Testosterone replacement 2002 - Rosemary A Jones

Testosterone replacement 2002 - Rosemary A Jones

Testosterone Testosterone Replacement Replacement for for Men Men and and Women Women Robert A. Jones Memorial Medical Centre Adelaide South Australia Presenting from the Premises of Port Power February 29, 2020

Dr. Robert A. Jones 2 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 its use February 29, 2020 Dr. Robert A. Jones

3 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 February 29, 2020 Dr. Robert A. Jones 4

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! February 29, 2020 Dr. Robert A. Jones 5 With the introduction of HRT (oestrogen only or ERT), testosterone status falls to zero. This is due to two factors

cessation of production from the ovary by suppression of LH binding of testosterone by SHBG February 29, 2020 Dr. Robert A. Jones 6 It follows therefore, that any woman taking oestrogen or producing excess oestrogens is relatively or absolutely testosterone deficient e.g. February 29, 2020

the oral contraceptive multicystic ovary oestrogen replacement Dr. Robert A. Jones 7 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! February 29, 2020 Dr. Robert A. Jones

8 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 February 29, 2020 Dr. Robert A. Jones 9 Indications for testosterone replacement

Symptoms Vulval discomfort ? Voiding dysfunction Painful benign breast disease ? Prevention of breast cancer Osteoporosis February 29, 2020 Dr. Robert A. Jones 10 Symptoms relieved Variable mood state-tearful or aggressive Loss of energy and stamina

Impaired concentration and memory General skin and scalp hair dryness Loss of sexual arousability Painful breasts Vulval skin dryness/ discomfort/ itching Voiding disorder ? February 29, 2020 Dr. Robert A. Jones 11

Odds and ends may improve tachycardias seems to suppress petit mal (despite warnings on the P.I.) some headaches improve neck and back pain improves athletic competition improved sleep quality

increases insulin sensitivity lichen sclerosis February 29, 2020 Dr. Robert A. Jones 12 Objective aims of Androgen Replacement Therapy (ART) improved quality of life increase bone density (5-12% p.a.)

suppression benign breast disease reduction of the incidence of breast cancer maintain the cardioprotective effect of ERT 29, 2020 Dr. Robert A. Jones 13 Februaryimproved muscle strength (skeletal Side Effects acne

loss evening restlessness excess libido nightmares possible relationship disruption facial greasiness and male type scalp hair facial hair February 29, 2020 Dr. Robert A. Jones 14

Interpretation of blood test blood best taken in the morning assay is not very accurate misleading to do only total testosterone always requesttestosterone/SHBG only free/active testosterone is relevant 29, 2020 A. Jones allows the effect 15 Februarycontrol of theDr. Robert SHBG

Preparations & Oral- andriol Patch- Androderm Injections- sustanon Implants- crystalline testosterone Topical-locally made (cetomagrocol aqueous cream not ointment) 2-5% or as Andro-Feme/ Andromen 1-10% February 29, 2020 Dr. Robert A. Jones 16 Oestrogen and Testosterone

Implants Insertion technique Dr Rob Baber North Shore Menopause Clinic February 29, 2020 4mins 50secs Dr. Robert A. Jones 17 February 29, 2020 Dr. Robert A. Jones 18 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. February 29, 2020 Dr. Robert A. Jones 19 While my conclusions are therefore predominantly derived from my own clinical observations, there is current intense interest from the basic scientists. 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 February 29, 2020 Dr. Robert A. Jones 20 This analysis will focus mainly on the prevention of breast cancer but must include the parameters of HDL/LDL cholesterol

Bone density in addition to February 29, 2020 Breast cancer Dr. Robert A. Jones 21 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%) the expected rate of Compared to 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 February 29, 2020 Dr.

Robert A. Jones significance when compared to a 22 Bone density Change in Lumbar Density 1.06 1.05 1.04 BMD The initial improvement in bone density of only 3.1% in either area fell short of expectation as did the overall loss. 1.03

mean 1.02 1.01 1 1 2 3 Lumbar Spine Density Change in Hip Density 0.77 0.76 BMD

Declining densities in smaller numbers was attributed to nonresponders to HRT 0.75 mean 0.74 0.73 0.72 1 2 2 Hip Density February 29, 2020 Dr. Robert A. Jones

23 Cholesterol It would appear that there was no serious adverse effect by the testosterone on these two markers. The mean levels while varying over time, would be acceptable. HDL Cholesterol 1.6 1.55 1.5 mean HDL

1.45 1.4 Year Year Year Year Ye 0-2 2-4 4-6 6-8 ar8-10 LDL Cholesterol 3.85 3.8 3.75 3.7 3.65 mean LDL 3.6 3.55

3.5 3.45 Year 0-2 February 29, 2020 Dr. Robert A. Jones Year 2-4 Year 4-6 Year 6-8 Year 8-10

24 The Male Menopause Good news and bad news! The bad news is that the male menopause does existit is a reality and should be taken seriously... February 29, 2020 Dr. Robert A. Jones 25 The good news is that it is synchronous with

death Prof. David ! Purdie February 29, 2020 Dr. Robert A. Jones 26 February 29, 2020 Dr. Robert A. Jones 27 Testosterone can be dangerous stuff! February 29, 2020

Dr. Robert A. Jones 28 February 29, 2020 Dr. Robert A. Jones 29 Partial androgen deficiency PADAM should be distinguished from absolute deficiency (agonadism, Klinefelters, haemochromatosis, pituitary tumours etc.) multiple aetiologies

(alchohol, obesity, stress, aging etc.) February 29, 2020 Dr. Robert A. Jones 30 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 February 29, 2020 Dr. Robert osteoporosis willA. Jones be improved 31 Obesity Appetite results from the expression of neuropeptide Y by the hypothalamus Leptin is expressed as a function of the ob gene in the fat deposits Leptin induces negative feedback on neuropeptideY Testosterone decreases the production of leptin and may therefore increase appetite

This may be overcome by an increase in February 29, 2020 B.M.R. Dr. Robert A. Jones 32 A.R.T. and CAD No improvement in CAD rates for offspring of fathers (white males) with premature coronary death Low endogenous testosterone correlates with increased coronary rates Disagreement about effect on HDL/LDL and triglycerides- ? transient benefit- ? result of oestrogen production by aromatisation

No change in carbohydrate February 29, 2020 Dr. Robert A. Jones 33 metabolism A.R.T. and Neuropsychology General anabolic and energising effect e.g. high dose ART to depressed males improves affect ? A degree of aromatisation of testosterone to oestradiol centrally (catechol oestrogens) Oestrogen displaces albumen bound tryptophane (the precursor of serotonin), effectively increasing serotonin uptake February 29, 2020 Dr. Robert A. Jones

34 Management deal with lifestyle issues: dietary control (central obesity and hyperinsulinism) substance abuse (drugs, alchohol, smoking) exercise and stress reduction trial of testosterone andriol, androderm, andromen or testosterone implant Correct both and look for spontaneous recovery February 29, 2020

Dr. Robert A. Jones 35 Beware the pumpki n prostate! February 29, 2020 Dr. Robert A. Jones 36 Somethin g to

aspire to February 29, 2020 Dr. Robert A. Jones 37 Ultimate objective Can we be seen to be producing a long living generation of superwomen (and men-?) February 29, 2020

Dr. Robert A. Jones 38

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