Monitoring Hormone Therapy Mark Newman, M.S. President of Precision Analytical Inc.
|
|
- Winfred Shaw
- 5 years ago
- Views:
Transcription
1 Mr Mark Newman
2 Monitoring Hormone Therapy Mark Newman, M.S. President of Precision Analytical Inc. 2
3 Avoiding Pitfalls in (B)HRT Monitoring and Picking the Right Lab Test Objectives: Outline how expected lab results change for different routes of administration of exogenous hormones Review data to assist is avoiding common HRT lab test combinations that can be clinically misleading Discuss case studies with serum, urine and saliva results 3
4 TESTING No Supplementation With Hormone Replacement Therapy MATRIX Sex Hormones Adrenal Oral Pg Oral (other) Sublingual Vaginal Pellet/Inj. Cream (skin) Gel (skin) B D F B D C B D B Serum Saliva 24 Hour Urine +Well accepted and reliable methods No metabolites No diurnal free cortisol Inaccurate# and too Fast* +Works for DHEA, estrogens No metabolites Too Fast* (back to baseline in <3hrs) Rise and fall is unpredictable, so timing is difficult +Well accepted and reliable methods No metabolites Values underrepresent some tissue levels Increases are more significant than with creams C B F B F D B D D + Good for tracking levels thru cycle Difficult analysis No metabolites +Diurnal free cortisol No metabolites Inaccurate# and too Fast* Difficult analysis No metabolites Contamination lasts longer than blood levels are elevated Rise and fall is unpredictable, so timing is difficult Difficult analysis No metabolites A C C B C D A D B +Mass spectrometry (accurate) Includes metabolites Difficult collection +Metabolites No diurnal cortisol Often "total" not "free" Metabolites of marginal value Difficult to avoid 1st pass metabolism (skip dose day of test) Difficult to avoid 1st pass metabolism from oral intake +Works for Pg Estrogen/Test contamination Hormones and metabolites % Values are too variable, change dramatically with different application sites, and do not represent systemic exposure Values underrepresent some tissue levels Increases are more significant than with creams New Precision Analytical Option A A+ C B C B+ A D B Mass spectrometry (accurate) Includes metabolites Easy collection IDEAL OPTION Diurnal Cortisol AND Metabolites! Metabolites of marginal value Difficult to avoid 1st pass metabolism (skip dose day of test) Difficult to avoid 1st pass metabolism from oral intake IDEAL OPTION free hormone contamination is removed Hormones and metabolites Values underrepresent some tissue levels Increases are more significant than with creams OBJECTIVE Discuss best options for monitoring different types of HRT therapy 4
5 TESTING No Supplementation MATRIX Sex Hormones Adrenal B D Serum Saliva 24 Hour Urine +Well accepted and reliable methods No metabolites C + Good for tracking levels thru cycle Difficult analysis No metabolites A +Mass spectrometry (accurate) Includes metabolites Difficult collection No diurnal free cortisol B +Diurnal free cortisol No metabolites C +Metabolites No diurnal cortisol Often "total" not "free" 5 New Precision Analytical Option A A+ Mass spectrometry (accurate) Includes metabolites Easy collection IDEAL OPTION Diurnal Cortisol AND Metabolites!
6 6
7 TESTING No Supplementation MATRIX Sex Hormones Adrenal B D Serum Saliva 24 Hour Urine +Well accepted and reliable methods No metabolites C + Good for tracking levels thru cycle Difficult analysis No metabolites A +Mass spectrometry (accurate) Includes metabolites Difficult collection No diurnal free cortisol B +Diurnal free cortisol No metabolites C +Metabolites No diurnal cortisol Often "total" not "free" 7 New Precision Analytical Option A A+ Mass spectrometry (accurate) Includes metabolites Easy collection IDEAL OPTION Diurnal Cortisol AND Metabolites!
8 TESTING No Supplementation MATRIX Sex Hormones Adrenal B D Serum Saliva 24 Hour Urine +Well accepted and reliable methods No metabolites C + Good for tracking levels thru cycle Difficult analysis No metabolites A +Mass spectrometry (accurate) Includes metabolites Difficult collection No diurnal free cortisol B +Diurnal free cortisol No metabolites C +Metabolites No diurnal cortisol Often "total" not "free" 8 New Precision Analytical Option A A+ Mass spectrometry (accurate) Includes metabolites Easy collection IDEAL OPTION Diurnal Cortisol AND Metabolites!
9 There is not a simple equivalency between these with lab results Young Healthy HRT Puberty Menopause HRT 9
10 Which Route of Administration Oral Sublingual Vaginal and transmucosal Injections and pellets Transdermal EACH ONE IS UNIQUE! 10
11 TESTING MATRIX Serum Oral Pg F Inaccurate# and too Fast* THERAPY Oral (other) B +Works for DHEA, estrogens No metabolites F B ORAL HORMONES Saliva Inaccurate# and too Fast* Difficult analysis No metabolites Hour Urine Precision New Analytical Option C B Metabolites of marginal value Difficult to avoid 1st pass metabolism (skip dose day of test) C B Metabolites of marginal value Difficult to avoid 1st pass metabolism (skip dose day of test)
12 TESTING MATRIX Serum Oral Pg F Inaccurate# and too Fast* THERAPY Oral (other) B +Works for DHEA, estrogens No metabolites ORAL PROGESTERONE F B Saliva Inaccurate# and too Fast* Difficult analysis No metabolites Hour Urine Precision New Analytical Option C B Metabolites of marginal value Difficult to avoid 1st pass metabolism (skip dose day of test) C B Metabolites of marginal value Difficult to avoid 1st pass metabolism (skip dose day of test)
13 Oral Pg doesn t increase Pg levels >6ng/mL is considered consistent with ovulation 13
14 14 VAGINAL vs Oral Progesterone
15 ORAL PROGESTERONE Serum/Saliva Return to baseline is too fast (2 hours) Most tests are inaccurately high 15
16 EIA = False Positive LC MS MS = true value 16
17 ORAL PROGESTERONE Urine Small doses don t raise serum levels, but lead to very high urine metabolites (1 st pass) Marginally valuable information can be taken from specific metabolism patterns 17
18 ORAL PROGESTERONE Testing is of limited value 18
19 TESTING MATRIX Serum Oral Pg F Inaccurate# and too Fast* THERAPY Oral (other) B +Works for DHEA, estrogens No metabolites F B ORAL HORMONES Saliva Inaccurate# and too Fast* Difficult analysis No metabolites Hour Urine New Precision Analytical Option C B Metabolites of marginal value Difficult to avoid 1st pass metabolism (skip dose day of test) C B Metabolites of marginal value Difficult to avoid 1st pass metabolism (skip dose day of test)
20 TESTING MATRIX Serum Oral Pg F Inaccurate# and too Fast* THERAPY Oral (other) B +Works for DHEA, estrogens No metabolites F B ORAL HORMONES Saliva Inaccurate# and too Fast* Difficult analysis No metabolites Hour Urine Precision New Analytical Option C B Metabolites of marginal value Difficult to avoid 1st pass metabolism (skip dose day of test) C B Metabolites of marginal value Difficult to avoid 1st pass metabolism (skip dose day of test)
