Dr Ling Sien Ngan Anti Aging, Aesthetic  Medical Practitioner
<ul><li>Millions of men are ignorant about their health, pretending to be almighty that their machine will never break dow...
<ul><li>Have you taken any proactive steps ? </li></ul>
Anti-aging secrete : internal beauty, external cosmetic Dr Ling Sien Ngan Anti Aging, Aesthetic  Medical Practitioner
 
Mission  <ul><li>My commitment is to enhance individual ‘s QoL ,  </li></ul><ul><li>Living a satisfying fulfilling , and a...
My USP <ul><li>I help successful & busy men & women, </li></ul><ul><li>Particularly those concerned with their blemishes, ...
Anti Aging  & Aesthetic   medical  practitioner   1. Anti Aging  medicine 2. Men’s health & Andrology 5. Cosmetic  surgery...
1)  Anti aging  medicine <ul><li>Balanced diet </li></ul><ul><li>Nutritional supplementations + antioxidants </li></ul><ul...
vs Wellness Industry Sickness Industry Anti Aging Medicine is   But here can still anti age !
What  <ul><li>Definition  :  </li></ul><ul><li>Slowing of aging process. </li></ul><ul><li>Aging    is a ubiquitous biolo...
WHAT  CAUSES AGING?   <ul><li>Loss of COLLAGEN Tissue  </li></ul><ul><ul><li>Sun damage </li></ul></ul><ul><ul><li>Collage...
What? <ul><li>Theories of anti aging  : </li></ul><ul><li>Primary  aging </li></ul><ul><li>Is ongoing normal process   Ox...
What  <ul><li>Cost  : as little as FOC, educate yourself </li></ul><ul><li>Side effect  : nil if < OPL nutrition + moderat...
What is aging  PROCESS   <ul><li>Skin  changes </li></ul><ul><li>Fat  displacement </li></ul><ul><li>Reduced  muscle   ton...
What is SIGNS   OF AGING   <ul><li>Wrinkles </li></ul><ul><li>Sagging face </li></ul><ul><li>Deep laughing lines </li></ul...
What is rate of aging ? Balanced aging
What is Ideal aging
What is Unbalanced aging
What is mother hormone
+ - - - + + - Somatostatin - GHRH GHRP GHRELIN HGH + IGF-1 + +  Muscle, Bone, Cartilage FAT + + THYMUS BRAIN GONAD LIVER +...
What is hGH decline
What is Collagen? <ul><li>Tough, insoluble protein    hold muscles and organs  </li></ul><ul><li>Supports epidermis,  + d...
WHAT   IS COLLAGEN & CELLS? <ul><li>Collagen </li></ul><ul><ul><li>*Bundles of fibers (interspersed with   wavy, branchin...
What is Elastin? <ul><li>*   keeps skin flexible.  </li></ul><ul><li>Allows skin spring back when stretched  </li></ul><ul...
What are   TYPES  OF ANTI-AGING TREATMENTS <ul><li>1. SKIN CARE (Retinol, Natopherol, AHA, Vitamin C) </li></ul><ul><ul><l...
What is Structure of skin
<ul><li>3 . DERMAL   </li></ul><ul><ul><li>Injectable Fillers </li></ul></ul><ul><ul><li>Laser Skin Rejuvenation </li></ul...
What are TYPES  OF ANTI-AGING Rx <ul><li>5. Bone </li></ul><ul><li>Zoledronate, Ca, Vit D </li></ul><ul><li>6. Body system...
<ul><li>What are the areas /  topics  ? </li></ul>
Why  anti aging ? <ul><li>Free from pain of sickness    CDD </li></ul><ul><li>Avoid cost of medical care </li></ul><ul><l...
Which  miss universe  for anti aging? <ul><li>“  Stress , coming in all shades of intensity, is most important & powerful ...
Which  miss universe  for anti aging? <ul><li>Exercise  </li></ul><ul><li>Balanced diet </li></ul><ul><li>High quality nut...
