restandol/andriol for hrt....

[marcus300]

Historical Factors

One hundred and fifty years ago, a German Professor called Berthold showed that transplant of a cockerel's testis prevented atrophy of the comb after castration. This first clearly documented case of successful hormone replacement therapy inaugurated a century of attempts to use testicular transplants and extracts to rejuvenate the male, which has resulted in the dubious "monkey-gland" image of testosterone treatment which persists to this day.

It was only with the isolation and synthesis of testosterone 60 years ago that effective replacement therapy with this hormone became possible. Testosterone was immediately introduced into clinical medicine either as pellets of the crystals, which is still the most effective and convenient form of treatment available so far, or as the oral form methyl testosterone, which unfortunately is toxic to the liver and heart, and has adversely coloured the thinking of the two intervening generations of physicians. It has only been recently that tests have been made available to measure levels of testosterone in samples of blood. Prior to this, there was no way of diagnosing by analysis whether a man was suffering from the Andropause . Such analytical methods now make dignosing the Andropause a simple matter.

Within the English speaking world there is not the eqyivalent of a gynaecologist for mens' health issues. There are a number of "Andrologists" who specifically deal in mens' health on the Continent of Europe, where the diagnosis and management of the Andropause is taken more seriously.

Furthermore, unlike the situation for womens health, there has been a chronic lack of interest and very little funding for mens' health. The disparity remains as great as ever, even now.

Medical Factors

In 1944 what is now described as the male menopause, or andropause, was reported in a key article in The Journal of the American Medical Association by two American doctors, Carl Heller and Gordon Myers. They compared the symptoms with those of the female menopause, and undertook a blind controlled trial showing the effectiveness of testosterone treatment. Even after this excellent article, the condition and treatment with testosterone in general, other than in obvious cases of testicular insufficiency, failed to achieve general acceptance.

400 men attending a private clinic in London complaining of symptoms which they or their GPs attributed to the male menopause, were studied. The nature of the complaints and their frequency were remarkably similar to those reported in the Heller and Myers study.

These included fatigue 82%, depression 70%, irritability 61%, reduced libido 79%, awareness of premature ageing 43%, aching and stiff joints in the hands and feet 63%, increased sweating especially at night 53%, and classic hot flushes 22%. Last but not least, 80% suffered erectile dysfunction, reduced early morning erections often being an early warning sign.

The age range of 31-80 (mean 54) was wider than that of the menopause in women (45-55) reflecting the importance of the wide range of factors influencing its onset. The overlapping associated factors appeared to be psychosocial stress (59%), alcohol (35%), injuries or operations, particularly vasectomy, (32%), medication (31%), smoking (26%), obesity (22%), infections (such as the orchitis caused by mumps and glandular fever, and prostatitis) (11%) and impaired descent of the testes (5%).

The hormonal picture clearly demonstrated the reasons why this condition remains undiagnosed. Total testosterone, which is all that is usually measured in men complaining of these symptoms, was only low in 13% of cases. However, more detailed blood analyses showed that the Free Androgen Index (FAI) obtained by dividing total plasma testosterone level by that of the important carrier protein, Sex Hormone Binding Globulin (SHBG), was decreased in 74%, mainly because of high levels of the latter.

One obvious difference between the female menopause and the andropause is the contrast between the abrupt fall in oestrogen levels in women, compared to the slow decline of total plasma testosterone levels with age in healthy men. However, there is a range of factors which can cause a relative rather than absolute deficiency of testosterone in men from mid-life onwards. Free, biologically active, testosterone in the blood and tissues decreases markedly with age, mainly because of the rising levels of the binding protein SHBG in the blood, which stops the testosterone getting into the cells to exert its many important functions. There is also decreased production of testosterone by the testes, because of stress, illness, low fat diets, and altered hormonal balance in the body due to ageing and other life events.

The findings in a cross-sectional survey of 1,000 men in London, indicated that impairment of the many actions of testosterone crucial to both vitality and virility causes symptoms of the Andropause to emerge when the FAI falls to a critical level of around 50%, or the total testosterone level is subnormal.

There was a significant dose related relief of the andropausal symptoms with two oral forms of treatment (Restandol [Organon], Pro-Viron [Schering]), and especially with testosterone implants. The safety of the forms of testosterone treatment used in this carefully monitored group of men, particularly in relation to the heart, liver and prostate gland was confirmed by detailed serial tests at periods of three to six months for up to five years.

Image Factors

There are a variety of what can best be described as image problems connected with the male menopause and the use of testosterone to treat it. Firstly the name of the condition, even if dignified with the medical title of Andropause, appears an unacceptable threat to masculinity, the "macho" self-image. It is seen as their end of life as potent males, as leaders and as lovers. While women are willing to discuss with each other, and with their medical advisers, their menopausal symptoms and HRT to mitigate them, men are remarkably reluctant to turn to either unless desperate.

Secondly, the condition is often incorrectly confused with the psychological traumas of the "Male Mid-life Crisis". Thirdly, because of reports of the abuse of anabolic steroids by athletes, testosterone has suffered a very bad press. Together with deliberately exaggerated horror stories of their physical and psychological dangers, which have filled the newspapers at increasingly frequent intervals over the last twenty years, this "pharmacological arms race" has damaged testosterone's image.

Fourthly, there is the public perception of testosterone as the hormone responsible for undesirable male traits such as aggression and hypersexuality. The unfounded fear that such treatment will "bring out the beast in men", and turn them into rapacious monsters as portrayed by Jack Nicholson in the recent film "Wolf", holds many andropausal men, who unlike him cannot claim to have "retained my testosterone longer than most males", back from treatment.

