Testosterone Replacement Therapy : Benefits versus Risks

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Lecture by Nelson Vergel , BsChE , MBA Email: nelsonvergel@gmail.com Web site: TestosteroneWisdom.com On facebook : Testosterone Replacement

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For More Information: TestosteroneWisdom.com

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Are you experiencing fatigue and low or no sex drive? For more information : www.testosteronewisdom.com

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Do you have less mental focus? For more information : www.testosteronewisdom.com

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Do you have less tolerance to stress and low mood? For more information : www.testosteronewisdom.com

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Are you getting fatter while eating the same amount of food? For more information : www.testosteronewisdom.com

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Have you been exercising for years without improvements in your body? For more information : www.testosteronewisdom.com

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You may be one of the 13 million men in the United States that are suffering needlessly from testosterone deficiency and not knowing it. But there is hope…

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Read “Testosterone: A Man’s Guide” Available on TestosteroneWisdom.com

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Testosterone: Target Organs brain libido, mood skin hair growth, balding, sebum production muscle increase in strength and volume liver synthesis of serum proteins kidney stimulation of erythropoietin production male sexual organs penile growth spermatogenesis prostate growth and function bone marrow stimulation of stem cells bone accelerated linear growth closure of epiphyses For more information : www.testosteronewisdom.com

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Albumin-bound T 38% Free T 2% SHBG-bound T 60% T = testosterone Only 2% is free testosterone and 98% is bound Testosterone Fractions in the Blood For more information : www.testosteronewisdom.com

Testosterone Deficiency (Hypogonadism):

Testosterone Deficiency ( Hypogonadism ) Normal levels in blood: Men... Total test. 300-1100 ng / dL , Free test. 5 - 21 ng / dL Women... Total test. 10-50 ng / dL Free test. 0.10-0.85 ng / dL Symptoms of testosterone deficiency: Fatigue, low or lack of sex drive, poor appetite, loss of muscle mass & strength, depression For more information : www.testosteronewisdom.com

Signs and Symptoms of Low Testosterone:

Signs and Symptoms of Low Testosterone Loss of muscle mass and strength Loss of libido and erectile dysfunction Depression Lethargy (fatigue, lack of focus) Osteoporosis (bone loss) Some regression of secondary sexual characteristics (body hair loss, etc) Oligospermia or azoospermia (low or no sperm count) Tenover JL. Endocrinol Metab Clin North Am . 1998;27:969-987 Petak SM, et al. AACE Clinical Practice Guidelines. Available at: http://www.aace.com/clin/guides/hypogonadism.html

Symptoms of Testosterone Deficiency (hypogonadism):

Symptoms of Testosterone Deficiency ( hypogonadism ) Constitutional: Decreased Energy; Fatigue; Insomnia; Hot Flushes, Sweats; Decreased Appetite Psychological: Depression; Irritability; Decreased Quality of Life, Well-Being, Memory, Self-Esteem For more information : www.testosteronewisdom.com

Signs :

Signs Loss of Body Hair/Facial Hair Gynecomastia (increased breast size) Decreased Testes Size (Anemia) For more information : www.testosteronewisdom.com

More Symptoms:

More Symptoms Body Composition: Decreased Muscle Mass & Bone Mineral Density (BMD); Increased Fat Mass Physical Fitness: Decreased Muscle Strength & Stamina Sexual: Decreased Libido; Nocturnal Erections; Erection Dysfunction; Decreased Satisfaction Cardiovascular: Angina; MI For more information : www.testosteronewisdom.com

Screening Questionnaires:

Screening Questionnaires ADAM (Androgen Deficiency in the Aging Male) MMAS (Massachusetts Male Aging Study) AMS (Aging Males Survey) For more information : www.testosteronewisdom.com

Causes of Hypogonadism (Low Testosterone Blood Level):

Causes of Hypogonadism (Low Testosterone Blood Level) Congenital hypogonadism Primary testicular failure Hypogonadotropic hypogonadism Severe systemic disease, including HIV infection Normal aging Medications: ketoconazole , glucocorticoids , spironolactone , cimetidine , phenytoin , flutamide , megesterol