21 Baseline (healthy) 21 Deficiency (induced) H.R.T.
22 22
23 ORAL ESTROGENS Rise and fall is slow, so serum or saliva testing can be effective 23
24 ORAL ESTROGENS and SERUM Serum E2(nmol) Hours Since Dose 24
25 Oral Estrogen and Urine Testing 25
26 Oral Estrogen and Urine Testing 26 Postmenopausal Range
27 27 Estrogen Metabolites and Cancer
28 Oral Estrogen and Urine Testing 28
29 Oral Estrogen and Urine Testing 29
30 Oral Estrogen and Urine Testing 30
31 TESTING MATRIX Serum Saliva 24 Hour Urine With THERAPY Hormon Sublingual D Too Fast* (back to baseline in <3hrs) F Contamination lasts longer than blood levels are elevated C Difficult to avoid 1st pass metabolism from oral intake SUBLINGUAL HORMONES NO GOOD TEST! 31 Precision New Analytical Option C Difficult to avoid 1st pass metabolism from oral intake
32 Why Not Serum with Sublingual TOO FAST! Gone before you can measure 32
33 33
34 Why Not Saliva with Sublingual Hormones are in mg in supplements Hormones are in pg in saliva There are 1 Billion pg in 1 mg 34
35 Why Not Saliva with Sublingual Contamination of the mouth lasts longer than increased blood levels Personal levels T<100 (unfortunately) at baseline Personal levels peaked at >100,000,000 with troche Results are of no value Waiting 30 hours is not an option 35
36 Urine with Sublingual Hormones Hormones get into circulation and urine gets its fair share 36
37 Urine with Sublingual Hormones Hormones get into circulation and urine gets its fair share This should work But it Doesn t...if you swallow it! 37
38 Monitoring Sublingual HRT No solution can help with dosing Urine testing adds value (metabolites help in estrogen, progesterone evaluation) and can work if not swallowed 38
39 TESTING MATRIX Serum Saliva 24 Hour Urine ne THERAPY Replaceme Vaginal C Rise and fall is unpredictable, so timing is difficult D Rise and fall is unpredictable, so timing is difficult D +Works for Pg Estrogen/Test contamination VAGINAL HORMONES 39 New Precision Analytical Option B+ IDEAL OPTION free hormone contamination is removed
40 VAGINAL HORMONES What happens 40
41 VAGINAL TESTOSTERONE & Serum 41
42 VAGINAL TESTOSTERONE Person #2 Person #1 Placebos 42
43 43 VAGINAL PROGESTERONE
44 Vaginal Hormone variables Hormone (E2, E3, Pg, T) Delivery Size Concentration Base (oil, water) Timing Inter individual variance 44
45 Vaginal Hormones and Urine Reduces the timing problem of blood/saliva BUT Testo/Estrogens contaminate urine THERE IS A SOLUTION! 45
46 Vaginal Hormones and Urine Testosterone (or estrogens) must be conjugated to be excreted in urine Water Soluble Conjugate (Testo + sugar) 46
47 Vaginal Hormones Contaminate Urine 47
48 Vaginal Hormones Contaminate Urine 48
49 TESTING MATRIX Serum Saliva 24 Hour Urine ne THERAPY Replaceme Vaginal C Rise and fall is unpredictable, so timing is difficult D Rise and fall is unpredictable, so timing is difficult D +Works for Pg Estrogen/Test contamination VAGINAL HORMONES 49 Precision New Analytical Option B+ IDEAL OPTION free hormone contamination is removed
50 50 TESTING MATRIX Serum Saliva 24 Hour Urine Precision New Analytical Option ent Therapy Pellet/Inj. Cream (skin) Gel (skin) B D B +Well accepted and reliable methods No metabolites Values underrepresent some tissue levels Increases are more significant than with creams B D D Difficult analysis No metabolites A D B Hormones and metabolites Values underrepresent some tissue levels Increases are more significant than with creams A D B Hormones and metabolites THERAPY PELLETS / INJECTIONS % Values are too variable, change dramatically USE YOUR with different application sites, and do not represent systemic exposure FAVORITE TEST Values underrepresent some tissue levels Increases are more significant than with creams
51 51 TESTING MATRIX Serum Saliva 24 Hour Urine Precision New Analytical Option ent Therapy Pellet/Inj. Cream (skin) Gel (skin) B D B +Well accepted and reliable methods No metabolites Values underrepresent some tissue levels Increases are more significant than with creams B D D Difficult analysis No metabolites A D B Hormones and metabolites Values underrepresent some tissue levels Increases are more significant than with creams A D B Hormones and metabolites THERAPY % Values are too variable, change dramatically with different application sites, and do not represent systemic exposure Values underrepresent some tissue levels Increases are more significant than with creams
52 Salivary Testing with Topical Hormones 52 Saliva testing teaches us that some tissue get more hormone than is reflected in urine or serum testing when topical hormones are used. Salivary levels (with topical hormones) are too variable Levels change dramatically with: Different application sites Different base Levels do NOT reflect systemic exposure
53 Monitoring Transdermal Hormones 53
54 Monitoring Transdermal Hormones 54
55 Monitoring Transdermal Hormones 55
56 Let s Get Clinical!...with Transdermal Testosterone Too much T results in negative feedback and LH goes down (that s why testicles shrink) 100mg weekly injections suppress LH entirely 56