Where ? <ul><li>Do any place , any time    home,/ work place </li></ul><ul><li>Service provider: anti aging clinic </li><...
Who ? <ul><li>Needs it?  </li></ul><ul><li>Those already having CDD/ cancer </li></ul><ul><li>One concerned about maintain...
How it is done? <ul><li>Non medically </li></ul><ul><li>Medically : </li></ul><ul><li>hGH </li></ul><ul><li>Stem cell, pla...
INTERNAL   BEAUTY CARE $$  3 reasons for this
Signs and Symptoms of testosterone Deficiency  <ul><li>Negative nitrogen balance </li></ul><ul><li>Decreased de novo prote...
<ul><li>Increase in insulin resistance </li></ul><ul><li>Dyslipidemia </li></ul><ul><li>Decreased cardiac endurance </li><...
Triad of hormonal approaches to increase testosterone –approach 1 <ul><li>A) </li></ul><ul><li>restoring balance by alteri...
Triad of hormonal approaches to increase testosterone <ul><li>Relative excess of estrogen to testosterone causes:  a) damp...
Triad of hormonal approaches to increase testosterone <ul><li>When estrogen is more than 30 ng/dl in male, need treatment ...
Triad of hormonal approaches to increase testosterone <ul><li>1)Tab Zn 50mg bd till improvement  .  50mg OD as maintenance...
Triad of hormonal approaches to increase testosterone <ul><li>2)Slim down if obese  .fat cell are full of aromatase  .once...
Triad of hormonal approaches to increase testosterone <ul><li>3)if alcoholic  .alcohol inhibit estrogen clearance  .alcoho...
 
Bio identical hormonal approaches to increase testosterone <ul><li>Eat plenty soy protein:  </li></ul><ul><li> [A] becaus...
Triad of hormonal approaches to increase testosterone <ul><li>4)eat plenty soy protein  .-soy is rich in isoflavones(a typ...
Triad of hormonal approaches to increase testosterone <ul><li>5)avoid grape fruit for men  -grape inhibit liver break down...
 
Triad of hormonal approaches to increase testosterone <ul><li>6)plenty cruciferous vegetables eg cauliflower,  broccoli  -...
Triad of hormonal approaches to increase testosterone <ul><li>Above 5 methods really work.  25% andropause men has good re...
Triad of hormonal approaches to increase testosterone – approach 2 <ul><li>B) HCG injection  --directly stimulate Lydig ce...
Triad of hormonal approaches to increase testosterone –approach 3 <ul><li>C)directly replace test  --Andriol cap, inj test...
Triad of hormonal approaches to increase testosterone –approach 4 <ul><li>Indirectly increase test :  by clomid &Tamoxifen...
+ - - - + + - Somatostatin - GHRH GHRP GHRELIN HGH + IGF-1 + +  Muscle, Bone, Cartilage FAT + + THYMUS BRAIN GONAD LIVER +...
 
Risk of test replacement <ul><li>Acne , hair loss in some susceptible individual </li></ul><ul><li>Local irritation with p...
 
The correct way -- investigation <ul><li>Baseline :  .DRE </li></ul><ul><li>.u/s  .Haematocrit  .PSA .others( TSH,FT4 ,ins...
 
SHBG  & BAT <ul><li>Free T  is difficult to do , & expensive. Equilibrium analysis measures TRUE free T </li></ul><ul><li>...
FSH & LH <ul><li>Both FSH & LH sky high = primary hypogonadism </li></ul><ul><li>Both FSH , LH ,low = secondary hypogonad ...
LH & testosterone <ul><li>Raised LH, but normal test.---occur in compensated state, in early andropause </li></ul><ul><li>...
Benefit of testosterone <ul><li>Strong anabolic activity with pronounced androgenic component  .—(so increase in strength,...
