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    Carruthers TTime The Testosterone Revolution For Men

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    'Testosterone is among the oldest drugs in medicine. It has a long efficacy and safety record for its prime role of androgen replacement therapy' 'androgen misuse is the systematic over-prescribing for unproven medical indications'

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    Carruthers TTime The Testosterone Revolution For Men

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    'Testosterone is among the oldest drugs in medicine. It has a long efficacy and safety record for its prime role of androgen replacement therapy' 'androgen misuse is the systematic over-prescribing for unproven medical indications'

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    Carruthers TTime the Testosterone Revolution for Men

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    'Testosterone is among the oldest drugs in medicine. It has a long efficacy and safety record for its prime role of androgen replacement therapy' 'androgen misuse is the systematic over-prescribing for unproven medical indications'

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    500 views58 pages

    Carruthers TTime The Testosterone Revolution For Men

    Uploaded by

    YoungBody
    'Testosterone is among the oldest drugs in medicine. It has a long efficacy and safety record for its prime role of androgen replacement therapy' 'androgen misuse is the systematic over-prescribing for unproven medical indications'

    Copyright:

    Attribution Non-Commercial (BY-NC)
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    of 58

    T Time

    The Testosterone Revolution for Men


    Dr Malcolm Carruthers Medical Director Mens Health Centre 20/20 Harley Street, London, W1G 9PH
    [email protected]

    Why Testosterone is Important King of Hormones Hormone of Kings High-T males: Potentates to Presidents NOW The Hormone of Preventive Medicine!

    A Hundred Years of Hormones

    1905 Sir Ernest Starling Introduced Word Hormone

    70 Years of Testosterone
    Ernst Laqueur Adolf Butenandt Leopold Ruzicka

    1935 Testosterone Isolated, Named, and Synthesised

    Symptoms of Testosterone Deficiency


    Potency Reduced Libido Reduced Drive Reduced Depression Memory Loss Aging Aches and Pains Sweats Hot Flushes Dry Skin

    What Do You Call It?


    Male Climacteric Male Menopause Idiopathic Hypergonadotrophic Hypogonadism Late-Onset Hypogonadism Andropause ADAM: Androgen Deficiency in the Adult Male

    T The Hormone of Preventive Medicine


    Affects body development Provides energy & drive KEEPS YOU FIT, ACTIVE and ATTRACTIVE - FROM CRADLE TO GRAVE Its not the man in your life thats important, its the life in your man!
    Mae West

    Ageing and Life Course

    Ageing and Life Course

    Importance of Testosterone Replacement Therapy

    Adding years to life and Life to years

    To Treat or Not to Treat That is the Question


    Against: David J. Handelsman, Professor of Andrology, ANZAC Research
    Institute, Concord Hospital, Sydney, NSW

    Testosterone: use, misuse and abuse Medical Journal of Australia, October 2006, vol 185, 436-9.
    Testosterone is among the oldest drugs in medicine. It has a long efficacy and safety record for its prime role of androgen replacement therapy in men with androgen deficiency.

    Androgen misuse is the systematic over-prescribing for unproven medical indications. Misuse is increasingly evident for male ageing ("andropause") and some other clinical conditions. Further trials for new indications for androgens require reliable safety data, but rising costs may make it increasingly attractive to circumvent the need for evidence by promoting off-label mass marketing. For: The rest of this talk, and the many researchers who have given evidence in favour of the proven need, safety and efficacy of its use.

    The ISSAM Recommendations

    American Endocrine Society Recommendations

    Testosterone and the Heart


    Professor Kevin Channer Consultant Cardiologist, Sheffield Hallam University, UK.

    Testosterone a Tonic for the Heart No link between High-T and heart disease. Men with heart disease have lower T levels than those without. TRT lower heart attack risk factors, including cholesterol, neutral fat, high blood pressure and blood clotting factors. TRT increases blood flow to the heart. TRT improves angina.

    Metabolic Syndrome (Syndrome-X) A Growth Industry

    Testosterone, Obesity and Diabetes


    Professor Stefan Arver Dierector of Andrology Centre, Karolinska Institute, Stockholm

    Testosterone and Metabolic Changes in Men with Abdominal Obesity

    Severe obesity is not a benign condition. It can lead to Metabolic Syndrome with raised cholesterol and neutral fat, blood pressure, heart disease and insulin resistance causing diabetes. Testosterone is low in Metabolic Syndrome. TRT improves body composition, reducing abdominal obesity and increasing muscle mass. It prevents and treats Metabolic Syndrome.

