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Cypionate

Cypionate

August 4, 2011

Endogenous androgens are responsible for normal growth and development of the male sex organs and for maintenance of secondary sex characteristics. These effects include growth and maturation of the prostate, seminal vesicles, penis, and scrotum; development of male hair distribution, such as beard, pubic, chest, and axillary hair, laryngeal enlargement, vocal cord thickening, and alterations in body musculature and fat distribution. Drugs in this class also cause retention of nitrogen, sodium, potassium, and phosphorous, and decreased urinary excretion of calcium. Androgens have been reported to increase protein anabolism and decrease protein catabolism. Nitrogen balance is improved only when there is sufficient intake of calories and protein.

Androgens are responsible for the growth spurt of adolescence and for eventual termination of linear growth, brought about by fusion of the epiphyseal growth centers. In children, exogenous androgens accelerate linear growth rates, but may cause disproportionate advancement in bone maturation. Use over long periods may result in fusion of the epiphyseal growth centers and termination of the growth process. Androgens have been reported to stimulate production of red blood cells by enhancing production of erythropoietic stimulation factor.

During exogenous administration of androgens, endogenous testosterone release is inhibited through feedback inhibition of pituitary luteinizing hormone (LH). At large doses of exogenous androgens, spermatogenesis may also be suppressed through feedback inhibition of pituitary follicle stimulating hormone (FSH).
There is a lack of substantial evidence that androgens are effective in fractures, surgery, convalescence, and functional uterine bleeding.

PHARMACOKINETICS
Testosterone esters are less polar than free testosterone. Testosterone esters in oil Injected intramuscularly are absorbed slowly from the lipid phase; thus, testosterone cypionate can be given at intervals of two to four weeks.

Testosterone in plasma is 98 percent bound to a specific testosterone-estradiol binding globulin, and about 2 percent is free. Generally, the amount of this sex-hormone binding globulin in the plasma will determine the distribution of testosterone between free and bound forms, and the free testosterone concentration will determine its half-life.

About 90 of a dose of testosterone is excreted in the urine as glucuronic and sulfuric acid conjugates of tesrtosterone and its metabolites; about 6 percent of a dose is excreted in the feces, mostly in the unconjugated form. Inactivation of testosterone occurs primarily in the liver. Testosterone is metabolized to various 17-keto steroids through two different pathways.

The half-life of testosterone cypionate when Injected intramuscularly is approximately eight days.

In many tissues the activity of testosterone appears to depend on reduction to dihydrotestost-
erone, which binds to cytosol receptor proteins. The steroid-receptor complex is transported to the nucleus where it initiates transcription events and cellular changes related to androgen action.

INDICATIONS AND USAGE:
Cypionate® is indicated for replacement therapy in the male in conditions associated with symptoms of deficiency or absence of endogenous testosterone.
1. Primary hypogonadism (congenital or acquired)-testicular failure due to cryptorchidism, bilateral torsion, orchitis, vanishing testis syndrome; or orchidectomy.
2. Hypogonadotropic hypogonadism (congenital or acquired)-idiopathic gonadotropin or LHRH deficiency, or pituitary-hypothalamic Injury from tumors, trauma, or radiation.

CONTRAINDICATIONS:
1. Know hypersensitivity to the drug
2. Males with carcinoma of the breast
3. Males with known or suspected carcinoma of the prostate gland
4. Women who are or who may become pregnant
5. Patients with serious cardiac, hepatic or renal disease

WARNINGS:
Hypercalcemia may occur in immobilized patients. If this occurs, the drug should be discontinued.Prolonged use of high doses of androgens (principally the 17-delta alkyl-androgens) has been associated with development of hepatic adenomas, hepatocellular carcinoma, and peliosis hepatis- all potentially life-threatening complications.

Geriatric patients treated with androgens may be at an increased risk of developing prostatic hypertrophy and prostatic carcinoma although conclusive evidence to support this concept is lacking.

