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Testosterone Replacement Therapy for Aging Men
Approximately 30% of men aged 60-70 years and 70% of men aged 70-80 have low levels of testosterone.
Hypogonadism is a clinical condition in which low levels of serum testosterone are found in association with specific signs and symptoms, including diminished sex drive and sense of vitality, erectile dysfunction, depression, anemia, reduced muscle mass and bone density, increased fat mass, frailty, and osteoporosis. When hypogonadism occurs in an older man, the condition is often called andropause, or Androgen Deficiency of the Aging Male (ADAM), because testosterone is in a class of hormones known as androgens. Testosterone levels can be measured by saliva or blood tests.It is recommended that elderly men with symptoms of hypogonadism and a total testosterone level less than 300 ng/dl be started on hormone replacement.
Depressed men have been found to have significantly lower bioavailable testosterone levels (bioavailable is the free form that can be used by the body), perhaps because an associated decrease in sexual function results in depression, irritability, and mood swings. Testosterone therapy may improve depressed mood in older men who have low levels of bioavailable testosterone.
Osteoporosis-related fractures occur in 12% of all men over 50 years of age. Twenty-five percent of all hip fractures occur in men, and 33% of these patients die within one year of fracture. Gradual loss of testosterone is one of the major causes of osteoporosis in elderly men. Studies have reported beneficial effects of testosterone therapy in older men, showing an increase in bone mineral density (BMD) and slowing of bone degeneration. Testosterone therapy in older men with low serum testosterone levels also increases lean body mass and decreases fat mass, improving physical performance and strength.
Testosterone replacement therapy (TRT) has relieved symptoms and improved the quality of life for many men. TRT is well tolerated, and long term TRT appears to be a safe and effective means of treating older men with low testosterone levels, provided that laboratory values and clinical response are frequently monitored.
The only absolute contraindication to androgen replacement therapy is the presence of prostate or breast cancer. Guidelines recommend that TRT should not be initiated in older men with PSA serum levels above the normal range. Testosterone should be used with caution in men with severe heart, kidney or liver disease, increased red blood cell counts, and sleep apnea.
Testosterone is well-absorbed from transdermal creams, gels, and lotions. Compounded preparations can be very advantageous because:
* the exact amount of hormone needed by each man can be applied as a single dose
* there is no need to shave the scrotum to apply one or more patches
* there is no skin irritation from patch adhesive.
A healthy lifestyle is associated with higher hormone levels, and higher hormone levels seem to induce a more active, healthier lifestyle. For optimal results, it is vital that hormone replacement therapy be combined with adequate exercise, proper nutrition, and appropriate use of supplements.
Ask our compounding pharmacist for more information about Testosterone Replacement Therapy.
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Vitiligo is a spontaneous irregular depigmentation of skin. Patients with vitiligo have low catalase levels and high levels of hydrogen peroxide in their skin. Patients with vitiligo also have problems maintaining calcium balance in their skin. Pseudocatalase cream is an externally applied UVB-activated product containing calcium chloride, manganese chloride, and sodium bicarbonate, which functions like catalase by removing peroxides from vitiligo affected skin and inhibits the progression of pigment loss in vitiligo. Melanocytes are still present in long-standing (> 25 years) depigmented skin of patients with vitiligo, and these melanocytes can recover their functionality upon the removal of hydrogen peroxide. This approach leads to recovery of the oxidative damage in the epidermis and remarkable repigmentation, which occurs in the majority of cases after 2-4 months. Call our compounding pharmacist for more information on pseudocatalase cream, which is not commercially available.