Hormone Replacement Therapy PDF

3/21/2017
Based on the principle of Anti-Aging Medicine,

HORMONE REPLACEMENT THERAPY aging process is considered as a disease that can
In the concept of Anti-Aging Medicine be prevented, treated, and reversed.
Wimpie Pangkahila Application of Anti-Aging Medicine should be

Post Graduate Program in Anti-Aging Medicine based on the understanding about aging process
Department of Andrology and Sexology and all its causative factors.
Medical Faculty Udayana University
Indonesian Center for Anti-Aging Medicine All changes occur as the causes or the result of
(INCAAM) aging process should be treated and reversed.
However, Causes many basic and clinical

of aging processdata
Change of hormone level occurs in early time of showed that aging process can be delayed,
aging process. Internal
even reversed factors External factors
This is considered as a main cause among several • hormone imbalance • unhealthy diet
causes of aging process. •Since freeaging
radicals and lifestyle
process occurs slowly via 3
glycosylation
•phases • wrong habitsage,
started in young chronological
methylation
•there • environmental
is a chance to get treatment
•Theapoptosis pollution
goal is to delay and reverse aging
immune
•process, system relatedstress
especially
•
to sexual function
• DNA damage • poverty
• genes
Wimpie Pangkahila - Center for Study of Anti-Aging Medicine, Department of Andrology and Sexology
Medical Faculty Udayana University - Indonesian Center for Anti-Aging Medicine
1
3/21/2017
There is a good news 3 phases of aging process
Aging process does not occur abruptly at the time Subclinical phase
when people reach old age. (ages 25-35)
Aging process occurs via 3 phases started in
chronological young age Transition phase
(age 35-45)
It means there is a chance to give intervention and
treatment
Clinical phase
(age 45 and above)
Wimpie Pangkahila - Center for Study of Anti-Aging Medicine, Department of Andrology and Sexology Wimpie Pangkahila - Center for Study of Anti-Aging Medicine, Department of Andrology and Sexology
Medical Faculty Udayana University - Indonesian Center for Anti-Aging Medicine Medical Faculty Udayana University - Indonesian Center for Anti-Aging Medicine
3 phases of aging process

Change of hormones level by aging process
Subclinical phase (ages 25-35)
• Hormones begin to decline: T, GH, E • T
• Free radical formation → damage cells • GH, IGF-1
and DNA, begins to affect the body • Renin, aldosterone • FSH, LH
• Triiodothyronine (T3) • Vasopressin
• Not outwardly detectable
• DHEA, DHEAS • Insulin
• Look and feel “normal” • PTH (para
• No signs or symptoms of aging thyroid hormone)
• But many women using hormone • ATH (atrial natriuretic
contraceptive agents have sexual desire hormone)
• Leptin
disorder
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Females tend to expose to hormone imbalance 3 phases of aging process

more than males through
Transition phase (age 35-45)
1. Hormonal contraceptive agent
• Hormone levels decrease 25%
2. Pregnancy and delivery process • Muscle mass is lost (1 kg / couple of
years) →
• loss of strength and energy,
increased body fat →
• insulin resistance
• increased risk of heart disease
• obesity
Central effects of neurotransmitters and hormones on sexual function

Transition phase (age 35-45) Testosterone
Clinical symptoms begin: Melanocortins +
+
• loss of elasticity and skin pigmentation, + 5 HT
Dopamine Estrogen
wrinkle Desire -
+
Progesterone
(female)
• decreased sexual desire and arousal - +
• start to feel and look older +
• free radical damage begins to affect Prolactin
-
Arousal
gene expression → many diseases of - Peripheral effect -
+
aging (cancer, arthritis, memory loss, +
Norepinephrine
CAD, diabetes) Oxytocin Orgasm

+
+
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Decrease of Total Testosterone with Age

In Normal Women Clinical phase (age 45 and above)
• Decline of hormones continues
• Loss of the ability to fully absorb
nutrients, vitamins and minerals
• Decrease in bone density--osteoporosis
• Accelerated muscle loss (1 kg/ 3 years)
→ the inability to burn calories and
increased body fat and weight
Zurnoff B et al. J Clin Endocrinol Metab 1995:80;142930
Clinical phase (age 45 and above) Decreased or deficient hormone level results in
specific signs, symptoms, and complaints.
• Chronic disease becomes apparent
There are also changes in physical appearance
• Organ systems begin to fail due to hormone problems.
• Inability to perform daily activities
• Sexual dysfunctions: prominent
complaints, disturb many couples
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Somatotropic-gonadotropic-gonadal axis
ED prevalence by decade of age Hypothalamus
GH
GnRH GHRH
Gonadotroph Hypophyse Somatotroph

Somatotroph
LH
FSH LIVER GH
IGF1
IGFBPs
Gonad
Wimpie Pangkahila - Center for Study

Medical Faculty Udayana
of Anti-Aging
1 Saigal CS. Arch Medicine,
UniversityHA,
2 Feldman
Intern Med
- Indonesian
Department
Center
et al. J Urol
of Andrology
2006;166:207-212
1994;151:54-61
and Sexology
(Based
Medicine
on U.S. NHANES 2002 data)
for Anti-Aging(Massachusetts Male Aging Study)
Steroid
Correlation between intra-abdominal fat mass and