Edema, with or without congestive heart failure, may be a serious complication in patients with pre-existing cardiac, renal or hepatic disease.

Gynecomastia may develop and occasionally persists in patients being treated for hypogonadism.

This product contains benzyl alcohol. Benzyl alcohol has been reported to be associated with a fatal “Gasping Syndrome” in premature infants.

Androgen therapy should be used cautiously in healthy males with delayed puberty. The effect on bone maturation should be monitored by assessing bone age of the wrist and hand every 6 months. In children, androgen treatment may accelerate bone maturation without producing compensatory gain in linear growth. This adverse effect may result in compromised adult stature. The younger the child the greater the risk of compromising final mature height.

This drug has not been shown to be safe and effective for the enhancement of athletic performance. Because of the potential risk of serious adverse health effects, this drug should not be used for such purpose.

PRECAUTIONS:
General: Patients with benign prostatic hypertrophy may develop acute urethral obstruction.
Priapism or excessive sexual stimulation may develop. Oligospermia may occur after prolo-
nged administration or excessive dosage. If any of these effects appear, the androgen should be stopped and if restarted, a lower dosage should be utilized.

Cypionate® should not be used interchangeably with testosterone propionate because of differences in duration of action.

Cypionate® is not for intravenous use.

Information for patients: Patients should be instructed to report any of the following nausea, vomiting, changes in skin color, ankle swelling, too frequent or persistent erections of the penis

Laboratory tests: Hemoglobin and hematocrit levels (to detect polycythemia) should be checked periodically in patients receiving long-term androgen administration.
Serum cholesterol may increase during androgen therapy.

Drug/Laboratory test Interferences: Androgens may decrease levels of thyroxine-binding globulin, resulting in decreased total T4 serum levels and increased resin uptake of T3 and T4 Free thyroid hormone levels remain unchanged, however, and there is no clinical evidence of thyroid dysfunction.

Carcinogenesis: Animal data. Testosterone has been tested by subcutaneous Injection and implantation in mice and rats. The implant induced cervical-uterine tumors in mice, which metastasized in some cases. There is suggestive evidence that Injection of testosterone into some strains of female mice increases their susceptibility to hepatoma. Testosterone is also known to increase the number of tumors and decrease the degree of differentiation of chemically-induced carcinomas of the liver in rats.

Human data. There are rare reports of hepatocellular carcinoma in patients receiving long term therapy with androgens in high doses. Withdrawal of the drugs did not lead to regression of the tumors in all cases.
Geriatric patients treated with androgens may be at an increased risk of developing prostatic hypertrophy and prostatic carcinoma although conclusive evidence to support this concept is lacking.

Pregnancy: Teratogenic Effects. Pregnancy Category X. (See CONTRAINDICATIONS).
Nursing mother: Cypionate® is not recommended for use in nursing mothers.
Pediatric use: Cypionate® is not recommended for use in children.

DRUG INTERACTIONS:
Androgens may increase sensitivity to oral anticoagulants. Dosage of the anticoagulant may require reduction in order to maintain satisfactory therapeutic hypoprothrombinemia.
Concurrent administration of oxyphenbutazone and androgens may result in elevated serum levels of oxyphenbutazone.

In diabetic patients, the metabolic effects of androgens may decrease blood glucose and therefore, insulin requirements.

ADVERSE REACTIONS:
The following adverse reactions in the male have occurred with some androgens:
Endocrine and urogenital: Gynecomastia and excessive frequency and duration of penile
erections. Oligospermia may occur at high dosages.

Skin and appendages: Hirsutism, male pattern of baldness, seborrhea, and acne.
Fluid and electrolyte disturbances: Retention of sodium, chloride, water, potassium, calcium, and inorganic phosphates.

Gastrointestinal: Nausea, cholestatic jaundice, alterations in liver function tests, rarely
hepatocellular neoplasms and peliosis hepatic (see WARNINGS).