57 Let s Get Clinical!...with Transdermal Testosterone 50mg Transdermal Gel Saliva goes up >15 fold Serum/Urine go up modestly What happens to LH? 57
58 50mg partially suppresses LH 58 Swerdloff R S et al. JCEM 2000;85:
59 Let s Get Clinical!...with Transdermal Testosterone LH suppression implies a modest dose, agreeing more with serum/urine testing Muscle increase only seen if serum goes up 59
60 60 TESTING MATRIX Serum Saliva 24 Hour Urine Precision New Analytical Option ent Therapy Pellet/Inj. Cream (skin) Gel (skin) B D B +Well accepted and reliable methods No metabolites Values underrepresent some tissue levels Increases are more significant than with creams B D D Difficult analysis No metabolites A D B Hormones and metabolites Values underrepresent some tissue levels Increases are more significant than with creams A D B Hormones and metabolites THERAPY % Values are too variable, change dramatically with different application sites, and do not represent systemic exposure Values underrepresent some tissue levels Increases are more significant than with creams
61 TESTING Best Way to Test? No Supplementation With Hormone Replacement Therapy MATRIX Sex Hormones Adrenal Oral Pg Oral (other) Vaginal Pellet/Inj. B D F B C B Serum Saliva 24 Hour Urine Precision New Analytical Option 61 +Well accepted and reliable methods No metabolites No diurnal free cortisol Inaccurate# and too Fast* +Works for DHEA, estrogens No metabolites Rise and fall is unpredictable, so timing is difficult +Well accepted and reliable methods No metabolites C B F B D B + Good for tracking levels thru cycle Difficult analysis No metabolites +Diurnal free cortisol No metabolites Inaccurate# and too Fast* Difficult analysis No metabolites Rise and fall is unpredictable, so timing is difficult Difficult analysis No metabolites A C C B D A +Mass spectrometry (accurate) Includes metabolites Difficult collection +Metabolites No diurnal cortisol Often "total" not "free" Metabolites of marginal value Difficult to avoid 1st pass metabolism (skip dose day of test) +Works for Pg Estrogen/Test contamination Hormones and metabolites A A+ C B B+ A Mass spectrometry (accurate) Includes metaoblites Easy collection IDEAL OPTION Diurnal Cortisol AND Metabolites! Metabolites of marginal value Difficult to avoid 1st pass metabolism (skip dose day of test) IDEAL OPTION free hormone contamination is removed Hormones and metabolites
62 Best Way to Test? Multiple Spot Urine Samples (with improved methods) 62
63 4 Spot Sample Value (ng/mg cr.) Hour Value
64 Best Way to Test? Multiple Spot Urine Samples Easiest Collection (with improved methods) 64
65 65
66 66 Dried Collections are Easier
67 Best Way to Test? Multiple Spot Urine Samples Easiest Collection (with improved methods) Represents more than ½of the day More clinical information (metabolites) Improved adrenal profile Diurnal free cortisol plus metabolism picture 67
68 Urinary Free Cortisol Salivary Free Cortisol Jerjes, (2005, 2006) 68
69 Problems with Cortisol Testing High Free Cortisol Low Free Cortisol Stage 1 Adrenal Fatigue Stage 3 Adrenal Fatigue 69 Overactive HPA Axis Underactive HPA Axis
70 A Tale of 2 Low Cortisols Free Cortisol Pattern Free Cortisol Pattern 70
71 A Tale of 2 Low Cortisols Cortisol Metabolites Free Cortisol Pattern Cortisol Metabolites Free Cortisol Pattern 71
72 A Tale of 2 Low Cortisols Cortisol Metabolites Free Cortisol Pattern Cortisol Metabolites Free Cortisol Pattern 72
73 73
74 TESTING Best Way to Test? No Supplementation With Hormone Replacement Therapy MATRIX Sex Hormones Adrenal Oral Pg Oral (other) Vaginal Pellet/Inj. B D F B C B Serum Saliva 24 Hour Urine Precision New Analytical Option 74 +Well accepted and reliable methods No metabolites No diurnal free cortisol Inaccurate# and too Fast* +Works for DHEA, estrogens No metabolites Rise and fall is unpredictable, so timing is difficult +Well accepted and reliable methods No metabolites C B F B D B + Good for tracking levels thru cycle Difficult analysis No metabolites +Diurnal free cortisol No metabolites Inaccurate# and too Fast* Difficult analysis No metabolites Rise and fall is unpredictable, so timing is difficult Difficult analysis No metabolites A C C B D A +Mass spectrometry (accurate) Includes metabolites Difficult collection +Metabolites No diurnal cortisol Often "total" not "free" cortisol Metabolites of marginal value Difficult to avoid 1st pass metabolism (skip dose day of test) +Works for Pg Estrogen/Test contamination Hormones and metabolites A A+ C B B+ A Mass spectrometry (accurate) Includes metabolites Easy collection IDEAL OPTION Diurnal Cortisol AND Metabolites! Metabolites of marginal value Difficult to avoid 1st pass metabolism (skip dose day of test) IDEAL OPTION free hormone contamination is removed Hormones and metabolites
75 THANK YOU!!! For more information or visit (video library) 75
76