 
4 preparations of test
1) Testerone Gel -1 <ul><li>100mg/ml,60g/tube </li></ul><ul><li>Hydroalcoholic gel, 10% conc. </li></ul><ul><li>Cont trans...
1)Test gel -2 <ul><li>Many prescribe BD </li></ul><ul><li>But single OM—mimic normal early morning rise in test </li></ul>...
2)Inj test enanthate oil <ul><li>200mg/ml,in 10 ml </li></ul><ul><li>Widely used test </li></ul><ul><li>Blood remain eleva...
3)Inj test Blend oil -1 ( Sustanon 250) <ul><li>250mg/ml, 10ml vial </li></ul><ul><li>4 test esters: </li></ul><ul><li>1)T...
3)Inj test Blend oil -2 <ul><li>1 st  2 : are quickly utilised,released into circulation within 4 days </li></ul><ul><li>3...
3)Inj test Blend oil -3 <ul><li>Is intelligently engineered blend---provide fast & extended release </li></ul><ul><li>Impr...
4)Test undecanoate soft gel(Andriol) <ul><li>40mg test undecanoate based in oil (oleic acid) </li></ul><ul><li>HISTORY:  ....
4)Test undecanoate soft gel (Andriol) <ul><li>Newer way to protect molecule :  .-undecanoate ester absorbed through lympha...
 
 
 
 
Promote Positive Ageing <ul><li>Acceptance of ageing </li></ul><ul><li>empowerment </li></ul><ul><li>individuality </li></...
If ageing can be halted... Ee The Lost Horizon Would you choose to be in it?
SEEKING   A GOOD LIFE STYLE ? <ul><li>Physically and emotionally strong </li></ul><ul><li>Age gracefully </li></ul><ul><li...
 
Be all that you are.   Show it off   <ul><li>VIBRANT  </li></ul><ul><li>RADIANT </li></ul><ul><li>VITALITY  </li></ul>
Thank you for your attention !
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Men's health & psa

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  • More Asians than ever are rediscovering themselves through SCIENCE-BASED AESTHETIC PROCEDURES and PLASTIC SURGERY.
  • Men's health & psa

    1. 1. Dr Ling Sien Ngan Anti Aging, Aesthetic Medical Practitioner
    2. 2. <ul><li>Millions of men are ignorant about their health, pretending to be almighty that their machine will never break down. By the time wanting to see Dr ,they are already at late stages of disease. </li></ul>
    3. 3. <ul><li>Have you taken any proactive steps ? </li></ul>
    4. 4. Anti-aging secrete : internal beauty, external cosmetic Dr Ling Sien Ngan Anti Aging, Aesthetic Medical Practitioner
    5. 6. Mission <ul><li>My commitment is to enhance individual ‘s QoL , </li></ul><ul><li>Living a satisfying fulfilling , and a purposeful life, </li></ul><ul><li>Through comprehensive & integrated anti aging & aesthetic healthcare services. </li></ul>
    6. 7. My USP <ul><li>I help successful & busy men & women, </li></ul><ul><li>Particularly those concerned with their blemishes, ballooning , + sagging curves, lost vitality & lethargy </li></ul><ul><li>Many professionals/executives whilst amassed wealth + acumen , are lost as to how to shape up , due to ravages of time, </li></ul><ul><li>I have programs specifically designed + scientifically tailored to the needs of such informed executives. </li></ul><ul><li>Effectiveness is assured with money back guarantee </li></ul>
    7. 8. Anti Aging & Aesthetic medical practitioner 1. Anti Aging medicine 2. Men’s health & Andrology 5. Cosmetic surgery 4. Cosmetic Dermatology 3. Holistic complimentary medicine Aesthetic / External Anti aging
    8. 9. 1) Anti aging medicine <ul><li>Balanced diet </li></ul><ul><li>Nutritional supplementations + antioxidants </li></ul><ul><li>Detoxification  ( chelation, colon hydrotherapy, FIR sauna, ozoniser okamizu </li></ul><ul><li>Correct, moderate exercise. </li></ul><ul><li>Weight management </li></ul><ul><li>Syndrome X + Mx of chronic deg dse -CDD </li></ul><ul><li>Osteoporosis </li></ul><ul><li>Bio –identical hormones </li></ul><ul><li>Occupational health  noise , chemical </li></ul><ul><li>Stress Mx: relaxation  meditation , yoga </li></ul>
    9. 10. vs Wellness Industry Sickness Industry Anti Aging Medicine is But here can still anti age !