    Woody Allen Love is the Answer

    But Sex Raises Some Interesting Questions

    Testosterone and Sex Drive


    Professor Abdul Traish Director of Urological Research, Boston University Female arousal disorder: Sexual function and androgen deficiency Dr Adrian Zentner Medical Director, National Well Men and Women Too Programme Australia. Dr Clem Williams Medical Director Dundarave Medical Clinic, West Vancouver, Canada. Clinical experiences with TRT in women

    Testosterone and the Penis


    Professor Abdul Traish Director of Urological Research, Boston University Testosterone deficiency damages the penis and prevents the chemical changes needed for erection. TRT , as well as restoring sex drive, reverses these changes, and improves erectile function in the majority of cases. TRT works well with Viagra, Levitra and Cialis where these are needed (Dream Team)

    Life expectancy and Alzheimers Disease

    Ronald Reagan

    Rita Hayworth Iris Murdoch

    Charlton Heston

    Duration of AD can be 20 years or more, but typically 4-8 years (The long good-bye)

    Brain Changes in Alzheimers Disease


    Neurofibrillary Tangles and Neuritic Plaques

    Loss of Dendrites

    Amyloid Core of Neuritic Plaque

    Chemical Andropause and Amyloid- Peptide


    Sam Gandy et al, JAMA, 2001, Vol. 285, No.17

    Male
    Brain
    Right Cerebral Cortex Thicker, HypothalamicLimbic nuclei

    Female
    Brain
    Left Cerebral Cortex Thicker, Corpus Callosum Larger

    Skills
    Spatial Specialisation Focussed Dyslexic Colour-blind

    Skills
    Verbal Multi-tasking Diffuse Emotional Intuitive

    Importance of ADAM Diagnosis and Treatment


    Great personal, social and economic, as well as medical, importance in aging populations world-wide Promotion of Active Aging and prevention and delaying of physical and mental disability Adding years to life and life to years

    Androgen Deficiency in the Adult Male (ADAM)


    Definition: An absolute or relative deficiency of testosterone or its metabolites according to the needs of that individual at that time in his life.
    (c.f. insulin in diabetes mellitus)

    The Multiple Causes of Androgen Deficiency


    CEREBRAL CORTEX Age, Stress (Underload and Overload), Drugs HYPOTHALAMUS AND PITUITARY Age, GNRH decreased, and more sensitive to feedback, Prolactin, Drugs TESTES Age, Impaired development, Infections, Alcohol, Diet, Xeno-estrogens and Anti-androgens, Temperature, Trauma, Drugs TARGET ORGANS Age, SHBG, Receptor anomalies, Reduction and Down- regulation, Androgen Resistance Syndrome, (ARS) Connective tissue thickening, Drugs,

    Diet and Obesity


    OBESITY Lower SHBG, TT, FT, and DHEA levels, but higher E2 and insulin levels than the nonobese SLIMMING Low CHO Low Protein TT and FT and Insulin lowered, and SHBG rises High Protein, Low Fibre (Atkins) TT and FT raised, SHBG reduced

    Andropause Symptom Scales


    AUTHOR Werner Heller Reiter Carruthers Carruthers Tremblay Heinemann SCALE TITLE Male Clim. Male Clim. IDUT ACL Short ACL CAS AMS YEAR STUDY BEGAN 1939 1944 1953 UKAS 1989 Web1996 1998 1999 NUMBER IN STUDY 273 23 100 1,500 1533 300 992 RESPONSES Yes/No Yes/No 0 -12 0-4 0 - 4 Yes/No 1 - 5. SYMPTOMS: Erectile Dysfunction 90 ++ ++ 84 83 ++ 88 Libido/sex drive/desire 81 ++ ++ 82 87 ++ 84 Fatigue/energy reduced 80 ++ + 78 94 + 80 Depression 77 + ++ 62 88 + 75 Anxiety/nervousness 91 ++ ++ ++ 85 + 69 Memory/concentration 76 + + 42 90 + Irritability/anger 80 + + 57 85 + 72 Aches/pains joints 33 + 57 83 77 Sweating esp. night 18 + 50 63 + 66 Vasomotor/flushes 46 + 27 + Ageing/older than years 43 55 59

    Problems With Sampling


    Circadian and Seasonal Variation, Diet, Fasting and Alcohol, Physical Activity and Posture, Sample Preservation and Storage

    Medical Problems
    Illness, Stress, Sexual Activity, Smoking

    Analytical Problems
    Methodology, Specificity and Interference, Accuracy and Precision

    Interpretation Problems
    Log-normal distribution, Age-related Levels Androgen receptor polymorphism Up- and down-regulation Interactions of other hormones and drugs

    Androgen Deficiency in the Adult Male (ADAM) Definition: An absolute or relative deficiency of testosterone or its metabolites according to the needs of that individual at that time in his lif

    Validity of Androgen Assays


    Problems With Sampling
    Pulsatile,Circadian and Seasonal Variation, Diet, Fasting and Alcohol, Physical Activity and Posture, Sample Preservation and Storage

    Medical Problems
    Illness eg metabolic syndrome, Stress, Sexual Activity, Smoking

    Analytical Problems
    Methodology, Specificity and Interference, Accuracy and Precision

    Interpretation Problems
    Log-normal distribution, Age-related Levels Androgen Resistance