Pros and Cons of Hormone Testing in Different Body Fluids with Different Routes of Hormone Delivery
Pros and Cons of Hormone Testing in Different Body Fluids with Different Routes of Hormone Delivery David T Zava, PhD ZRT laboratory A Guide to Steroid Hormone Testing in Different Body Fluids Following
More informationFemale testosterone level chart
Female testosterone level chart The Borg System is 100 % Female testosterone level chart Mar 23, 2015. Male, Female. Age: T Level (ng/dl):, Age: T Level (ng/dl):. 0-5 mo. 75-400, 0-5 mo. 20-80. 6 mos.-9
More informationAccession # Erin Ferguson 2377 Stone Glen Cres Oakville, ON L6M 0C7. DOB: Gender: Female
Provider: Jane Smith ND Oreringp 444 Natural hysician: Way Vancouver, ahmich onbc V0V 0V0 Accession # 00219191 Erin Ferguson 2377 Stone Glen Cres Oakville, ON L6M 0C7 Accession # 500000 DOB:1962-11-27
More informationSex Hormones and Metabolites
Accession # 00268796 Male Sample Report 123 A Street Sometown, CA 90266 Sex Hormones and Metabolites Ordering Physician: Precision Analytical DOB: 1967-08-09 Age: 50 Gender: Male Last Menstrual Period:
More informationHormone Metabolite Assessment
Accession # 00206213 Anna Salanti 7619 SW 26th Ave Portland, OR 97219 Hormone Metabolite Assessment Ordering physician: Joel Grimwood DOB:1952-01-26 Gender: Female Collection Times: 2014-11-19 05:00PM
More informationAccession # Jane Doe 123 4th St. Anytown, FL DOB: Age: 40 Gender: Female
Accession # 00239871 Jane Doe 123 4th St. Anytown, FL 97155 Ordering physician: Precision Analytical DOB: 1976-01-03 Age: 40 Gender: Female Last Menstrual Period: Collection Times: 2016-10-01 06:00AM 2016-10-01
More informationAssociate Professor Geoff Braatvedt
Associate Professor Geoff Braatvedt Endocrinologist Diabetologist and Physician Green Lane and Auckland City Hospitals Auckland 14:00-14:55 WS #145: Approach to Low Testosterone Values 15:05-16:00 WS #157:
More informationNatural Hair Transplant Medical Center, Inc Dove Street, Suite #250, Newport Beach, CA Phone
Natural Hair Transplant Medical Center, Inc. 1000 Dove Street, Suite #250, Newport Beach, CA 92660 Phone-949-622-6969 Finasteride (PROPECIA ) Acknowledgement Finasteride is an oral medication, manufactured
More informationTREATMENT OPTIONS FOR MALE HYPOGONADISM
TREATMENT OPTIONS FOR MALE HYPOGONADISM Bruce Biundo, RPh, FACA PCCA Pharmacy Consulting Department Updated July 2012 Hypogonadism in men is primarily a state involving lower than expected levels of testosterone,
More informationPremarin cream and weight gain
Premarin cream and weight gain Can Premarin cause Weight Gain? Weight Gain is a known side effect of Premarin. Complete analysis from patient reviews and trusted online health resources, including. Many
More informationTestosterone Hormone Replacement Drug Class Prior Authorization Protocol
Testosterone Hormone Replacement Drug Class Prior Authorization Protocol Line of Business: Medicaid P&T Approval Date: February 21, 2018 Effective date: April 1, 2018 This policy has been developed through
More informationIssues. What is a low testosterone? Who needs testosterone therapy? Benefits/adverse effects of testosterone replacement Treatment options
Male Hypogonadism Jauch Symposium Waterloo, IA May 17, 2013 Janet A. Schlechte, M.D. Disclosure of Financial Relationships Janet A. Schlechte, M.D. has no relationships with any proprietary entity producing
More informationDrug Class Monograph
Drug Class Monograph Class: Testosterone Hormone Replacement Drug: Androderm (testosterone transdermal system), Androgel (testosterone topical gel), Axiron (testosterone topical solution), Aveed (testosterone
More informationTestosterone Hormone Replacement Drug Class Prior Authorization Protocol
Line of business: Medi-Cal Effective Date: August 16, 2017 Revision Date: August 16, 2017 Testosterone Hormone Replacement Drug Class Prior Authorization Protocol This policy has been developed through
More informationMALE HORMONE THERAPY OPTIONS
MALE HORMONE THERAPY OPTIONS The following tables have been compiled by Women s International Pharmacy staff pharmacists to represent some of the more frequently prescribed regimens for men. The Women
More informationTransgender 201: Case Discussion Group
Transgender 201: Case Discussion Group Melissa Davis, MD Maria Barnett, DO October 19, 2017 Maria Barnett, DO, Date Welcome! Disclosures Introductions Discussion The total time of this workshop will depend
More informationWADA Technical Document TD2014EAAS. Endogenous Anabolic Androgenic Steroids Measurement and Reporting
Endogenous Anabolic Androgenic Steroids Measurement and Reporting 1.0 Introduction The purpose of this Technical is to harmonize the approaches to the measurement and reporting of endogenous anabolic androgenic
More informationMALE HORMONE THERAPY OPTIONS
MALE HORMONE THERAPY OPTIONS The following tables have been compiled by Women s staff pharmacists to represent some of the more frequently prescribed regimens for men. The Women s logo is placed throughout
More informationAre Steroids Worth the Risk?