    10. 11. What <ul><li>Definition : </li></ul><ul><li>Slowing of aging process. </li></ul><ul><li>Aging  is a ubiquitous biologic process, characterized by a progressive, inevitable evolution and maturation until death. </li></ul>Stay Young?? Not a zero-sum game ,trading away our liberty/ lifestyle
    11. 12. WHAT CAUSES AGING? <ul><li>Loss of COLLAGEN Tissue </li></ul><ul><ul><li>Sun damage </li></ul></ul><ul><ul><li>Collagen fibers twist and mat </li></ul></ul><ul><li>Hormonal changes </li></ul><ul><ul><li>Female/male hormones ratio changes </li></ul></ul><ul><ul><li>ALL Hormone production slows down </li></ul></ul>
    12. 13. What? <ul><li>Theories of anti aging : </li></ul><ul><li>Primary aging </li></ul><ul><li>Is ongoing normal process  OxS damage </li></ul><ul><li>Programmed theory, the biological clock </li></ul><ul><li>Shortened telomere </li></ul><ul><li>2. Secondary aging </li></ul><ul><li>To environmental insult : pollution ,toxin nutrition, radiation , disease </li></ul><ul><li># is complex ,multifactorial ,non mutually exclusive . > 300 theories postulated. </li></ul>
    13. 14. What <ul><li>Cost : as little as FOC, educate yourself </li></ul><ul><li>Side effect : nil if < OPL nutrition + moderate exercise + balanced diet </li></ul><ul><li>Benefits : </li></ul><ul><li>1) stays healthy, @ optimal level </li></ul><ul><li>2) Slows /reverse /stop CDD , Cancer </li></ul><ul><li>3) Insurance to future medical cost </li></ul><ul><li>Success rate : very high, feel good, energetic </li></ul>
    14. 15. What is aging PROCESS <ul><li>Skin changes </li></ul><ul><li>Fat displacement </li></ul><ul><li>Reduced muscle tone </li></ul><ul><li>Bone shrinkage </li></ul><ul><li>Compensatory changes </li></ul>
    15. 16. What is SIGNS OF AGING <ul><li>Wrinkles </li></ul><ul><li>Sagging face </li></ul><ul><li>Deep laughing lines </li></ul><ul><li>Eye bags </li></ul><ul><li>Droopy eyelids </li></ul>
    16. 17. What is rate of aging ? Balanced aging
    17. 18. What is Ideal aging
    18. 19. What is Unbalanced aging
    19. 20. What is mother hormone
    20. 21. + - - - + + - Somatostatin - GHRH GHRP GHRELIN HGH + IGF-1 + + Muscle, Bone, Cartilage FAT + + THYMUS BRAIN GONAD LIVER + - - Hypothalamus Anterior Pituitary + STOMACH
    21. 22. What is hGH decline
    22. 23. What is Collagen? <ul><li>Tough, insoluble protein  hold muscles and organs </li></ul><ul><li>Supports epidermis, + durability </li></ul>
    23. 24. WHAT IS COLLAGEN & CELLS? <ul><li>Collagen </li></ul><ul><ul><li>*Bundles of fibers (interspersed with  wavy, branching rubbery fibers of elastin.) </li></ul></ul><ul><ul><li>skin’s infrastructure  strength + resiliency. </li></ul></ul><ul><li>Cells </li></ul><ul><ul><li>Basic structural & functional unit </li></ul></ul><ul><ul><li>Free oxygen production  free radical </li></ul></ul>
    24. 25. What is Elastin? <ul><li>* keeps skin flexible. </li></ul><ul><li>Allows skin spring back when stretched </li></ul><ul><li>Properties fade with age  wrinkles and sagging skin. </li></ul>
