RESUMEN
An insufficient level of testosterone in aging men and women is associated with a constellation of adverse conditions (cognitive decline, loss of muscle mass, osteopenia, decreased libido, changes in fat distribution, fragility, depression, a greater risk of fracture). Research has confirmed that supplementary testosterone can ameliorate those signs and symptoms in hypogonadic individuals, but the benefits and risks of that therapy remain controversial. The treatment of such patients should be based on knowledge of the physiologic effects of testosterone in the elderly, effective screening for testosterone deficiency accurate measurement of bioavailable levels of that hormone, and safe and effective treatment options, all of which are examined in this article. In designing hormone replacement regimens, the skill of a compounding pharmacist who can customize dose and dosage forms to answer individual medical needs and preferences can be instrumental in achieving the desired outcome.
RESUMEN
Bone loss leads to an increased incidence of fracture and is associated with the development of osteoporosis, which can strike people of any age and afflicts 10 million individuals in the U.S. today. Research indicates that osteoporosis causes more than 1.5 million fractures annually, including approximately 300,000 fractures at other sites. Early detection of bone loss (resorption), like that revealed by a combination of dual energy X-ray absorptiometry and monitoring the level of deoxypyridinoline in urine, provides the most complete picture of long-term and short-term bone health. In this reports, we examine the effects of increased bone resorption and various methods of testing for bone loss, present findings from the literature on the effects of and monitorying for bone resorption, and profile individuals most likely to benefit from testing for a decrease in bone mass.
RESUMEN
Saliva is an excellent medium for the measurement of the biologically active fraction of steroid hormones in the bloodstream because it is a natural ultrafiltrate of blood, and steroids not bound by carrier proteins in the blood freely diffuse into saliva. The baseline measurement of hormone levels in saliva provides an accurate assessment and can be used to identify or monitor a number of clinical conditions, including climacteric changes in perimenopausal or postmenopausal women, adrenal disorders such as Addison's disease or Cushing's disease, and androgen deficiency in men and women, the age-related decrease of hormones such as testosterone and dehydroepiandrosterone can also be assessed and monitored. When compared with serum testing, saliva testing offers several advantages. Saliva collection is simple, noninvasive, stress free, painless, and safe for the patient and practitioner. The collection time for saliva testing is more controllable than that for serum testing. The transport of saliva samples for assessment can be accomplished inexpensively via the U.S. Postal Service because hormones are stable in saliva for three weeks at room temperature, and the cost of that testing is covered by many insurance plans. In this first of a two-part series, we discuss the clinical use and basic elements of saliva testing and provide guidelines for postreatment interpretation by compounding pharmacists.
RESUMEN
Published research has substantiated the accuracy of saliva testing in determining the values of specific hormones such as the major estrogens (estradiol, estrone, estriol), progesterone, androgens (dehydroepiandrosterone, testerone, 5a-dihydrotestosterone), cortisol, and melatonin. When compared with serum testing, saliva testing also offers multiple advantages in cost and convenience. In this second of a two-part series, we discuss in greater detail the types of hormones that can be accurately identified in saliva samples, the pharmacokinetics of hormone replacelment therapy,and the importance of timely testing.
RESUMEN
BACKGROUND: Saliva collection is an easy, non-invasive method to measure hormones. METHODS: Two studies were performed. In the first, a convenience sample of 1,454 males who had submitted saliva for salivary testosterone measurements were studied. In the second study, we intensively studied symptoms and measurements of total testosterone, free testosterone symptoms and measurements of total testosterone, free testosterone and bioavailable testosterone in relationship to salivary testosterone in 127 men. A secondary endpoint was to examine the relationship of salivary testosterone to hypogonadal symptoms in the ADAM and AMS questionnaires. RESULTS: In the first study, we have shown that salivary testosterone, measured in 1,454 males aged 20 to 89 years, declines by 47% over the lifespan. In the second study, salivary testosterone was strongly correlated with bioavailable testosterone (p < 0.000001) calculated free testosterone (p < 0.00001) and total testosterone (p < 0.002). Salivary testosterone was significantly related to hypogonadal symptoms on the St. Louis University ADAM questionnaire and the Aging Male Survey. CONCLUSIONS: These studies support the use of salivary testosterone as an acceptable assay for screening for hypogonadism. Salivary testosterone is not a better assay than other measures to diagnose hypogonadism.