Are Steroids Worth the Risk? Dominic has baseball on the brain. Just being good isn't enough he wants to be the best. He dreams of playing in the majors someday, but worries about the intense competition
More informationAll About T Testosterone for FTMs. Presented by John Otto, MLIS
All About T Testosterone for FTMs Presented by John Otto, MLIS Who? Anyone thinking about transitioning Those who have transitioned, but want to know more Empowerment from self-managing transition Allies
More informationUpdates on Anti-doping and TUE Management in Paralympic Sport
International Paralympic Committee Updates on Anti-doping and TUE Management in Paralympic Sport Matthew Fedoruk, Ph.D. March 15, 2018 PyeongChang 2018 IPC Medical / Sports Science Committee Workshops
More informationInsight into male menopause'
Insight into male menopause' Dr Mark Vanderpump MD FRCP Consultant Endocrinologist Clinics: Tuesday PM Mark Vanderpump Consultant Physician and Endocrinologist Introduction Serum total and free testosterone
More informationReproductive DHT Analyte Information
Reproductive DHT Analyte Information - 1 - DHT Introduction Dihydrotestosterone (DHT) together with other important steroid hormones such as testosterone, androstenedione (ASD) and dehydroepiandrosterone
More informationInappropriate Testosterone Billings
Inappropriate Testosterone Billings Carla Patrick-Fagan March 30, 2015 Truven Health Analytics Inc. All Rights Reserved. 1 Agenda Proposed in the 2015 analytic plan Steroid prescriptions Code of Federal
More informationLIFETIME FITNESS HEALTHY NUTRITION. UNIT 2 Lesson 14 FLEXIBILITY LEAN BODY COMPOSITION
LIFETIME FITNESS HEALTHY NUTRITION MUSCULAR STRENGTH AEROBIC ENDURANCE UNIT 2 Lesson 14 FLEXIBILITY LEAN BODY COMPOSITION MUSCULAR ENDURANCE Created by Derek G. Becher B.P.E., B. Ed., AFLCA Resistance
More informationSimultaneous Determination of a Panel of 22 Steroids in Urine and Serum by SPE and LC-MS/MS
Simultaneous Determination of a Panel of 22 Steroids in Urine and Serum by SPE and LC-MS/MS UCT Part Numbers: CUQAX22Z Clean-Up C8+QAX, 2mg/1mL BETA-GLUC- ml Beta-Glucuronidase Enzyme, liquid form SLAQID21-3UM
More informationThe Science of. NUTRICULA Longevity Journal
32 December, 2011 The Science of 33 NUTRICULA Longevity Journal As men age, there is often a decline in libido and sexual function. This decline frequently interferes in intimacy within romantic relationships,
More informationMODULE #8 - Lesson 3
MODULE #8 - Lesson 3 21st Century Man: Testosterone and Andropause Module 8 - Lesson 3 21st Century Man: Testosterone and Andropause Testosterone and andropause are 2 pressing issues for men in the 21st
More informationCONFÉRENCE À SUCCÈS EN SCIENCES DE LA VIE : ENDOCEUTICS
CONFÉRENCE À SUCCÈS EN SCIENCES DE LA VIE : ENDOCEUTICS 13 Septembre 2018 Quebec, Canada 1 ENDOCEUTICS No. 1 Innovative pharmaceutical company in menopausal women s health in the world 2 Facilities Head
More informationAffirming Care of the Transgender Patient
Mountain West AIDS Education and Training Center Affirming Care of the Transgender Patient Jessica Rongitsch, MD, FACP This presentation is intended for educational use only, and does not in any way constitute
More informationMI Androgen Deficiency Hypogonadism
MI Androgen Deficiency Hypogonadism WADA TUE Expert Group John A Lombardo, MD October 2014, Columbus, Ohio USA Hypothalamic-Pituitary-Gonadal Axis / 2 Hypogonadism/Androgen Deficiency Clinical syndrome:
More informationIcd 10 hormone replacement therapy male
Icd 10 hormone replacement therapy male 2018 ICD - 10 code for Hormone replacement therapy is Z79.890. Lookup the complete ICD 10 Code details for Z79.890. The ICD - 10 system requires that. TEENren who
More informationAndrogenes and Antiandrogenes
Androgenes and Antiandrogenes Androgens The androgens are a group of steroids that have anabolic and/or masculinizing effects in both males and females. Testosterone [tess-toss-terone], the most important
More informationChapter 5. General discussion
Chapter 5. General discussion 127 Chapter 5 In 2003, two review papers concluded that endogenous androgens do not show any consistent association with cardiovascular disease (CVD) risk 1,2. Apparently,
More informationHigh speed UHPLC-MS/MS determination of multiple steroids in human serum using the Nexera MX system for multiplex analysis
PO-CON695E High speed UHPLC-MS/MS determination of multiple steroids in human serum using the Nexera MX system for multiplex analysis MSACL 6 EU Neil Loftus, Stephane Moreau, Mikaël Levi 3, Anja Grüning
More informationGynaecomastia. Benign breast conditions information provided by Breast Cancer Care
Gynaecomastia This booklet tells you about gynaecomastia. It explains what gynaecomastia is, what causes it, how it s diagnosed and what will happen if it needs to be treated or followed up. Benign breast
More informationSecrets of Abang Sado : Effects of testosterone therapy. Azraai Nasruddin
+ Secrets of Abang Sado : Effects of testosterone therapy Azraai Nasruddin + Testosterone Testosterone : Steroid hormone - Made primarily by the testicles in males - Small amounts produced by the adrenal
More informationM0BCore Safety Profile. Pharmaceutical form(s)/strength: 5 mg SE/H/PSUR/0002/006 Date of FAR:
M0BCore Safety Profile Active substance: Finasteride Pharmaceutical form(s)/strength: 5 mg P-RMS: SE/H/PSUR/0002/006 Date of FAR: 16.05.2014 4.3 Contraindications Finasteride is not indicated for use in
More informationHGH for Sale Natural Anti-Aging Human Growth Hormone
HGH for Sale Natural Anti-Aging Human Growth Hormone Human growth hormone is one of the hottest supplement trends on the market, and now you can purchase top-quality HGH to be delivered right to your home!
More informationPostmenopausal Hormone Therapy
PL Detail-Document #280506 This PL Detail-Document gives subscribers additional insight related to the Recommendations published in PHARMACIST S LETTER / PRESCRIBER S LETTER May 2012 Postmenopausal Hormone
More informationAndrogens and Anabolic Steroids Prior Authorization with Quantity Limit - Through Preferred Topical Androgen Agent
Androgens and Anabolic Steroids Prior Authorization with Quantity Limit - Through Preferred Topical Androgen Agent Androgens/Anabolic Steroids Prior Authorization with Quantity Limit Through Preferred
More informationHARVARD PILGRIM HEALTH CARE RECOMMENDED MEDICATION REQUEST GUIDELINES
Generic Brand HICL GCN Exception/Other METHYL ANDROID METHITEST METHYL TESTRED 01404 ROUTE MISCELL. CYPIONATE ENANTHATE GUIDELINES FOR USE ANDRODERM ANDROGEL AXIRON FORTESTA NATESTO STRIANT TESTIM VOGELXO
More informationEssential Standards. 8.ATOD.2 Understand the health risks associated with alcohol, tobacco, and other drug use.
