for weight The postmenopausal ovary continues to produce...
As the ovary fails, it continues to produce testosterone and perhaps in  increased  amounts…for a variable number of years...
With the introduction of HRT (oestrogen only or ERT), testosterone status falls to zero. This is due to two factors www.fr...
It follows therefore, that any woman taking oestrogen or producing excess oestrogens is relatively or absolutely testoster...
Oestrogen and progesterone are the mainstay of ERT. Testosterone may still be viewed as the, “Cinderella of the hormonal b...
Symptoms Testosterone replacement is generally regarded as indicated for loss of libido (by a predominantly male professio...
Indications for testosterone replacement <ul><li>Symptoms </li></ul><ul><li>Vulval discomfort </li></ul><ul><li>? Voiding ...
Symptoms relieved <ul><li>Variable mood state-tearful or aggressive </li></ul><ul><li>Loss of energy and stamina </li></ul...
Odds and ends <ul><li>may improve tachycardias </li></ul><ul><li>seems to suppress petit mal </li></ul><ul><li>(despite wa...
Objective aims of Androgen Replacement Therapy (ART) <ul><li>improved quality of life </li></ul><ul><li>increase bone dens...
Side Effects  ♀ <ul><li>evening restlessness </li></ul><ul><li>excess libido </li></ul><ul><li>nightmares </li></ul><ul><l...
Interpretation of blood test <ul><li>blood best taken in the morning </li></ul><ul><li>assay is not very accurate </li></u...
Preparations  ♂ & ♀ <ul><li>Oral- andriol </li></ul><ul><li>Patch- Androderm </li></ul><ul><li>Injections- sustanon </li><...
Oestrogen and Testosterone Implants Insertion technique Dr Rob Baber North Shore Menopause Clinic 4mins  50secs www.freeli...
www.freelivedoctor.com
There is very little data on the human female There has been a data collection from my practice, undertaken on 512 women o...
www.freelivedoctor.com My data is currently under continuing biostatistical analysis with The National Institute of Health...
This analysis will focus mainly on the prevention of breast cancer but must include the parameters of www.freelivedoctor.c...
Breast cancer results Study group(ERT+ART) 7 breast cancers Expected incidence ERT only) 12(14)  “  “ However the 10-year ...
Bone density The initial improvement in bone density of only 3.1% in either area fell short of expectation as did the over...
Cholesterol <ul><li>It would appear that there was no serious adverse effect by the testosterone on these two markers. </l...
www.freelivedoctor.com The Male Menopause Good news and bad news! The bad news is that the male menopause does exist…it is...
The good news is that it is synchronous with Prof. David Purdie www.freelivedoctor.com death!
www.freelivedoctor.com Grumpy old men
Testosterone can be dangerous stuff! www.freelivedoctor.com
www.freelivedoctor.com
Partial androgen deficiency “ PADAM ” <ul><li>should be distinguished from absolute deficiency (agonadism, Klinefelter’s, ...
Symptom complex    Precisely the same as for women except for breast soreness and vulval skin problems  suggestion that ...
www.freelivedoctor.com Obesity <ul><li>Appetite results from the expression of neuropeptide Y by the hypothalamus </li></u...
www.freelivedoctor.com A.R.T. and CAD <ul><li>No improvement in CAD rates for offspring of fathers (white males) with prem...
www.freelivedoctor.com A.R.T. and Neuropsychology <ul><li>General anabolic and energising effect </li></ul><ul><li>e.g. hi...
Suggested Management <ul><li>deal with lifestyle issues: </li></ul><ul><li>   dietary control (central obesity and  hyper...
