1. Testosterone Replacement for Men and Women www.freelivedoctor.com

2. Presenting from the Premises of Port Power www.freelivedoctor.com

3. www.freelivedoctor.com While testosterone replacement is being used in women with good effect… it is used without the approval of the Australian Drug Evaluation Committee …and the individual practitioner must take individual responsibility for it’s use

4. The human ovary produces more testosterone than oestrogen- weight for weight The postmenopausal ovary continues to produce testosterone after the cessation of follicular activity cuts off the supply of oestrogen www.freelivedoctor.com

5. As the ovary fails, it continues to produce testosterone and perhaps in increased amounts…for a variable number of years. This is the so called… “continuation of ovarian function postmenopausally”. i.e. progressive androgenisation! www.freelivedoctor.com

6. With the introduction of HRT (oestrogen only or ERT), testosterone status falls to zero. This is due to two factors www.freelivedoctor.com  cessation of production from the ovary by suppression of LH  binding of testosterone by SHBG

7. It follows therefore, that any woman taking oestrogen or producing excess oestrogens is relatively or absolutely testosterone deficient e.g. the oral contraceptive multicystic ovary oestrogen replacement www.freelivedoctor.com

8. Oestrogen and progesterone are the mainstay of ERT. Testosterone may still be viewed as the, “Cinderella of the hormonal ball”… but she got to marry Prince Charming! www.freelivedoctor.com

9. Symptoms Testosterone replacement is generally regarded as indicated for loss of libido (by a predominantly male profession) … .. and while this may be true, other symptoms are of greater importance. www.freelivedoctor.com

17. Oestrogen and Testosterone Implants Insertion technique Dr Rob Baber North Shore Menopause Clinic 4mins 50secs www.freelivedoctor.com

18. www.freelivedoctor.com

19. There is very little data on the human female There has been a data collection from my practice, undertaken on 512 women over 12 years. www.freelivedoctor.com

20. www.freelivedoctor.com My data is currently under continuing biostatistical analysis with The National Institute of Health Bethesda, Maryland, USA. in an attempt to correlate the epidemiology with the basic science While my conclusions are therefore predominantly derived from my own clinical observations, there is current intense interest from the basic scientists.

21. This analysis will focus mainly on the prevention of breast cancer but must include the parameters of www.freelivedoctor.com  HDL/LDL cholesterol  Bone density in addition to  Breast cancer

22. Breast cancer results Study group(ERT+ART) 7 breast cancers Expected incidence ERT only) 12(14) “ “ However the 10-year breast cancer ‘free survival rate’ for patients in the trial was < 97.41%.(no. reduced from 8 to 7) (95% c.i. 95.5-99.29%) Compared to the expected rate of 97.52%. It would appear then that the survival from the diagnosis breast cancer did not differ from that of the South Australian population at large of whom 44.3% were taking oestrogens but may be shown to be reduced to statistical significance when compared to a population of 100% oestrogen users . www.freelivedoctor.com

23. Bone density The initial improvement in bone density of only 3.1% in either area fell short of expectation as did the overall loss. Declining densities in smaller numbers was attributed to non- responders to HRT www.freelivedoctor.com Change in Hip Density Change in Lumbar Density

25. www.freelivedoctor.com The Male Menopause Good news and bad news! The bad news is that the male menopause does exist…it is a reality and should be taken seriously...

26. The good news is that it is synchronous with Prof. David Purdie www.freelivedoctor.com death!

27. www.freelivedoctor.com Grumpy old men

28. Testosterone can be dangerous stuff! www.freelivedoctor.com

29. www.freelivedoctor.com

31. Symptom complex  Precisely the same as for women except for breast soreness and vulval skin problems  suggestion that cholesterol profile may be improved  expectation that osteoporosis will be improved www.freelivedoctor.com

36. Beware the www.freelivedoctor.com prostate!! pumpkin

37. Something to aspire to… www.freelivedoctor.com

38. www.freelivedoctor.com Can we be seen to be producing a long living generation of superwomen (and men-?) Ultimate objective