Essential Standards 8.ATOD.2 Understand the health risks associated with alcohol, tobacco, and other drug use. Clarifying Objective 8.ATOD.2.2 Evaluate the magnitude and likelihood of the risks associated
More informationPhysician Copy. Patient: SAMPLE PATIENT DOB: Sex: MRN: ACH24.1
Physician Copy Patient: SAMPLE PATIENT DOB: Sex: MRN: ACH24.1 ID: Steroidogenic Pathway At-A-Glance 0.60 1 0.10 RR : 0-0.90 RR : 0.30-4.20 RR : 0.60-2.50 0.10 RR : 0.16-0.65 1.48 RR : 1.20-6.10 2.47 RR
More informationExtend the time window for the detection of low level anabolic androgenic steroids and their metabolites
Application Note Doping Control Extend the time window for the detection of low level anabolic androgenic steroids and their metabolites Steroid profiling, screening, and confirmatory analysis using the
More informationEndocrine and cardiac parameters in parturient mares - Prediction of foaling -
Endocrine and cardiac parameters in parturient mares - Prediction of foaling - Christina Nagel 1, Jörg Aurich 2, Regina Erber 1, Christine Aurich 1 1 Centre for Artificial Insemination and Embryo Transfer,
More informationNational Institute for Public Health and the Environment Annual CRL workshop 22 October Update on natural Hormone studies
2008 Annual CRL workshop 22 October 2008 Update on natural Hormone studies Natural hormone studies: update Possible approaches - C12/C13 ratio: can result in proof of abuse - Determination of intact esters
More informationThe physiology of normal androgen production in
Mayo Clin Proc, April 2004, Vol 79 (Supplement) Formulations and Use of Androgens S3 Supplement Article Formulations and Use of Androgens in Women MICHELINE C. CHU, MD, AND ROGERIO A. LOBO, MD The physiology
More informationIf looking for a book Testosterone: Boost Testosterone Naturally - For - Weight Loss, Muscle Building, Libido & Erectile Dysfunction (Testosterone
Testosterone: Boost Testosterone Naturally - For - Weight Loss, Muscle Building, Libido & Erectile Dysfunction (Testosterone Enanthate, Testosterone Replacement... Pressure, Tongkat Ali, Increase Testo)
More informationTestosterone Effects in Transmen
Transmen Testosterone Effects in Transmen EFFECT Skin oiliness/acne Facial/body hair growth Scalp hair loss Increased muscle mass/strength Fat redistribution Cessation of menses Clitoral enlargement Vaginal
More information1001 West Broadway, Vancouver, BC V6H 4B1. Topical Finasteride
1001 West Broadway, Vancouver, BC V6H 4B1 Topical Finasteride 1 Topical finasteride is a solution containing the drug finasteride typically sold under the brand names Propecia and Proscar. The Finasteride
More informationCigna Drug and Biologic Coverage Policy
Cigna Drug and Biologic Coverage Policy Subject Implantable Hormone Pellets Table of Contents Coverage Policy... 1 General Background... 3 Coding/Billing Information... 5 References... 6 Effective Date...
More informationPresence and metabolism of natural steroids in meat-producing animals: current knowledge and potential strategies for detecting their abuse
Presence and metabolism of natural steroids in meat-producing animals: current knowledge and potential strategies for detecting their abuse James Scarth, HFL, UK October 2007 Overview of presentation Context
More informationFINASTERIDE (PROPECIA, PROSCAR) SIDE EFFECT & CONSENT FORM
750 West Broadway Street Suite 905 Vancouver, BC M5Z 1K1 FAX: (604) 648-9003 vancouveroffice@donovanmedical.com FINASTERIDE (PROPECIA, PROSCAR) SIDE EFFECT & CONSENT FORM What is finasteride? Finasteride
More informationAndrogen Measurements
Chapter 5 / Androgen Measurements 63 Androgen Measurements Methods, Interpretation, and Limitations 5 Frank Z. Stanczyk SUMMARY Androgens are measured primarily in serum by direct and indirect (with one
More informationDr Tarza Jamal Pharmacology Lecture 2
Contraceptives and androgen hormone Contraceptives: Currently, interference with ovulation is the most common pharmacologic intervention for preventing pregnancy. Major classes of contraceptives 1. Combination
More informationWADA Technical Document TD2016EAAS. Endogenous Anabolic Androgenic Steroids Measurement and Reporting
Endogenous Anabolic Androgenic Steroids Measurement and Reporting Introduction The purpose of this Technical Document (TD) is to harmonize the approaches to the measurement and reporting of Endogenous
More informationab Androstenedione ELISA Kit
ab108672 Androstenedione ELISA Kit Instructions for Use A competitive immunoenzymatic assay for the quantitative measurement of Androstenedione in serum and plasma (citrate). This product is for research
More informationWADA Technical Document TD2018MRPL
MINIMUM REQUIRED PERFORMANCE LEVELS FOR DETECTION AND IDENTIFICATION OF NON-THRESHOLD SUBSTANCES In order to ensure that all WADA-accredited Laboratories can report the presence of Prohibited Substances,
More informationDonald W. Morrish, MD, PhD, FRCPC Presented at Mountain Man: Men's Health Conference, May Terry s Testosterone
Focus on CME at University of Alberta ADAM: Dealing with the Decline Donald W. Morrish, MD, PhD, FRCPC Presented at Mountain Man: Men's Health Conference, May 2005 We now know there is a decline in total
More informationTESTOFEN HUMAN CLINICAL TRIAL GENCOR PACIFIC, INC. Copyright 2006 by Gencor Pacific, Inc.