    Lower Limits TT in Relation to PBS Cut-off Point


    Sikaris,K., Handelsman,DJ. et al. J Clin.Endocrinol.Metab. 2005,90,5928-36
    14 12 Total Testosterone (nmol/l) 10 8 6 4 2 0 GCMS A B C D E F G Laboratory Low er Limits

    PBS Manufacturers Arithmetic Logarithmic

    Blood Testosterone Threshold for Androgen Deficiency Symptoms

    PBS ------------------------------ PBS ------------------------------ PBS

    Each person had a consistent testosterone threshold for androgen deficiency symptoms that differed markedly between individuals Kelleher,S.; Conway,A.J.; Handelsman,D.J. J Clin.Endocrinol.Metab. 2004,89,3813-17

    Sites of Androgen Resistance


    T DHT or E2
    AR AR

    AR

    AR

    ARE

    ARE

    Translation and post-translational factors


    Modified from Nussey,S.S., Whitehead, S.A. 2001

    Sensitivity to T Feedback

    Age and the


    GNRH Oestrogens GH

    Regulation of Testosterone Synthesis


    Mean LH Pulse Amplitude

    DHEA

    Testicular Degeneration

    Modified from Nussey,S.S., Whitehead, S.A. 2001

    Circadian rhythm of testosterone is lost in aging men


    Total testosterone (ng/ml) 30 8 * p<0.05; ** p<0.01 (young vs. old)

    ** ** **

    **
    25 7

    ** *

    * * *

    **
    YOUNG MEN

    6 20

    5 15 4 nmol/l 08.00 12.00 16.00 20.00 Time


    Bremner et al. J Clin Endocrinol Metab 1983;56:1278-1281 OLD MEN

    24.00

    04.00

    08.00

    ARS LONGA VITA BREVIS


    (Freely translated means Androgen Resistance Syndrome long-term shortens life )
    Ref. Low Serum Testosterone and Mortality in Male Veterans, M.Shores et al, Arch.Intern.Med.,2006;166:1660-5.

    Testosterone Treatment

    Testosterone Pellet Implants Testosterone Undecanoate Injections (Nebido) Testosterone orally - Restandol Transdermal Creams DHT and Testosterone Transdermal Gels Androgel and Testogel Danazol

    Application of Testogel

    once daily, preferably in the morning on clean, dry and intact skin on upper arm, shoulder and / or abdomen - not on the genitals

    Feldmann RJ,.Maibach HI. Regional variation in percutaneous penetration of 14C cortisol in man. Journal of Investigative Dermatol. 1967;48:181-3.

    Amounts of steroid absorbed by skin in different areas compared to forearm

    Conclusions on Testosterone Treatment and Prostate Cancer (Mr Mark Feneley Senior Lecturer in Urologic Oncology, Institute of Urology, London)
    No evidence that testosterone treatment causes prostate cancer Pre-screening is important prior to testosterone therapy PSA monitoring identifies prostate cancer at an early stage Prostate cancer identified by PSA is potentially curable

    Adverse Reactions to Testosterone 1963-2002 (Yellow Card) UK Medicines Control Agency


    Total - 214 Reactions in 185 Patients (3Deaths)
    Cutaneous + Local Reaction 117 Implant + Injection complications 90, Rash 15 Psychiatric + General Endocrine + Metabolic + Musculo-skeletal Gastrointestinal + Liver + Respiratory Vascular Neurological + Eye Neoplasms + Urological 27 17 16 15 13 9 Aggression 6,Depression 3,(Suicide 1) Muscle cramps 3, Arthralgia3, Hirsutism 1, Diabetes1 Diarrhoea 7, Nausea 3, Abdominal pain 3,Jaundice 2 Cardiac 8, CVA2, DVT 4, Embolus 1 Paraesthesia 6,Headache 6(OD-CVA1) ?Prostate 2, (Sarcoma 1), Breast 1, Priapism 2,Test.Pain 2,Renal failure 1

    Costs of Treatment/Month (Medication only other costs to medical system and patients not included)

    Testosterone Preparation Testosterone Pellet Implants Injected T-Esters (Sustenon) Injected T-Undecanoate (Nebido) Oral T-Undecanoate (Andriol) T-Gel (Testogel) Scrotal T-Cream (Andromen)

    Cost () % Abs. Theory Practice 20 10 22 27 33 8 100 * 100 * 100 ** 10 ** 15 *** 70 **** *** * **** ** *** ***

    Key Messages Testosterone Treatment is:


    Simple, if you dont make it complicated A very effective form of treatment An economic form of treatment Gives many grateful patients Safe, if you take a few simple precautions A powerful form of preventive medicine

    Why is it T-Time?
    70 years of experience with testosterone treatment shows its safe, effective and not rocket science. Its being recognised that symptoms rather than blood tests are better for diagnosing testosterone deficiency. Testosterone deficiency can be due to resistance to its action as well as a low level. Resistance in the medical profession to its therapeutic use is being overcome. It is becoming accepted as an important factor in heart disease, obesity, diabetes, erection problems and the causes of physical and mental ageing. It is an economic form of treatment that can add life to years, as well as years to life.

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