Hematologic: Suppression of clotting factors II, V, VII, and X, bleeding in patients on concomitant anticoagulant therapy, and polycythemia.Nervous system: Increased or decreased libido, headache, anxiety, depression, and generalized paresthesia.

Allergic: Hypersensitivity, including skin manifestations and anaphylactoid reactions.
Miscellaneous: Inflammation and pain at the site of intramuscular Injection.

DRUG ABUSE AND DEPENDENCE:
Controlled Substance Class: Testosterone is a controlled substance under the Anabolic Steroids Control Act, and Cypionate® has been assigned to Schedule III,

OVERDOSAGE:
There have been no reports of acute overdosage with the androgens.

DOSAGE AND ADMINISTRATION:
Cypionate® is for intramuscular use only. It should not be given Intravenously. Intramuscular Injections should be given deep in the gluteal muscle.

The suggested dosage for Cypionate® varies depending on the age, sex, and diagnosis of the individual patient. Dosage is adjusted according to the patient’s response and the appearance of adverse reactions.

Various dosage regimens have been used to induce pubertal changes in hypogonadal males; some experts have advocated lower dosages initially, gradually increasing the dose as puberty progresses, with or without a decrease to maintenance levels. Other experts emphasize that higher dosages are needed to induce pubertal changes and lower dosages can be used for maintenance after puberty. The chronological and skeletal ages must be taken into consideration, both in determining the initial dose and in adjusting the dose.
For replacement in the hypogonadal male, 50-400 mg should be administered every two to four weeks.

Parenteral drug products should be inspected visually for particulate matter and discoloration
prior to administration, whenever solution and container permit. Warming and shaking the vial should redissolve any crystals that may have formed during storage at temperatures lower than recommended.

Vials should be stored at controlled room temperatures 15-30°C (59-86° F) and protected from light.

HOW SUPPLIED- Cypionate® Injection, Solution-Intramuscular-200 mg/ml is supplied in 1 ml vial.

Sidney Gordon

President

Cell. 561-213-7772

Ph. 866-641-CORE (2673)

Fax. 866-686-5280

WWW.CoreInstitutes.com

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Some of side effects of Human Growth Hormone

Some of side effects of Human Growth Hormone

December 23, 2010

Most of the side effects are limited to HGH injections. HGH sprays or HGH supplements are considered to be milder forms of the product, and hence, are not associated with any adverse side effects. However, the indiscriminate use of any of the HGH product is linked to severe side effects and can result in complications.

Few of the most commonly documented side effects include: increased susceptibility to diabetes, swelling of joints and the face, joint pain, and carpel tunnel syndrome.

Excessive usage of HGH has also been found to be associated with an increased risk of developing colon cancer, in the elderly. Surprisingly, one of the biggest drawbacks of the prolonged use of HGH products is the reduction in the life expectancy and a proneness to develop cardiac and respiratory distress.

Recently published studies indicate that, the benefits of HGH replacement are very few especially for healthy adults. As per the studies, individuals who benefit most from the use of HGH replacement, are those suffering from Growth Hormone Deficiency.




Progesterone for women

Progesterone for women

December 8, 2010

Until recently, the only commercial testosterone products available contained methyltestosterone, a synthetic form of testosterone, in dosages only appropriate for men. Current studies, however, clearly show that testosterone is also an important hormone for women. Now, because of its increased popularity, there has been a rush by both pharmaceutical companies and compounding pharmacies to meet the demand. The estradiol-testosterone combination patch Estratest® provides dosages appropriate for women, but does not contain natural, bio-identical testosterone. Presently, bio-identical testosterone can only be purchased from compounding pharmacies, formulated as tablets, capsules, creams, gels, or sublinguals.