Beware the www.freelivedoctor.com prostate!! pumpkin
Something to aspire to… www.freelivedoctor.com
www.freelivedoctor.com Can we be seen to be producing a long living  generation of superwomen (and men-?) Ultimate objective
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Testosterone replacement

  1. 1. Testosterone Replacement for Men and Women www.freelivedoctor.com
  2. 2. Presenting from the Premises of Port Power www.freelivedoctor.com
  3. 3. www.freelivedoctor.com While testosterone replacement is being used in women with good effect… it is used without the approval of the Australian Drug Evaluation Committee …and the individual practitioner must take individual responsibility for it’s use
  4. 4. The human ovary produces more testosterone than oestrogen- weight for weight The postmenopausal ovary continues to produce testosterone after the cessation of follicular activity cuts off the supply of oestrogen www.freelivedoctor.com
  5. 5. As the ovary fails, it continues to produce testosterone and perhaps in increased amounts…for a variable number of years. This is the so called… “continuation of ovarian function postmenopausally”. i.e. progressive androgenisation! www.freelivedoctor.com
  6. 6. With the introduction of HRT (oestrogen only or ERT), testosterone status falls to zero. This is due to two factors www.freelivedoctor.com  cessation of production from the ovary by suppression of LH  binding of testosterone by SHBG
  7. 7. It follows therefore, that any woman taking oestrogen or producing excess oestrogens is relatively or absolutely testosterone deficient e.g. the oral contraceptive multicystic ovary oestrogen replacement www.freelivedoctor.com
  8. 8. Oestrogen and progesterone are the mainstay of ERT. Testosterone may still be viewed as the, “Cinderella of the hormonal ball”… but she got to marry Prince Charming! www.freelivedoctor.com
  9. 9. Symptoms Testosterone replacement is generally regarded as indicated for loss of libido (by a predominantly male profession) … .. and while this may be true, other symptoms are of greater importance. www.freelivedoctor.com
  10. 10. Indications for testosterone replacement <ul><li>Symptoms </li></ul><ul><li>Vulval discomfort </li></ul><ul><li>? Voiding dysfunction </li></ul><ul><li>Painful benign breast disease </li></ul><ul><li>? Prevention of breast cancer </li></ul><ul><li>Osteoporosis </li></ul>www.freelivedoctor.com
  11. 11. Symptoms relieved <ul><li>Variable mood state-tearful or aggressive </li></ul><ul><li>Loss of energy and stamina </li></ul><ul><li>Impaired concentration and memory </li></ul><ul><li>General skin and scalp hair dryness </li></ul><ul><li>Loss of sexual arousability </li></ul><ul><li>Painful breasts </li></ul><ul><li>Vulval skin dryness/ discomfort/ itching </li></ul><ul><li>Voiding disorder ? </li></ul><ul><li>Restored/ increased muscle strength </li></ul>www.freelivedoctor.com
  12. 12. Odds and ends <ul><li>may improve tachycardias </li></ul><ul><li>seems to suppress petit mal </li></ul><ul><li>(despite warnings on the P.I.) </li></ul><ul><li>some headaches improve </li></ul><ul><li>neck and back pain </li></ul><ul><li>improves athletic competition </li></ul><ul><li>improved sleep quality </li></ul><ul><li>increases insulin sensitivity </li></ul><ul><li>lichen sclerosis </li></ul>www.freelivedoctor.com
  13. 13. Objective aims of Androgen Replacement Therapy (ART) <ul><li>improved quality of life </li></ul><ul><li>increase bone density (5-12% p.a.) </li></ul><ul><li>suppression benign breast disease </li></ul><ul><li>reduction of the incidence of breast cancer </li></ul><ul><li>maintain the cardioprotective effect of ERT </li></ul><ul><li>improved muscle strength (skeletal and myocardial) </li></ul>www.freelivedoctor.com
  14. 14. Side Effects ♀ <ul><li>evening restlessness </li></ul><ul><li>excess libido </li></ul><ul><li>nightmares </li></ul><ul><li>possible relationship disruption </li></ul><ul><li>facial greasiness and acne </li></ul><ul><li>male type scalp hair loss </li></ul><ul><li>facial hair </li></ul>www.freelivedoctor.com
  15. 15. Interpretation of blood test <ul><li>blood best taken in the morning </li></ul><ul><li>assay is not very accurate </li></ul><ul><li>misleading to do only total testosterone </li></ul><ul><li>always request- “testosterone/SHBG” </li></ul><ul><li>only free/active testosterone is relevant </li></ul><ul><li>control of the SHBG allows the effect or controls excess replacement </li></ul>www.freelivedoctor.com
  16. 16. Preparations ♂ & ♀ <ul><li>Oral- andriol </li></ul><ul><li>Patch- Androderm </li></ul><ul><li>Injections- sustanon </li></ul><ul><li>Implants- crystalline testosterone </li></ul><ul><li>Topical- locally made (cetomagrocol aqueous cream not ointment) 2-5% </li></ul><ul><li>or as Andro-Feme/ Andromen 1-10% </li></ul>www.freelivedoctor.com
  17. 17. Oestrogen and Testosterone Implants Insertion technique Dr Rob Baber North Shore Menopause Clinic 4mins 50secs www.freelivedoctor.com
  18. 18. www.freelivedoctor.com
  19. 19. There is very little data on the human female There has been a data collection from my practice, undertaken on 512 women over 12 years. www.freelivedoctor.com
  20. 20. www.freelivedoctor.com My data is currently under continuing biostatistical analysis with The National Institute of Health Bethesda, Maryland, USA. in an attempt to correlate the epidemiology with the basic science While my conclusions are therefore predominantly derived from my own clinical observations, there is current intense interest from the basic scientists.
