Andropause Hormone Balance for Men.ppt

1、Andropause Hormone Balance for Men,Rebecca L. Glaser M.D., FACS,Andropause,Testosterone levels begin to decline in some men as early as 35 years of age, typically age 50 Gradual onset Deterioration of the mental and physical condition Testosterone therapy has been used for over 60 years Diet and lif

2、estyle are extremely important to hormone balance Every person is a unique individual,Testosterone,Anabolic hormone that improves muscle mass and bone density Improves mental sharpness, concentration, and memory Increases energy level Improves flexibility and mobility Prevents aches and pains Increa

3、ses sex drive and libido,Testosterone (cont.),Normal levels are protective against Alzheimers dementia, Parkinsons disease, & cognitive decline Protects against diabetes Protects against abdominal obesity Antidepressant Protects against bone loss Prevents inflammatory conditions,Testosterone and the

4、 Heart,Muscle building hormone A low testosterone is a risk factor for CHF Prevents CAD (heart disease) Dilates coronary arteries Helps maintain healthy cholesterol levels As testosterone declines BP rises,Testosterone,Does not cause prostate cancer Low testosterone levels correlate with more aggres

5、sive disease and worse outcomes May stimulate an undiagnosed cancer Does not cause liver failure (17) Methyltestosterone (synthetic) Orally effective Hepatotoxic, jaundice, cysts, hepatocellular adenomas Increased LDL, suppressed HDL, Increased risk HDMoralis 01: Algarte-Genin 04: Imamoto 04: Gooren

6、 04: Slater 00,DHEA ( dehydroepiandrosterone),Precursor hormone for both testosterone and the estrogens Low levels have been associated with depression, autoimmune diseases, and other chronic diseases (heart disease & diabetes) Low levels and high levels have been associated with breast cancer,Estra

7、diol/Testosterone,Testosterone is converted to estradiol (estrone) by aromatase (enzyme) As men age the ratio of estradiol to testosterone increases Elevated estradiol/testosterone increases the risk of BPH and prostate cancer It is not only the decline in testosterone but also the increase in estra

8、diol that cause the symptoms of Andropause,Symptoms of Andropause,Mental fatigue, feeling burned out, inability to concentrate, insomnia Decreased mental sharpness Increased forgetfulness Depression, irritability, anger, anxiety Physical fatigue, tiredness in the afternoon Aches, joint and muscle pa

9、in Decreased muscle mass,Symptoms of Andropause cont.,Shortness of breath with activities Development of chest pain, dx. of heart disease, blockage of arteries, rising BP Swelling of ankles, varicose veins Lightheadedness, dizzy spells Increased sweating, hot flashes Rising blood sugar, worsening di

10、abetes Incontinence Erectile dysfunction and decreased libido,Factors that Contribute to Testosterone Deficiency,Mumps Alcohol, stress, obesity Drugs that affect the liver NSAIDs (ibuprofen), Tylenol, ASA Statins (cholesterol lowering drugs) Many heart and BP medications Antidepressants H2 blockers

11、Chemotherapy,Raise Testosterone Naturally,Exercise, weight loss, eliminating processed foods (lowers insulin levels), reducing stress, and limiting alcohol will raise testosterone levels Fruits, vegetables, nuts, seeds, and fiber will offer protection to the prostate gland,Supplements Raise testoste

12、rone and protect prostate,Zinc 25-50mg, Vitamin C (1000mg) Chrysin (with piperine), flavones, Rx. arimidex Saw Palmetto 350mg, Nettle Root Vitamin E (400mg), B Complex (folate, B6, B12) Magnesium 500mg Omega 3 Fatty Acids (flaxseed, fish oil) Whole soy foods 2-3 times weekly Pygeum, pumpkin seed, ly

13、copene I3C (Indole-3-carbinol)www.hormonebalance.org TopicsProstate Protection,Progesterone,Levels decline after 60 Protects the prostate gland and lowers PSA Inhibits aromatase and 5 alpha reductase, raising testosterone levels Antagonizes the stimulatory effect of estrogen on the prostate gland St

14、imulates p53 (antitumor antigen),Hormone Testing,Saliva, Urine, Blood www.hormonebalance.org Featured reference sites Hormone Testing Bio-available (free) testosterone Saliva 24 hour Urine Free testosterone in blood (vs. total Testosterone),Testing,Saliva: Profile I (estradiol, DHEA-S, progesterone,

