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Androgens in the Aging Male The RxFiles May-June 2003 What the world needs is a little more testosterone!

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Presentation on theme: "Androgens in the Aging Male The RxFiles May-June 2003 What the world needs is a little more testosterone!"— Presentation transcript:

1 Androgens in the Aging Male The RxFiles May-June 2003 What the world needs is a little more testosterone!

2 Hormones and Aging Females – sudden drop Males –gradual decline

3 Androgen Deficiency Symptoms Do you have a decrease in libido (sex drive)? * Do you have a lack of energy? Do you have a decrease in strength and/or endurance? Have you lost height? Have you noticed a decreased "enjoyment of life?" Are you sad and/or grumpy? Are your erections less strong? * Have you noticed a recent deterioration in your ability to play sports? Are you falling asleep after dinner? Has there been a recent deterioration in your work performance? ADAM or Morley Questionaire ???

4 Morley Questionnaire 10 questions every middle aged man is afraid to ask 88% sensitivity for low BT –catches most 60% specificity for low BT –catches many (~40%) who should not be caught multifactorial nature of symptoms natural course of aging other medical conditions

5  Testosterone by System Brain –libido, depression, irritable,  concentration Body –abdominal obesity,  muscle & strength, hair regression,  BMD, gynecomastia Genitourinary –smaller, softer, impotence General –fatigue,  energy

6 SHBG = sex hormone binding globulin tightly BINDS Testosterone making it unavailable Total T = free T (unbound T) + bound T ~6-28 nmol/L; AGE adjusted norms?: 40-59y = ; >60= Bioavailable T = free T + T bound weakly to albumin Free Androgen Index U Testosterone (T) Levels

7 Males

8 Trials Limited - too small, too short –lack good data for large scale treatment of PADAM –some efficacy on some parameters –subjective benefits –safety data lacking

9 Benefit vs Risk body strength mood libido cognition function prostate cardiovascular Hct (stroke) gynecomastia treated with tamoxifen? inappropriate behavior cost of treatment

10 Monitoring Symptoms/side effects Prostate –DRE, PSA*baseline, annual Lab –Hct, Hgb (stroke); lipids (heart) –testosterone Other

11 Androgens - Oral ANDRIOL –testosterone undecanoate –storage refrigerate in pharmacy at room temperature after dispensing (Exp. 90 days) –take after food

12 Androgens - Topical Gel ANDROGEL –testosterone 1% gel –apply daily in AM –a shirt prevents sharing

13 Androgens - Transdermal Patch ANDRODERM –testosterone –apply daily at HS –rotate sites weekly –skin irritation common

14 Androgens - Injectable DELATESTRYL –Testosterone enanthate small volume advantage DEPO- TESTOSTERONE –Testosterone cypionate Lower drug cost


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