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Available on TestosteroneWisdom.com

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For More Information: TestosteroneWisdom.com

Testosterone Metabolism :

Testosterone Metabolism

Hourly Testosterone Blood Levels in Healthy Young and Older Men in a Day :

Hourly Testosterone Blood Levels in Healthy Young and Older Men in a Day Source: Bremner WJ, Vitiello MV, Prinz PN., J Clin Endocrinol Metab 1983;56:1278-1281 0000 2000 1600 1200 0800 0400 0000

Testosterone Replacement Therapy (TRT) Benefits:

Testosterone Replacement Therapy (TRT) Benefits Sexual Function (Libido; ED (libido); Spontaneous/ Nocturnal Erections; Satisfaction) Body Composition (BMD; LBM; Fat Mass) Physical Fitness (Strength) Psychological (Depression; Well-Being; QoL ; Energy; Cognitive Testing) Reduction in cardiovascular risk; Improved lipids and glycemic control For more information : www.testosteronewisdom.com

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TRT Benefits sexual function Mental focus Stamina and Bone Strength Lean Body Mass

Hypogonadism Blood Analysis Panel:

Hypogonadism Blood Analysis Panel Comp Metabolic Panel (Liver Function Tests; Lipids; Iron) Cell Blood Count (Hemoglobin/ Hematocrit ) Total Testosterone Luteinizing Hormone /Follicle Stimulating Hormone Prolactin Thyroid Stimulating Hormone Prostate Specific Antigen (PSA) (if over 40) Sex Hormone Binding Globulin (SHBG) For more information : www.testosteronewisdom.com

Monitoring:

Monitoring Comprehensive Metabolic Panel ( L iver F unction Tests- LFTs ; Lipid Panel; Etc.) Testosterone Hemoglobin and Hematocrit PSA/DRE (digital rectal exam) For more information : www.testosteronewisdom.com

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Available on TestosteroneWisdom.com

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Testosterone Options 1 2 3 4 5

Intramuscular TRT :

Intramuscular TRT Testosterone Propionate (3-5 Days) Testosterone Cypionate (7-10 Days) Testosterone Enanthate (10-14 Days ) Combinations of the above by compounding. Testosterone Undecanoate ( Aveed - Endo Pharmaceuticals /USA, Nebido /Europe) FDA CRL December 2009 For more information : www.testosteronewisdom.com

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Testosterone Blood Levels After 200 mg Injection

Mean Steady-State Testosterone Concentrations in Patients Receiving AndroGel®:

Mean Steady-State Testosterone Concentrations in Patients Receiving AndroGel ® Day 90 Data on file. Unimed Pharmaceuticals, Inc.

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Testosterone Metabolites and Their Functions Testosterone 5-7 mg/day Androgen Receptor Androgen Receptor Estrogen Receptor Dehydro Testosterone (DHT) (by 5 α -reductase) Estradiol (by aromatase) Direct Effect LH Oxidation by Liver Elimination by Kidneys Skin, Prostate Hair, Brain, Bone Muscle, Brain

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Potential Side Effects Polycythemia Benign Prostatic Hypertrophy Acne Gynecomastia Increased BP

HPTA Protocol :

HPTA Protocol hCG (human chorionic gonadotropin ) Clomiphene Tamoxifen More information at http://www.hptaxis.com/ For more information : www.testosteronewisdom.com

Testosterone Replacement Contradications :

Testosterone Replacement Contradications Prostate Cancer (PSA) Breast Cancer BPH (Benign Prostatic Hyperplasia) Polycythemia Sleep Apnea Congestive Heart Failure For more information : www.testosteronewisdom.com

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For More Information: TestosteroneWisdom.com

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Lecture by Nelson Vergel , BsChE , MBA Email: nelsonvergel@gmail.com Web site: TestosteroneWisdom.com On facebook : Testosterone Replacement