Testosterone questionnaire template,muscle maker grill tribeca menu,clickbank review sites,clean and lean diet reviews nyc - 2016 Feature

18.12.2014, admin  
Category: Muscle Gainer Supplements

We are all aware that women go through menopause during their late 40s or early 50s, and during the perimenopausal period, they may experience symptoms such as tiredness, depression and hot flashes.
Men may also experience similar symptoms as they get older, caused by a decline in testosterone levels, and this can be loosely termed as male menopause or andropause. In the properly selected patient, testosterone replacement therapy (TRT) will help to alleviate these symptoms and improve quality of life. Of 1,000 men screened in a primary care clinic based health screening in Singapore, 26% were found to have hypogonadal symptoms.
The patient should be examined for evidence of gynaecomastia, changes in male body hair distribution and testicular atrophy.
Free testosterone levels can be calculated from the levels of total testosterone, albumin and SHBG.
Currently, there is no arbitrary value of total testosterone or free testosterone level below which to start TRT. Once it is established that the serum testosterone is low, it is useful to check the levels of luteinising hormone (LH), follicle stimulating hormone (FSH), and prolactin to rule out secondary hypogonadism [Figure 3].
If there is any suspicion that the patient has underlying heart disease, it may be prudent to get that assessed first before starting on TRT. Patients with symptomatic TDS should see their symptoms and quality of life improve after administration of TRT. There is some evidence that TRT reduces fat mass, increases lean body mass and improves bone density in older men.9,10 In hypogonadal men with obesity and diabetes mellitus, testosterone replacement therapy may improve glycaemic control and help with weight loss. TRT will depress spermatogenesis and is therefore not recommended for patients who still wish to have biological fatherhood. There is a fear that giving testosterone supplementation to patients with prostate cancer may cause the cancer to worsen.
It is preferable to use preparations containing testosterone undecanoate, which are available in oral, gel or injectable form. During follow up, the patient should be asked if his symptoms have improved after starting on the treatment.
Serum testosterone, full blood count and serum PSA should be performed at three- to six-monthly intervals.
Dr Ng Chee Kwan is Director and Consultant Urologist of CK Ng Urology and Minimally Invasive Surgery at Mount Elizabeth Novena Hospital, Singapore.

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Treatment should be restricted to patients with symptoms and testosterone levels that are proven to be low. The Aging Male Score (AMS) questionnaire [Figure 2] is useful as a tool to assess patients’ symptoms at baseline and subsequent response to treatment.
Free testosterone is available for use by the body, with the remainder being bound to albumin and sex hormone binding globulin (SHBG).
In particular, erections, libido and energy levels should noticeably improve.8 In clinical practice, these improvements in quality of life can be quite dramatic. There is no solid evidence for this but until further consensus emerges, TRT is contraindicated for patients with untreated prostate cancer. Nevertheless, it is recommended that these potential risks be discussed with patients before starting on TRT, especially in patients who are elderly or have pre-existing heart disease. Testosterone undecanoate is not metabolised by the liver and hence risk of liver toxicity is low. Hands should be thoroughly washed after application and skin contact with others should be avoided for four hours after gel application. The initial two injections are given six weeks apart, and subsequent injections at three-monthly intervals. Hypothalamic-pituitary-testicular axis disruptions in older men are differentially linked to age and modifiable risk factors: the European Male Aging Study. Age-associated changes in hypothalamic-pituitary-testicular function in middle-aged and older men are modified by weight change and lifestyle factors: longitudinal results from the European Male Ageing Study.
Diurnal rhythms of serum total, free and bioavailable testosterone and of SHBG in middle-aged men compared with those in young men. Testosterone replacement therapy improves mood in hypogonadal men – a clinical research center study.
Effect of testosterone treatment on body composition and muscle strength in men over 65 years of age.
Effects of long-term testosterone therapy on patients with “diabesity”: results of observational studies of pooled analyses in obese hypogonadal men with type 2 diabetes.

FDA Drug Safety Communications: FDA evaluating risk of stroke, heart attack, and death with FDA-approved testosterone products. Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. Content and images are meant for practicing medical doctors, allied health care professionals and other establishments in the medical industry. A detailed history should be taken for other co-morbidities, especially pre-existing heart disease. There are situations where the total testosterone levels are normal but free testosterone levels are low due to increase in SHBG. If the patient develops polycythaemia during treatment, it is best to stop the therapy until the haematocrit levels normalise. The advantage of oral medication is the short duration of action and ability to discontinue rapidly if there are side effects. The advantage of testosterone gel is the short duration of action and ability to discontinue rapidly. Once the levels are stable, the investigations can be performed at six- to 12-monthly intervals. Patients should be informed of possible side effects, including potential cardiovascular risk as highlighted by a recent FDA alert.
However, testosterone levels may fluctuate as absorption of the drug may vary depending on the amount of dietary fat. As the drug is released slowly into the bloodstream, the testosterone levels tend to be more stable. Patients should be monitored regularly for adverse effects, the most common side effect being polycythaemia which easily resolves after a drug holiday.
The disadvantage is that it cannot be rapidly discontinued and some patients may complain of local problems at the injection site.

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