    25. 26. What are TYPES OF ANTI-AGING TREATMENTS <ul><li>1. SKIN CARE (Retinol, Natopherol, AHA, Vitamin C) </li></ul><ul><ul><li>Start early, delay onset </li></ul></ul><ul><ul><li>Nourishes skin, promotes collagen synthesis & renewal </li></ul></ul><ul><ul><li>Reduces FINE LINES & LAXITY </li></ul></ul><ul><li>2. EPIDERMAL </li></ul><ul><ul><li>Glycolic Peels, </li></ul></ul><ul><ul><li>Microdermabrasion, </li></ul></ul><ul><ul><li>Laser Resurfacing </li></ul></ul><ul><ul><li>Pigmentation treatment </li></ul></ul>
    26. 27. What is Structure of skin
    27. 28. <ul><li>3 . DERMAL </li></ul><ul><ul><li>Injectable Fillers </li></ul></ul><ul><ul><li>Laser Skin Rejuvenation </li></ul></ul><ul><ul><li>Dermo Lift </li></ul></ul><ul><ul><li>Mesotherapy </li></ul></ul><ul><li>4. MUSCLE </li></ul><ul><ul><li>BTA Procedure </li></ul></ul>What are TYPES OF ANTI-AGING TREATMENTS
    28. 29. What are TYPES OF ANTI-AGING Rx <ul><li>5. Bone </li></ul><ul><li>Zoledronate, Ca, Vit D </li></ul><ul><li>6. Body system </li></ul><ul><li># HRT </li></ul><ul><li># Supplements </li></ul><ul><li># Antioxidants </li></ul><ul><li># Detox heavy metals, toxins </li></ul>
    29. 30. <ul><li>What are the areas / topics ? </li></ul>
    30. 31. Why anti aging ? <ul><li>Free from pain of sickness  CDD </li></ul><ul><li>Avoid cost of medical care </li></ul><ul><li>Stays functional during golden years </li></ul><ul><li>Simply feel good factor of being healthy </li></ul><ul><li>Now a life style ! </li></ul>
    31. 32. Which miss universe for anti aging? <ul><li>“ Stress , coming in all shades of intensity, is most important & powerful enemy of, & taking years away of your anti aging. Respect it, & by managing your fear + greed, instantly added years of abundance to your anti aging. “ -- Dr Ling Sien Ngan </li></ul>Anti aging is common sense Anti aging can be free of cost
    32. 33. Which miss universe for anti aging? <ul><li>Exercise </li></ul><ul><li>Balanced diet </li></ul><ul><li>High quality nutritional supplements </li></ul><ul><li>Bio-identical hormone versus pharm drug </li></ul><ul><li>Latest  Men’s health niche area </li></ul>
    33. 34. Where ? <ul><li>Do any place , any time  home,/ work place </li></ul><ul><li>Service provider: anti aging clinic </li></ul>
    34. 35. Who ? <ul><li>Needs it? </li></ul><ul><li>Those already having CDD/ cancer </li></ul><ul><li>One concerned about maintaining optimal health </li></ul><ul><li>Providers? </li></ul><ul><li>Anti aging trained Dr </li></ul>
    35. 36. How it is done? <ul><li>Non medically </li></ul><ul><li>Medically : </li></ul><ul><li>hGH </li></ul><ul><li>Stem cell, placenta </li></ul><ul><li>HRT </li></ul>
    36. 37. INTERNAL BEAUTY CARE $$ 3 reasons for this
    37. 38. Signs and Symptoms of testosterone Deficiency <ul><li>Negative nitrogen balance </li></ul><ul><li>Decreased de novo protein synthesis </li></ul><ul><li>Decrease in lean body mass </li></ul><ul><li>Decrease in bone mass </li></ul><ul><li>Negative calcium balance </li></ul><ul><li>Decreased joint cartilage </li></ul><ul><li>Increase in adiposity </li></ul><ul><li>Decline in glucose tolerance </li></ul>
    38. 39. <ul><li>Increase in insulin resistance </li></ul><ul><li>Dyslipidemia </li></ul><ul><li>Decreased cardiac endurance </li></ul><ul><li>Decreased LV thickness and Ejection fraction </li></ul><ul><li>Decreased B and T Cell function </li></ul><ul><li>Decline in macrophage function </li></ul><ul><li>Decreased antibody response to vaccines </li></ul><ul><li>Decrease in epidermal-dermal thickness </li></ul><ul><li>Decreased rate of wound healing </li></ul><ul><li>Decreased sleep and other quality of life outcomes </li></ul>