GENCOR PACIFIC, INC. 920 E. Orangethorpe Avenue, Suite B, Anaheim, CA 92801 Ph: 714.870.8723 714.870.8724 efax: 732.875.0306 drjit@gencorpacific.com gita@gencorpacific.com www.gencorpacific.com TESTOFEN
More informationHair Testing to provide additional evidence in doping cases of potential (clenbuterol) contaminations
Hair Testing to provide additional evidence in doping cases of potential (clenbuterol) contaminations Detlef Thieme Institute of Doping Analysis, Dresden, Germany Beijing, Oct 2017 [M. Jahn (www.kreischa.net)]
More informationAlthough women produce only
For mass reproduction, content licensing and permissions contact Dowden Health Media. Mary Lake Polan, MD, PhD, MPH Katharine Dexter McCormick and Stanley McCormick Memorial Professor and Chair Emeritus,
More informationPRODUCT INFORMATION PROVIRON
PRODUCT INFORMATION PROVIRON NAME OF TE MEDICINE Mesterolone is a white to yellowish crystalline powder and is practically insoluble in water. The chemical name for mesterolone is 17 beta-ydroxy-1 alpha-methyl-5
More informationProhibited substances in sport supplements
Prohibited substances in sport supplements International Conference on Doping and Public Health, Oslo, Norway Olivier de Hon Introduction Supplements & Sport; a topic for several millennia Ancient Olympic
More informationMethylprednisolone detection in urine following local and oral administrations
Susana MS Simões, Marta Calçada, Luís Horta, Xavier de la Torre Methylprednisolone detection in urine following local and oral administrations Laboratório de Análises e Dopagem. Instituto do Desporto de
More informationDevelopment of a Clinical Research Method for the Measurement of Testosterone. Dihydrotestosterone
Development of a Clinical Research Method for the Measurement of Testosterone and Dihydrotestosterone Martijn van Faassen, Maarten van den Noort and Ido Kima University Medical Center, Groningen, Netherlands
More informationMonitoring of performance an training in rowers
Monitoring of performance an training in rowers Jaak Jürimäe Demands of the Sport High maximal oxygen consumption (VO 2max ); Ability to perform at a high percentage of VO 2max for the duration of event;
More informationCopyright 2009 by UniScience Group Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form.
Copyright 2009 by UniScience Group Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form. This book is intended to give general information, not personal, one-on-one
More informationIcd-10 low levels of testosterone
Icd-10 low levels of testosterone The Borg System is 100 % Icd-10 low levels of testosterone 1-10-2017 if your hormone levels are too high or too low, you may have a hormone disorder. Hormone diseases
More informationNatural estrogens estradiol estrone estriol
Estrogens Natural estrogens estradiol estrone estriol Nonsteroidal synthetic Diethylstilbestrol Chlorotrianisene Methallenestril Steroidal synthetic Ethinyl estradiol Mestranol Quinestrol To decrease some
More informationLCMSMS Solutions For Steroid Analysis
LCMSMS Solutions For Steroid Analysis Dan Blake Manager, Clinical Applications For Research Use Only. Not for use in diagnostic procedures. RUO-MKT-18-1166-A Agenda Special considerations for steroid analysis
More informationThe Application of QuEChERS in the Extraction of Anabolic Steroids in Whole Blood
The Application of QuEChERS in the Extraction of Anabolic Steroids in Whole Blood UCT Part Numbers: ECQUUS1015CT- Enviro-Clean 15 ml centrifuge tube with 400 mg MgSO 4 and 100 mg NaCl CUMPS2CT - Enviro-Clean
More informationNolvadex. Nolvadex Functions & Traits: Effects of Nolvadex:
Nolvadex Nolvadex is a popular and powerfully effective Selective Estrogen Receptor Modulator (SERM) that is often referred to as an anti-estrogen. However, while being an antagonist it is also an agonist
More informationHAIR LOSS HORMONE IMBALANCE HAIR LOSS HORMONE IMBALANCE PDF HAIR LOSS - WIKIPEDIA HORMONE IMBALANCE CHECKLIST - WEIGHT LOSS PROGRAMS
PDF HAIR LOSS - WIKIPEDIA HORMONE IMBALANCE CHECKLIST - WEIGHT LOSS PROGRAMS 1 / 6 2 / 6 3 / 6 hair loss hormone imbalance pdf Male pattern hair loss is believed to be due to a combination of genetics
More information*Dr. Mushreq Aziz Tnesh AL-Lamy, **Dr. Asaad Adnan Aziz Al-Safi. *, ** Physical Education College /Al-Qadisiyah University ABSTRACT
EFFECT OF THE ABUSE OF STEROIDAL ANDRO- GENIC HORMONES AND THEIR RELATIVE CONTRI- BUTION TO THE LEVEL OF HORMONES (TESTOS- TERONE, FSH, LH) AND THE PROPORTION OF IN- FERTILITY IN BODYBUILDERS *Dr. Mushreq
More informationWhat s in Happ-E-Mare?