15、 testosterone, and cortisol) 24 hour Urine Blood : Testosterone , free testosterone (non-SHBG bound), estradiol, estrone, and PSA Blood : Thyroid Panel (T4, free T3, TSH), IGF-1ZRT laboratory 503-466-2445Rhein Consulting (Urine Testing) 503-292-1988,Options for HRT men,Testosterone (bio-identical)

16、 Oral capsule (40-120 mg) Sublingual tablet or lozenge (5-10 mg) TDD (Patch 5mg-10mg) Skin Cream/Gel (Patented 50-100 mg/5gm)(Compounded 20-100 mg/gm) Injections (T cypionate 100-200 mg IM) Pellets (four 200 mg./4-6 months) DHEA 25-50 mg/day Progesterone (5-10 mg/d),Oral Testosterone,Testosterone is

17、 absorbed well from the gut but is metabolized and inactivated in the liver Micronized in oil shifts the absorption to the lymphatics and thus to the systemic circulation via the thoracic duct to the subclavian vein Testosterone undecanoate (esterified) also attempts to shift absorption to the lymph

18、atics Alkylated testosterones (methyltestosterone) are metabolized more slowly but cause problems with lipid metabolism and liver toxicity,Sublingual Testosterone Lozenge/Tablet,Avoids intestinal absorption and hepatic inactivation Dose is 5-10 mg. three times daily Serum levels peak in 30 minutes a

19、nd return to baseline in 4-6 hours Increase in serum estradiol and DHT Patented 30 mg buccal mucoadhesive system applied twice daily Avoid swallowing saliva Variability in absorption,Transdermal Testosterone (TDD) Patches,Patented Products 1990s Testoderm scrotal patch (4 to 6 mg/d), rapid absorptio

20、n, applied daily, elevated DHT Andropatch Applied daily Androderm Applied daily, rotating sites, delivers 5 mg T/d Alcohol base to enhance absorption Skin irritation (50%) or contact dermatitis (12%) Problems with hair and sweating,Percutaneous Testosterone Creams and Gels,Base Natural Cream Non alc

21、oholic gel Hydro-alcoholic gel (9-14% bioavailable) AndroGel, Testim, Testogel Dose 50-100 mg (delivers 5-10 mg of Testosterone) Can combine testosterone with progesterone 5-10 mg Apply cream/gel to inner arms, abdomen, chest, neck Rotate sites, rub vigorously, wash hands if handling infant Variabil

22、ity in absorptionSwerdloff 00: Wang 00: Wang 01: McNicholas 03: Gooren 04: Ebert 05: Meikle 04: Rolf 02: Nieschlag 04:,Testosterone Injections,Widely used in Europe, low cost, consistent absorption Well tolerated, intramuscular injection Esterification of the 17 hydroxyl group Lipid soluble Depot Hy

23、drolyzed in vivo to release Testosterone Long acting esters Testosterone Cypionate (every 2 weeks, weekly) Testosterone Propionate (every 2 weeks) Testosterone Undecanoate (every 12 weeks),Testosterone Pellets,Have been used since 1940 Implanted in the subcutaneous tissue of the lower abdominal wall

24、 Requires a minor procedure 3-6 200 mg pellets provide a physiologic dose of testosterone for 4-6 months Effective form of therapy with complete bioavailability No elevation of DHT or estradiol Transient accelerated release rate 1-2 d only Extrusion 5%, minor bleeding 2%, infection 1%,Compounding Ph

25、armacy,Oral Capsules Sublingual lozenges or tablets Creams and Gels Pellets Injectable testosterone esterswww.hormonebalance.org TopicsCompounding Pharmacies Featured Reference SitesFind a compounding pharmacy,Dosing Swerdloff 00: Wang 96, 00, 01: McNicholas 03: Gooren 04: Ebert 05: Meikle 04: Rolf

26、02: Nieschlag 04: Marbury 03,Cost,Patented Androgel $235.00/mo. USP Testosterone Gel $30.00-$45.00/mo. USP Testosterone SL lozenge (5-10 mg.)two or three times daily$30.00-$45.00/mo. Pellets 200 mg pellets implanted/6 mos $365Injection $30 twice monthly or at home,BHRT and the Prostate,PSA ( 4.0 pro

27、state biopsy FU estradiol, estrone, free testosterone, and testosterone levels at 3 months Testosterone does not cause prostate cancer but may stimulate an existing cancer,Conclusion,BALANCE Individual Levels Biologically Identical Hormones Disease Prevention Active Participant,Recommended Reading,www.lef.org Testosterone Protocol The Testosterone Syndrome Shippen/Fryer The Hormone Solution Thierry Hertoghe Adrenal Fatigue James Wilson The Miracle of Natural Hormones Brownstein,