    39. 40. Triad of hormonal approaches to increase testosterone –approach 1 <ul><li>A) </li></ul><ul><li>restoring balance by altering test/ estradiol ratio, in favor of testosterone </li></ul>
    40. 41. Triad of hormonal approaches to increase testosterone <ul><li>Relative excess of estrogen to testosterone causes: a) dampended sexuality </li></ul><ul><li>b)inhibit hypothallamus/pituitary axis c)block action of test in all body tissue </li></ul>
    41. 42. Triad of hormonal approaches to increase testosterone <ul><li>When estrogen is more than 30 ng/dl in male, need treatment to lower it </li></ul>
    42. 43. Triad of hormonal approaches to increase testosterone <ul><li>1)Tab Zn 50mg bd till improvement . 50mg OD as maintenance . Testestosterone---------------  to estradiol . Aromatase .Zn inhibit aromatase </li></ul><ul><li>Many restored balance purely by use of Zn----very effective </li></ul>
    43. 44. Triad of hormonal approaches to increase testosterone <ul><li>2)Slim down if obese .fat cell are full of aromatase .once fat cell decreased----------less convertion--------restored ratio </li></ul>
    44. 45. Triad of hormonal approaches to increase testosterone <ul><li>3)if alcoholic .alcohol inhibit estrogen clearance .alcohol decrease Zinc level </li></ul>
    45. 47. Bio identical hormonal approaches to increase testosterone <ul><li>Eat plenty soy protein: </li></ul><ul><li> [A] because soy is rich in isoflavones(a type of phytoestrogen), has similar structure of human estrogen but only 1/500 of estrogen activity </li></ul><ul><li> [B] high concentration of phytoestrogen will compete for estradiol receptor, blocking out human estradiol action ---causing </li></ul><ul><li>i) inhibition of pituitary function to stimulate more estradiol, </li></ul><ul><li>ii) stimulate P450 system in liver (to excrete excess estradiol) </li></ul>
    46. 48. Triad of hormonal approaches to increase testosterone <ul><li>4)eat plenty soy protein .-soy is rich in isoflavones(a type of phytoestrogen), has similar structure of human estrogen but only 1/500 of estrogen activity .– high conc of phytoestrogen –compete for estradiol receptor, blocking out human estradiol action ---causing i) inhibition of pituitary function to stimulate more estradiol, ii) stimulate P450 system in liver (to excrete excess estradiol) </li></ul>
    47. 49. Triad of hormonal approaches to increase testosterone <ul><li>5)avoid grape fruit for men -grape inhibit liver break down of estrogen </li></ul>
    48. 51. Triad of hormonal approaches to increase testosterone <ul><li>6)plenty cruciferous vegetables eg cauliflower, broccoli --cruciferous stimulate burning of extra estradiol </li></ul>
    49. 52. Triad of hormonal approaches to increase testosterone <ul><li>Above 5 methods really work. 25% andropause men has good recovery by above methods. </li></ul>
    50. 53. Triad of hormonal approaches to increase testosterone – approach 2 <ul><li>B) HCG injection --directly stimulate Lydig cell ,producing test indirectly </li></ul>
