Professional Documents
Culture Documents
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3/21/2017
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
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3/21/2017
+
• 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
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3/21/2017
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
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
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
4
3/21/2017
Somatotropic-gonadotropic-gonadal axis
ED prevalence by decade of age Hypothalamus
GH
GnRH GHRH
LH
FSH LIVER GH
IGF1
IGFBPs
Gonad
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
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3/21/2017
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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3/21/2017
Symptoms and signs of the AGHD syndrome Symptoms and signs of the AGHD Syndrome
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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.
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3/21/2017
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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
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