Drugs that Cause Erectile Dysfunction / Male Impotence

Drugs that Cause Erectile Dysfunction / Male Impotence

December 3, 2010

Here is a list of drugs that cause Erectile Dysfunction / Male Impotence

Drug Class

Generic

Brand

Antihypertensives
and Diuretics

Hydrochlorothiazide

Esidrix, Hydrodiuril, Inderide, Moduretic, Oretic, Lotensin

Triamterine

Maxide, Dyazide

Furosdmide

Lasix

Chlorothalidone

Hygrotone

Bumetanide

Bumex

Guanfacine

Tenex

Methyldopa

Aldomet

Clonidine

Catapres

Verapamil

Calan, Isoptin, Verelan

Nifedipine

Adalat, Procardia

Hydralazine

Apresoline

Captopril

Capoten

Enalapril

Vasotec

Metoprolol

Lopressor

Propranolol

Inderal

Labetalol

Normodyne

Atenolol

Tenormin

Phenoxybenzamine

Dibenzyline

Spironolactone

Aldactone

Antidepressants,
Anti-Anxiety Drugs
and Anti-Epileptic Drugs

Fluoxetine

Prozac

Tranylcypromine

Parnate

Sertraline

Zoloft

Isocarboxazid

Marplan

Amitriptyline

Elavil

Amoxipine

Asendin

Clomipramine

Anafranil

Desipramine

Norpramin

Nortriptyline

Pamelor

Phenelzine

Nardil

Buspirone

Buspar

Chlordiazepoxide

Librium

Clorazepate

Tranxene

Diazepam

Valium

Doxepin

Sinequan

Imipramine

Tofranil

Lorazepam

Ativan

Oxazepam

Serax

Phenytoin

Dilantin

Antihistamines

Dimenhydrinate

Dramamine

Diphenhydramine

Benadryl

Hydroxyzine

Vistaril

Meclizine

Antivert

Promethazine

Phenergan

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Naproxen

Anaprox, Naprelan, Naprosyn

Indomethacin

Indocin

Parkinson’s Disease Medications

Biperiden

Akineton

Benztropine

Cogentin

Trihexylphenidyl

Artane

Procyclidine

Kemadrin

Bromocriptine

Parlodel

Levodopa

Sinemet

Anti-Arrythmics

Disopyramide

Norpace

Histamine H2-Receptor Antagonists

Cimetidine

Tagamet

Nizatidine

Axid

Ranitidine

Zantac

Muscle Relaxants

Cyclobenzaprine

Flexeril

Orphenadrine

Norflex

Prostate Cancer
Medications

Flutamide

Eulexin

Leuprolide

Lupron

Chemotherapy
Medications

Busulfan

Myleran

Cyclophosphamide

Cytoxan




Erectile Dysfunction (ED) Treatment & Diagnosis.

Erectile Dysfunction (ED) Treatment & Diagnosis.

Core Clinic takes a multi-faceted approach to treating erectile dysfunction (ED) / Male Impotence.  The first step is an evaluation by one of Core’s highly-trained physicians to identify what is causing erectile dysfunction.  Upon completing our evaluation, an individualized treatment regimen is then created by a Core physician. Besides eliminating an underlying cause such as potassium deficiency or arsenic contamination of drinking water, the first line treatment of erectile dysfunction typically consists of a prescription for a PDE5 inhibitor medication (the first of which was sildenafil or Viagra, followed by Cialis and Levitra). In some cases, however, the PDE5 inhibitor is ineffective or prescribed use of a PDE5 inhibitor is contraindicated because of a patients’ health.

Our physicians will then explore treatment options ranging from Hormone Replacement Therapy (HRT) to prostaglandin tablets in the urethra or intracavernosal injections with a fine needle into the penis that can cause an erection.  The most widely used of these injectable treatments is Trimix which is an injectable three-drug cocktail used to treat erectile dysfunction. The active ingredients in the mixture are usually alprostadil, papaverine, and phentolamine.  In beginning the use of Trimix, it is critical that our physicians find the correct dosage as it does vary from patient to patient.  Additionally, we provide education to our patients on the least invasive way to administer the treatment.

Diagnosis of ED

A doctor will do a thorough examination that will include the following: medical/ sexual history, medication history, surgical history, physical exam, blood work, and an international index of ED questionnaire that will assess quality of erectile function and sexual intercourse.