    51. 54. Triad of hormonal approaches to increase testosterone –approach 3 <ul><li>C)directly replace test --Andriol cap, inj test enantate, inj test blend </li></ul>
    52. 55. Triad of hormonal approaches to increase testosterone –approach 4 <ul><li>Indirectly increase test : by clomid &Tamoxifen -test that has –ve feedback on hypothallamus is blocked----leading to LH surge –releasing more test </li></ul>
    53. 56. + - - - + + - Somatostatin - GHRH GHRP GHRELIN HGH + IGF-1 + + Muscle, Bone, Cartilage FAT + + THYMUS BRAIN GONAD LIVER + - - Hypothalamus Anterior Pituitary + STOMACH
    54. 58. Risk of test replacement <ul><li>Acne , hair loss in some susceptible individual </li></ul><ul><li>Local irritation with patch/gel </li></ul><ul><li>Risk of cardiovascular disease(due to increased haematocrite/viscosity </li></ul><ul><li>Prostate hypertrophy & cancer—no conclusive evidence .-no evidence test cause/accelerate hypertrophy . .—no evidence test cause cancer .—no significant increase in PSA with long term (2 yr) replacement </li></ul>
    55. 60. The correct way -- investigation <ul><li>Baseline : .DRE </li></ul><ul><li>.u/s .Haematocrit .PSA .others( TSH,FT4 ,insulin ,cortisol , E2, FSH , LH, T test, SHBG, LFT, DHEA, lipid profile) </li></ul><ul><li>Even better if there is age/race specific PSA </li></ul><ul><li>Monitor over time: a change of PSA more than 0.75 ng/dl per yr------indicate needs for further investigation </li></ul><ul><li>T test (AM sample ), BAT bioavailable test (albumin bound [18%]+ free T[1-2%]) , 80% are SHBG bound </li></ul>
    56. 62. SHBG & BAT <ul><li>Free T is difficult to do , & expensive. Equilibrium analysis measures TRUE free T </li></ul><ul><li>Free test index=T test/SHBG </li></ul><ul><li>SHBG increased 1 % /yr, over 40 yr old </li></ul><ul><li>Free test decreased 1%/yr, over 40 yr </li></ul><ul><li>High SHBG – occur in hyperthyroid,liver dse, sever androgen deficiency </li></ul><ul><li>Low SHBG – occur in hypothyroid, obesity, acromegaly </li></ul>
    57. 63. FSH & LH <ul><li>Both FSH & LH sky high = primary hypogonadism </li></ul><ul><li>Both FSH , LH ,low = secondary hypogonad </li></ul><ul><li>Both FSH , LH normal[or mildly raised] =elderly (andropause) </li></ul>
    58. 64. LH & testosterone <ul><li>Raised LH, but normal test.---occur in compensated state, in early andropause </li></ul><ul><li>Raised LH , low test. ---------occur in decompensated state, in late andropause, (testes burnt out) </li></ul><ul><li>In this case andropause is a problem of testes </li></ul>
    59. 65. Benefit of testosterone <ul><li>Strong anabolic activity with pronounced androgenic component .—(so increase in strength, muscle mass, libido, RBC & Oxygen rich blood) </li></ul><ul><li>Additional benefit : relief of tendon pain & faster recuperation </li></ul>
    60. 67. 4 preparations of test
    61. 68. 1) Testerone Gel -1 <ul><li>100mg/ml,60g/tube </li></ul><ul><li>Hydroalcoholic gel, 10% conc. </li></ul><ul><li>Cont transdermal delivery mimic diurnal variation, with peak & low throughout </li></ul><ul><li>Normal blood test conc=598-1043mg/ml </li></ul><ul><li>After few weeks application , blood test level=800mg/ml </li></ul>
