1. Testosterone Replacement for Men and Women Memorial Medical Centre
Robert A. Jones
Memorial Medical Centre
Adelaide
South Australia

2. Presenting from the Premises of Port Power
September 19, 2018
Dr. Robert A. Jones

3. While testosterone replacement is being used in women with good effect… it is used without the approval of the Australian Drug Evaluation Committee …and the individual practitioner must take individual responsibility for it’s use
September 19, 2018
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
September 19, 2018
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!
September 19, 2018
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
September 19, 2018
Dr. Robert A. Jones

7. It follows therefore, that any woman taking oestrogen or producing excess oestrogens is relatively or absolutely testosterone deficient e.g. the oral contraceptive multicystic ovary oestrogen replacement
September 19, 2018
Dr. Robert A. Jones

8. Oestrogen and progesterone are the mainstay of ERT
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!
September 19, 2018
Dr. Robert A. Jones

9. (by a predominantly male profession)
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.
September 19, 2018
Dr. Robert A. Jones

10. Indications for testosterone replacement
Symptoms
Vulval discomfort
? Voiding dysfunction
Painful benign breast disease
? Prevention of breast cancer
Osteoporosis
September 19, 2018
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
September 19, 2018
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
September 19, 2018
Dr. Robert A. Jones

13. Objective aims of Androgen 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)
September 19, 2018
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
September 19, 2018
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
September 19, 2018
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%
September 19, 2018
Dr. Robert A. Jones

17. Oestrogen and Testosterone Implants
Insertion technique
Dr Rob Baber
North Shore Menopause Clinic
4mins 50secs
September 19, 2018
Dr. Robert A. Jones

18. September 19, 2018
Dr. Robert A. Jones

19. There is very little data on the human female There has been a data collection from my practice, undertaken on 512 women over 12 years.
September 19, 2018
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 with The National Institute of Health Bethesda, Maryland, USA. in an attempt to correlate the epidemiology with the basic science
September 19, 2018
Dr. Robert A. Jones

21.  HDL/LDL cholesterol  Breast cancer
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
September 19, 2018
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 %)
Compared to
the expected rate of %.
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.
September 19, 2018
Dr. Robert A. Jones

23. Bone density
Change in Lumbar 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
Change in Hip Density
September 19, 2018
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
September 19, 2018
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...
September 19, 2018
Dr. Robert A. Jones

26. The good news is that it is synchronous with
death!
Prof. David Purdie
September 19, 2018
Dr. Robert A. Jones

27. Grumpy old men
September 19, 2018
Dr. Robert A. Jones

28. Testosterone can be dangerous stuff!
September 19, 2018
Dr. Robert A. Jones

29. September 19, 2018
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.)
September 19, 2018
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
September 19, 2018
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.
September 19, 2018
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
September 19, 2018
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
September 19, 2018
Dr. Robert A. Jones

35. Correct both and look for spontaneous recovery
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
September 19, 2018
Dr. Robert A. Jones

36. Beware the
pumpkin
prostate!!
September 19, 2018
Dr. Robert A. Jones

37. Something to aspire to…
September 19, 2018
Dr. Robert A. Jones

38. Can we be seen to be producing a long living generation
Ultimate objective
Can we be seen to be producing a long living generation of
superwomen
(and men-?)
September 19, 2018
Dr. Robert A. Jones