Lastly, there is the same argument that women had to overcome in relation to HRT, that it was flying in the face of nature and they should learn to grow old gracefully. Given the wide range of benefits to psyche, soma and sexuality that oestrogens are being shown to offer postmenopausal women in adding life to years as well as years to life, increasing numbers see it more as modern science giving nature a helping hand. It seems likely that men will come to the same view of living their lives like alk****e batteries, going full charge to the end.



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Key Points on TRT in the treatment of the Andropause
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Reduced Testosterone activity is common in men from the age of 40 onwards.
This causes the loss of energy, libido and potency which make up the "Male Menopause" or "Andropause".
The Condition can usually be helped by carefully monitored Testosterone Replacement Therapy (TRT).
TRT is as safe and effective as Hormone Replacement Therapy (HRT) for women.
In addition to TRT, a wide range of other treatments to restore potency are available, especially Viagra.
TRT is an important form of preventive medicine, probably slowing the ageing process in men.

Testosterone Replacement Therapy for Men (TRT)

TRT - HRT for men using Testosterone, has been shown to be dramatically effective in relieving symptoms and restoring drive, health, potency, and a sense of renewed vitality and virility when the right preparations are given to the right patients in the right doses at the right time.

To ensure its safety and effectiveness however it is essential that a full assessment or "work-up" of each patient is carried out before hormone replacement is started, and that the results of treatment are carefully monitored. For this purpose careful history-taking and examination and blood tests need to be carried out.

Both to establish the diagnosis and to monitor the treatment properly, laboratory measurements of the sex hormones and the complex range of factors regulating their action, together with tests of blood fat, liver, kidney, and prostate function and haematology profile, all need to be checked before treatment and at each follow-up assessment.

TRT is usually given in tablet or capsule form for the first three to six months. It can then be continued if necessary by mouth, transdermally, by injection, or by implantation of pellets of fused testosterone crystals into the buttock, under a local anaesthetic, at six monthly intervals.

Availability of Testosterone Preparations

In many parts of the world, the two main safe oral preparations, Testosterone Undecanoate (Andriol or Restandol made by Organon) and Mesterelone (Pro-Viron made by Scherring) are available, as well as Testosterone Pellet Implants, also made by Organon. Transdermal Testosterone in the form of body or scrotal patches or creams is also available in most countries. In the USA, Testosterone is mainly available either by patches, or injectable forms such as Testosterone Enanthate , though it is hoped that Andriol may soon also be available there.

Availability of treatment


The availability of testosterone treatment is rapidly increasing world-wide, as more doctors become convinced of the benefits and safety of TRT for men. One of the aims of the Andropause Society is to accelerate this process by making doctors more aware of the problems associated with the Male Menopause, or andropause, and informing them of the latest research in its favour and providing training for them via the Web using the latest video conferencing technology.

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Potency Problems Page
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This is the commonest presenting problem in male sexual dysfunction clinics and peaks at the time when the andropause appears, that is the mid-forties onwards. It is a major health problem which is seldom adequately investigated or treated.

The Mechanics of Erection

Man's ability to have an erection, which has been worshipped from the earliest of times, is actually a recurring miracle of hydraulic engineering. It is brought about by a complex series of chemical changes and nerve reflexes, which work together to increase the amount of blood flowing into the penis and temporarily decrease the amount going out. Two elongated blood sacks, the corpora cavernosa, become engorged and create the erection. This event, which is achieved with effortless and sometimes embarrassing ease in the teens and twenties, usually becomes a more difficult feat in the thirties and forties, can be variable in the fifties and sixties, and is often a disappointingly brief and infrequent wonder in the seventies and beyond, especially in the 'hormonally challenged' andropausal male.

Testosterone and Erectile Function

Though it is difficult to say precisely what part testosterone plays in helping to produce erections, it certainly both primes the penis and triggers the chain of events which bring an erection about. It is surprising, but gratifying, how often when adequate testosterone therapy is given, all the symptoms of the andropause disappear within a few weeks or months, including erectile difficulties, particularly when other factors contributing to its onset or continuation are dealt with.

A statistically highly significant improvement in erectile function occurred in over 70 per cent of 1000 cases treated with a variety of different forms of testosterone. This was particularly marked with the more powerful oral preparation, Restandol (Andriol), which sometimes needed to be given in high but safe doses, and with the testosterone pellet implants.

Though this use of testosterone to help erection problems is controversial and not acknowledged by some authorities, which say it only increases frustration without giving back the means to perform, this is certainly not the experience in this large group of patients. The efficiency of testosterone in restoring potency is a common experience with doctors prepared to give it an adequate trial.

It was even recognised over 50 years ago in the article on the 'male climacteric' by Drs Heller and Myers in an article on"The Male Climacteric" in JAMA in 1944. They found that erectile function returned in nearly all of their testosterone deficient patients when they gave the hormone and went away again when they stopped.

Even though it is more difficult to restore function than desire, unless the source of the problems is obviously psychological or mechanical, it seems logical to investigate the testosterone balance of the patient, and restore it to normal as the first stage of treatment. Even if erections are not greatly improved by this alone, libido and confidence usually are. The most commonly used methods such as penile injections of prostaglandins, as in Caverject, then seem to work much better. Recent experience at in London has shown this to be particularly true when Viagra and Testosterone are combined to cure over 98% of impotence problems.

[IBdmfkr]

BUMP, very informative post.