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Robert A. Jones Memorial Medical Centre Adelaide South Australia

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

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Robert A. Jones Memorial Medical Centre Adelaide South Australia

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  1. Testosterone ReplacementforMen and Women Robert A. Jones Memorial Medical Centre Adelaide South Australia

  2. Presenting from the Premises of Port Power Dr. Robert A. Jones

  3. While testosterone replacement is being used in women with good effect…it isused without the approval of the Australian Drug Evaluation Committee…and the individual practitioner must take individual responsibility for it’s use Dr. Robert A. Jones

  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 Dr. Robert A. Jones

  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! Dr. Robert A. Jones

  6. 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 Dr. Robert A. Jones

  7. It follows therefore, that any woman taking oestrogen or producing excess oestrogens is relatively or absolutely testosterone deficiente.g. the oral contraceptive multicystic ovary oestrogen replacement Dr. Robert A. Jones

  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! Dr. Robert A. Jones

  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. Dr. Robert A. Jones

  10. Indications for testosterone replacement Symptoms Vulval discomfort ? Voiding dysfunction Painful benign breast disease ? Prevention of breast cancer Osteoporosis Dr. Robert A. Jones

  11. 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 ? Restored/ increased muscle strength Dr. Robert A. Jones

  12. 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 Dr. Robert A. Jones

  13. Objective aims ofAndrogen 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 improved muscle strength (skeletal and myocardial) Dr. Robert A. Jones

  14. Side Effects ♀ evening restlessness excess libido nightmares possible relationship disruption facial greasiness and acne male type scalp hair loss facial hair Dr. Robert A. Jones

  15. Interpretation of blood test blood best taken in the morning assay is not very accurate misleading to do only total testosterone always request- “testosterone/SHBG” only free/active testosterone is relevant control of the SHBG allows the effect or controls excess replacement Dr. Robert A. Jones

  16. 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% Dr. Robert A. Jones

  17. Oestrogen and Testosterone Implants Insertion technique Dr Rob Baber North Shore Menopause Clinic 4mins 50secs Dr. Robert A. Jones

  18. Dr. Robert A. Jones

  19. There is very little data on the human femaleThere has been a data collection from my practice, undertaken on 512 women over 12 years. Dr. Robert A. Jones

  20. 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 withThe National Institute of HealthBethesda, Maryland, USA.in an attempt to correlate the epidemiology with the basic science Dr. Robert A. Jones

  21. 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 Breast cancer Dr. Robert A. Jones

  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. Dr. Robert A. Jones

  23. Change in Lumbar Density Bone density Change in Hip 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 Dr. Robert A. Jones

  24. Cholesterol HDL 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. LDL Cholesterol Dr. Robert A. Jones

  25. 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... Dr. Robert A. Jones

  26. Prof. David Purdie The good news is that it is synchronous with death! Dr. Robert A. Jones

  27. Grumpy old men Dr. Robert A. Jones

  28. Testosterone can be dangerous stuff! Dr. Robert A. Jones

  29. Dr. Robert A. Jones

  30. Partial androgen deficiency“PADAM” should be distinguished from absolute deficiency (agonadism, Klinefelter’s, haemochromatosis, pituitary tumours etc.)  multiple aetiologies (alchohol, obesity, stress, aging etc.) Dr. Robert A. Jones

  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 Dr. Robert A. Jones

  32. 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 B.M.R. Dr. Robert A. Jones

  33. 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 metabolism Dr. Robert A. Jones

  34. 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 Dr. Robert A. Jones

  35. Suggested 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 Dr. Robert A. Jones

  36. Beware the pumpkin prostate!! Dr. Robert A. Jones

  37. Something to aspire to… Dr. Robert A. Jones

  38. Ultimate objective Can we be seen to be producing a long living generation of superwomen (and men-?) Dr. Robert A. Jones

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