24 hour GH secretion
All changes caused by hormone imbalance
result in disorders and dysfunctions
many signs, symptoms, complaints
decreased quality of life (QoL)
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Menopause complaints
1. Physical general symptoms: Similar to males, in females decreased or
Hot flash, night sweats, sleep disorder, fatigue, deficient level of testosterone causes:
itchy, bone pain due to osteoporosis,
headache, tachycardy, incontinence, visceral 1.Reduced sexual motivation, sexual fantasizing
obesity, hair loss, wrinkle46 2.Reduced sexual arousal and enjoyment
2. Psychological symptoms: 3.Reduced vaginal congestion
Anxiety, mood swing, irritability, decreased 4.Reduced bone and muscle mass
concentration, decreased memory 5.Reduced quality of life (mood, affect, energy)
3. Sexual problems: 6.Increased vasomotor instability (hot flashes)
Decreased sexual desire, thinning vaginal 7.More frequent insomnia
epithel,decreased vaginal lubrication. This 8.More frequent depression
causes dyspareunia during sexual intercourse. 9.More frequent headache.
Decreased testosterone level results in In the other side, there are increases in:
decreases of the following aspects:
1.Fat mass which change the body
1.General well-being composition, especially visceral obesity
2.Sexual function and spermatogensis 46
2.Cardiovascular accidents
3.Cognitive function 3.Mood and sleep disorder
4.Red blood cell volume
5.Muscle strength
6.Bone mass with an increased fracture risk
7.Immune competence
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Sexual dysfunction is an indicator of Endothelial dysfunction:

aging process Final common pathway to some diseases
Hypertension DM Dyslipidemia Cigarette

Why?
Sexual dysfunction 46
may be caused by
factors: Oxidative Stress
1. Hormones and neurotransmitters
2. Blood vessel
3. Nerves Endothelial Injury Erectile
Myocardial Dysfunction/
4. Life style Female Sexual
Infarction
arousal disorder
Stroke
Renal disease
Symptoms and signs of the AGHD syndrome Symptoms and signs of the AGHD Syndrome
• Depressed mood • Increased LDL cholesterol and Apo B.

• Increased anxiety • Decreased HDL cholesterol
• Lack of energy levels • Accelerated atherogenesis
• Social isolation •A variable decrease in cardiac muscle mass--
• Lack of positive well being impaired cardiac function
• Increased body fat (central adiposity) •Decreased total and extracellular fluid volume
• Decreased muscle mass •Increased concentration of plasma fibrinogen
• Decreased insulin sensitivity and increased and plasminogen activator inhibitor type I
prevalence of impaired glucose tolerance •Decreased bone density, associated with an
• Decreased sexual drive increased risk of fracture
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3/21/2017
Michelangelo's David
Therefore hormone replacement therapy should
be the “drug of choice” to reverse the total
health condition as in the optimum state.
46
HRT should be based on:

The indication of HRT is based on:
1). Indication
2). Contraindication 1). the signs, symptoms, and complaints
3). Dosage 2). physical examination
46 3). supported by laboratory tests
4). Formulation of hormone
5). Evaluation and monitoring
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O, 24 years old man

Surabaya
A man, 58 years old His complaints:
Jakarta small penis, obesity
T 158 Obese, gynaecomastia,

Patient of Dr Pangkahila visceral adiposity,
IGF1 136 micro penis: p 2cm,θ -, Patient of Dr Pangkahila
Grasia Clinic testis 12/12 Grasia Clinic
Erectile dysfunction
LH 6.06 (1.5-9.3)
FSH 6.79 (1.4-18.1)
T 266.40 (249-836)
How old are these men?

Chronological age Chronological age
65 years old 32 years old 65 years old 32 years old

Patient of Dr Pangkahila
Patient 46
of Dr Pangkahila 46 Clinic
Grasia
Grasia Clinic
Physiological age
Physiological age
32 years old 65 years old 32 years old 65 years old
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3/21/2017
Misuses
HRT should not be applied in the following
condition: No indication
No physical examination
1). There is no indication No laboratory tests
46
2). There is contraindication No monitoring
3). Without laboratory test Only for money
4). Without evaluation and monitoring Never consider patient’s risk and consequences
Professional doctors will not misuse hormone

treatment
Many data show the benefit of HRT in

the condition of decreased or deficient level
10

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3/21/2017

Based on the principle of Anti-Aging Medicine,

Wimpie Pangkahila Application of Anti-Aging Medicine should be

However, Causes many basic and clinical

There is a good news 3 phases of aging process

3 phases of aging process

Females tend to expose to hormone imbalance 3 phases of aging process

Central effects of neurotransmitters and hormones on sexual function

CAD, diabetes) Oxytocin Orgasm

Decrease of Total Testosterone with Age

Gonadotroph Hypophyse Somatotroph

Wimpie Pangkahila - Center for Study

Correlation between intra-abdominal fat mass and

many signs, symptoms, complaints

decreased quality of life (QoL)

Sexual dysfunction is an indicator of Endothelial dysfunction:

Hypertension DM Dyslipidemia Cigarette

• Depressed mood • Increased LDL cholesterol and Apo B.

HRT should be based on:

O, 24 years old man

T 158 Obese, gynaecomastia,

How old are these men?

65 years old 32 years old 65 years old 32 years old

Professional doctors will not misuse hormone

Many data show the benefit of HRT in

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