  21. 21. This analysis will focus mainly on the prevention of breast cancer but must include the parameters of www.freelivedoctor.com  HDL/LDL cholesterol  Bone density in addition to  Breast cancer
  22. 22. Breast cancer results Study group(ERT+ART) 7 breast cancers Expected incidence ERT only) 12(14) “ “ However the 10-year breast cancer ‘free survival rate’ for patients in the trial was < 97.41%.(no. reduced from 8 to 7) (95% c.i. 95.5-99.29%) Compared to the expected rate of 97.52%. It would appear then that the survival from the diagnosis breast cancer did not differ from that of the South Australian population at large of whom 44.3% were taking oestrogens but may be shown to be reduced to statistical significance when compared to a population of 100% oestrogen users . www.freelivedoctor.com
  23. 23. Bone density The initial improvement in bone density of only 3.1% in either area fell short of expectation as did the overall loss. Declining densities in smaller numbers was attributed to non- responders to HRT www.freelivedoctor.com Change in Hip Density Change in Lumbar Density
  24. 24. Cholesterol <ul><li>It would appear that there was no serious adverse effect by the testosterone on these two markers. </li></ul><ul><li>The mean levels while varying over time, would be acceptable. </li></ul>www.freelivedoctor.com LDL Cholesterol HDL Cholesterol
  25. 25. www.freelivedoctor.com The Male Menopause Good news and bad news! The bad news is that the male menopause does exist…it is a reality and should be taken seriously...
  26. 26. The good news is that it is synchronous with Prof. David Purdie www.freelivedoctor.com death!
  27. 27. www.freelivedoctor.com Grumpy old men
  28. 28. Testosterone can be dangerous stuff! www.freelivedoctor.com
  29. 29. www.freelivedoctor.com
  30. 30. Partial androgen deficiency “ PADAM ” <ul><li>should be distinguished from absolute deficiency (agonadism, Klinefelter’s, haemochromatosis, pituitary tumours etc.) </li></ul><ul><li> multiple aetiologies (alchohol, obesity, stress, aging etc.) </li></ul>www.freelivedoctor.com
  31. 31. Symptom complex  Precisely the same as for women except for breast soreness and vulval skin problems  suggestion that cholesterol profile may be improved  expectation that osteoporosis will be improved www.freelivedoctor.com
  32. 32. www.freelivedoctor.com Obesity <ul><li>Appetite results from the expression of neuropeptide Y by the hypothalamus </li></ul><ul><li>Leptin is expressed as a function of the ‘ob gene’ in the fat deposits </li></ul><ul><li>Leptin induces negative feedback on neuropeptideY </li></ul><ul><li>Testosterone decreases the production of leptin and may therefore increase appetite </li></ul><ul><li>This may be overcome by an increase in B.M.R. </li></ul>
  33. 33. www.freelivedoctor.com A.R.T. and CAD <ul><li>No improvement in CAD rates for offspring of fathers (white males) with premature coronary death </li></ul><ul><li>Low endogenous testosterone correlates with increased coronary rates </li></ul><ul><li>Disagreement about effect on HDL/LDL and triglycerides- ? transient benefit- ? result of oestrogen production by aromatisation </li></ul><ul><li>No change in carbohydrate metabolism </li></ul>
  34. 34. www.freelivedoctor.com A.R.T. and Neuropsychology <ul><li>General anabolic and energising effect </li></ul><ul><li>e.g. high dose ART to depressed males improves affect </li></ul><ul><li>? A degree of aromatisation of testosterone to oestradiol centrally (catechol oestrogens) </li></ul><ul><li>Oestrogen displaces albumen bound tryptophane (the precursor of serotonin), effectively increasing serotonin uptake </li></ul>
  35. 35. Suggested Management <ul><li>deal with lifestyle issues: </li></ul><ul><li> dietary control (central obesity and hyperinsulinism) </li></ul><ul><li> substance abuse (drugs, alchohol, smoking) </li></ul><ul><li> exercise and stress reduction </li></ul><ul><li>trial of testosterone </li></ul><ul><li> andriol, androderm, andromen or testosterone implant </li></ul><ul><li>Correct both and look for spontaneous recovery </li></ul>www.freelivedoctor.com
  36. 36. Beware the www.freelivedoctor.com prostate!! pumpkin
  37. 37. Something to aspire to… www.freelivedoctor.com
  38. 38. www.freelivedoctor.com Can we be seen to be producing a long living generation of superwomen (and men-?) Ultimate objective

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