Happ-E-Mare Is This Your Mare? Anxious and upset Can t settle down Loss of focus Difficult to ride Always in heat Muscle sore Colic-like signs Irritable Stressed The only mare product to reduce mare issues
More informationClinical Policy: Testosterone Reference Number: AZ.CP.PHAR.02 Effective Date: Last Review Date: Line of Business: Arizona Medicaid
Clinical Policy: Reference Number: AZ.CP.PHAR.02 Effective Date: 11.16.16 Last Review Date: 09.12.18 Line of Business: Arizona Medicaid Revision Log See Important Reminder at the end of this policy for
More informationw w w. o p t i m a l h e a l t h m d. c o m Optimal Health & Rejuvenation Center, LLC 2007
Optimize your life. LONGEVITY GUIDE TO 2 0 0 7 w w w. o p t i m a l h e a l t h m d. c o m Optimize your life. INTRODUCTION..................................I DO YOU NEED THERAPY?.........................1
More informationCLINICAL ASSESSMENT AND DIAGNOSIS
FERTILITY AND STERILITY VOL. 77, NO. 4, SUPPL 4, APRIL 2002 Copyright 2002 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A. CLINICAL ASSESSMENT
More information1 Monday, July 14, 14
1 SUPPLEMENTS What supplement companies don t want you to KNOW Nearly 75% of the world population takes some type of supplement each day. There are literally thousands of brands and millions of products
More informationUnitedHealthcare Pharmacy Clinical Pharmacy Programs
UnitedHealthcare Pharmacy Clinical Pharmacy Programs Program Number 2017 P 2018-9 Program Prior Authorization/Medical Necessity Topical Androgens Medication Axiron*, Androderm, Androgel*, Fortesta*, Natesto*,
More informationJeremiah Murphy, MD Mercy Urology Clinic. October 21, 2017
Jeremiah Murphy, MD Mercy Urology Clinic October 21, 2017 Describe an appropriate strategy for the evaluation and diagnosis of male hypogonadism Endocrine Society Clinical Practice Guideline-2010 Review
More informationTestosterone ELISA Kit
Testosterone ELISA Kit Catalog Number KA3396 96 assays Version: 03 Intended for research use only www.abnova.com Table of Contents Introduction... 3 Background... 3 Principle of the Assay... 3 General
More informationSIMPLE, EFFICIENT AND SIMULTANEOUS DETERMINATION OF ANABOLIC STEROIDS IN HUMAN URINE
SIMPLE, EFFICIENT AND SIMULTANEOUS DETERMINATION OF ANABOLIC STEROIDS IN HUMAN URINE Pages with reference to book, From 216 To 218 S.J. Khurshid, M. Riaz, S. Ahmed ( Nuclear Chemistry Division, Pakistan
More informationTestosterone Use and Effects
Parkland College Natural Sciences Poster Sessions Student Works 2013 Testosterone Use and Effects Brandon Mills Parkland College Recommended Citation Mills, Brandon, "Testosterone Use and Effects" (2013).
More informationTrenbolone. Trenbolone Acetate Functions & Traits: Trenbolone Acetate
Trenbolone Trenbolone Acetate Trenbolone Acetate is an extremely powerful anabolic steroid and is considered the single greatest anabolic steroid by many performance enhancing athletes. This is one of
More informationAuthor of: The Six-Pack Diet Plan: The Secrets to Getting Lean Abs and a Rock-Hard Body Permanently
Interview with Rehan Jalali, President, Supplement Research Foundation Author of: The Six-Pack Diet Plan: The Secrets to Getting Lean Abs and a Rock-Hard Body Permanently Background Information: According
More informationIncrease testosterone naturally studies, testosterone boosting workout plan. > Click Now < Free download pre party pump workouts a closer
Increase testosterone naturally studies, testosterone boosting workout plan. > Click Now < Free download pre party pump workouts a closer look increase testosterone during workout, tabata increase testosterone
More informationWADA Technical Document TD2017NA
HARMONIZATION OF ANALYSIS AND REPORTING OF 19-NORSTEROIDS RELATED TO NANDROLONE 1.0 Introduction This document has been established to harmonize the Confirmation Procedure for the analysis and reporting
More informationCreatine Versus Anabolic Steroids. Over the past few years, many athletes have been using performance-enhancing
Hester 1 Kyle Hester Instructor s Name ENGL 1013 Date Creatine Versus Anabolic Steroids Over the past few years, many athletes have been using performance-enhancing supplements on a regular basis. Two
More informationProviron. Proviron Functions & Traits: (Mesterolone)
Proviron (Mesterolone) Proviron represents one of the oldest anabolic androgenic steroids on the market. A product of the giant pharmaceutical company Schering, it would first appear in 1934. Officially
More informationDUPROST Capsules (Dutasteride)
Published on: 10 Jul 2014 DUPROST Capsules (Dutasteride) Composition Each soft gelatin capsule contains: Dutasteride... 0.5 mg Dosage Form Capsule Pharmacology Pharmacodynamics Mechanism of Action Dutasteride
More informationTrace-Level Analysis of Metanephrines in Plasma by HILIC LC-MS/MS
Abstract Highly sensitive analysis of metanephrines in plasma is critical in the diagnosis and treatment of pheochromocytoma and paraganglioma. Here, a HILIC LC-MS/MS method was developed using a Raptor
More information2011 PROHIBITED DRUG CLASSES AND METHODS. Dr Nicolas Theron Loch Logan Waterfront Sport and Travel Medicine Centre Tel :
2011 PROHIBITED DRUG CLASSES AND METHODS Dr Nicolas Theron Loch Logan Waterfront Sport and Travel Medicine Centre Tel : 051-4481389 Doping is defined as the administration of substances belonging to prohibited
More informationAnadrol For Sale Oxymetholone
Anadrol For Sale Anadrol 50, a brand name for the chemical oxymetholone (C 12 H 32 O 3 ), is a powerful anabolic steroid that most people still refer to as simply Anadrol. Anadrol reviews are usually positive,
More informationSkin metabolism of steroid hormones as endogenous compounds?
Skin metabolism of steroid hormones as endogenous compounds? Van Luu-The Department of Molecular Medicine Laval University Québec, Canada This work has been supported by L Oréal Research Steroid hormones
More informationMens Health Post Puberty. Nayan Patel PharmD
Mens Health Post Puberty Nayan Patel PharmD Definition of Androgen Deficiency * Consistently low testosterone * Associated signs/symptoms * Evidence based review of literature * Data is weak at best Definition
More information... Remember that message? Well, you made a wise decision in requesting this report. You will learn
SPECIAL REPORT FOR C RITICAL... RITICALB ENCH. COM SUBSCRIBERS... HOW TO RAPIDLY BOOST TESTOSTERONE FOR BIG MUSCLE MASS GAINS... WITHOUT ANABOLIC S TEROIDS! Dear Friend, If you read just the first 3 pages
More informationDoping in Sports: Catching and Preventing It An Expert Interview With Gary I. Wadler, MD
Doping in Sports: Catching and Preventing It An Expert Interview With Gary I. Wadler, MD Carol Peckham; Gary I. Wadler, MD As part of our coverage of the 2012 Olympics, Medscape interviewed Gary I. Wadler,
More information