    62. 69. 1)Test gel -2 <ul><li>Many prescribe BD </li></ul><ul><li>But single OM—mimic normal early morning rise in test </li></ul><ul><li>Fat layer beneath skin slows release. so that blood level maintained longer </li></ul>
    63. 70. 2)Inj test enanthate oil <ul><li>200mg/ml,in 10 ml </li></ul><ul><li>Widely used test </li></ul><ul><li>Blood remain elevated x 2 wks </li></ul><ul><li>At treatment dose—aromatisation to estradiol is not a problem </li></ul><ul><li>May wish to use anti-estrogen: eg tamoxifen or mesterolone </li></ul>
    64. 71. 3)Inj test Blend oil -1 ( Sustanon 250) <ul><li>250mg/ml, 10ml vial </li></ul><ul><li>4 test esters: </li></ul><ul><li>1)Test propionate 30mg </li></ul><ul><li>2)Test phenyl propionate 60mg </li></ul><ul><li>3)Test isocaproate 60mg </li></ul><ul><li>4)Test decanoate 100mg </li></ul>
    65. 72. 3)Inj test Blend oil -2 <ul><li>1 st 2 : are quickly utilised,released into circulation within 4 days </li></ul><ul><li>3 rd , 4 th : released slowly into circulation over 2 & 3 weeks , respectively </li></ul>
    66. 73. 3)Inj test Blend oil -3 <ul><li>Is intelligently engineered blend---provide fast & extended release </li></ul><ul><li>Improvement from standard cypionate & ethanate (which have shorter action durtion, more variable blood level) </li></ul><ul><li>Most popular testosterone used </li></ul><ul><li>At treatment dose—will not aromatase(to estradiol) excessively </li></ul><ul><li>May use anti estrogen—tamoxifen or mesterolone </li></ul>
    67. 74. 4)Test undecanoate soft gel(Andriol) <ul><li>40mg test undecanoate based in oil (oleic acid) </li></ul><ul><li>HISTORY: .-earlier test preparation enter blood through liver, quickly broken down during first pass .when cpd given structural protection by adding methyl group, can withstand first pass, but put stress in liver </li></ul>
    68. 75. 4)Test undecanoate soft gel (Andriol) <ul><li>Newer way to protect molecule : .-undecanoate ester absorbed through lymphatic, due to high fat solubility </li></ul><ul><li>Once in circulation , undecanoate ester breaks off ----giving free active test. </li></ul><ul><li>Undecanoate does not aromatise at a rate as high as all other test. ester </li></ul>
    69. 80. Promote Positive Ageing <ul><li>Acceptance of ageing </li></ul><ul><li>empowerment </li></ul><ul><li>individuality </li></ul><ul><li>physical activity </li></ul><ul><li>social contact/friendship </li></ul><ul><li>developing coping skills </li></ul><ul><li>valuing experience, knowledge etc. </li></ul><ul><li>Denial of ageing </li></ul><ul><li>disempowerment </li></ul><ul><li>being stereotyped </li></ul><ul><li>sedentary lifestyle </li></ul><ul><li>social withdrawal </li></ul><ul><li>psychological stress </li></ul><ul><li>overvaluing paid work </li></ul>Ee Brendan Kennelly Encourage Avoid
    70. 81. If ageing can be halted... Ee The Lost Horizon Would you choose to be in it?
    71. 82. SEEKING A GOOD LIFE STYLE ? <ul><li>Physically and emotionally strong </li></ul><ul><li>Age gracefully </li></ul><ul><li>Feel good factor </li></ul>
    72. 84. Be all that you are. Show it off <ul><li>VIBRANT </li></ul><ul><li>RADIANT </li></ul><ul><li>VITALITY </li></ul>
    73. 85. Thank you for your attention !

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