Click here for a list of Drugs that cause Erectile Dysfunction (ED)




Erectile dysfunction (ED, “male impotence”) – What is it?

Erectile dysfunction (ED, “male impotence”) – What is it?

Erectile dysfunction (ED, “male impotence“) is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis sufficient for satisfactory sexual performance.

An erection occurs as a hydraulic effect due to blood entering and being retained in sponge-like bodies within the penis. The process is most often initiated as a result of sexual arousal, when signals are transmitted from the brain to nerves in the penis. Erectile dysfunction is indicated when an erection is difficult to produce. The most important organic causes are cardiovascular disease and diabetes, neurological problems (for example, trauma from prostatectomy surgery), hormonal insufficiencies (hypogonadism) and drug side effects

Please click here to view a list of drugs That Cause Erectile Dysfunction.

Psychological impotence is where erection or penetration fails due to thoughts or feelings (psychological reasons) rather than physical impossibility; this is somewhat less frequent but often can be helped. Notably in psychological impotence, there is a strong response to placebo treatment or counseling sessions with a qualified psycho-therapist. Erectile dysfunction, tied closely as it is about ideas of physical well being, can have severe psychological consequences if left untreated.  In many cases, anxiety stemming from the uncertainty of an individuals’ ability to develop an erection can further exacerbate psychological impotence.

Click here for Erectile Dysfunction Treatment information




MALE MENOPAUSE

MALE MENOPAUSE

November 23, 2010

Middle-aged? Tired? Not Interested in sex?


Think only a new convertible could spark your desire?

HRT Clinic Core Medical Group of Florida can reverse the effects of aging!

Do not let low hormone levels bring you down.

 

 

Is male menopause a true medical condition or just a good punch line when you’re 50-something and not feeling quite yourself?
You know, “Oh, that male menopause must’ve kicked in”?

Could your doctor really diagnose male menopause, or is it merely a phrase that Oprah or GQ use to hook you?
My middle-aged male editor wanted to know. No punch lines here, my friend, er, boss.
There is such a thing as male menopause (though technically the name is all wrong – but we’ll get to that).
Is every man destined for the same hot flashes and mood swings they dread to see in the women they love?
That’s another story.
But the hormonal change is real and so are a multitude of symptoms that can accompany it – from a loss in libido or erectile dysfunction to fatigue or depression. And, yes, sometimes even night sweats.
Every woman who lives long enough will experience menopause – a (permanent) pause in her menstrual cycle that signals the end to the steady stream of the hormone estrogen her body makes. Hence the name menopause. Normally, this happens between the ages of 45 and 50. And the dramatic drop in hormones can trigger all sorts of physical and psychological changes.
Conversely, the hormone faucet in men never turns off. But the flow of testosterone does begin to gradually decrease at a rate of about 1 percent a year beginning at age 30. And for some men, the result over the years can be simply unpleasant or potentially life-changing.

While some call it male menopause, doctors often call these age-related hormone changes in men “andropause” – from the word androgen, a term to describe hormones such as testosterone.

How common is it?
It’s unclear how many men develop andropause. A study of more than 3,000 European men published in the June 17 issue of The New England Journal of Medicine suggests the number is only perhaps 2 percent of the population. Anecdotally, some doctors say that number seems low.
“It’s certainly higher than that one study would suggest,” said Dr. Lawrence Hakim, chairman of the Department of Urology at the Cleveland Clinic in Weston . It may be a matter of definition, Hakim and others suggest.

Diagnosis a challenge
There is no single way to test for andropause, explains Dr. Robert Tan, author of The Andropause Mystery and founder of the OPAL Medical Clinic, which specializes in men’s health and aging.
A lab test is needed to figure out how much testosterone a man produces, plus a look at his overall health.
How low is low testosterone? It depends who you ask.
Studies have defined low testosterone in men as 250 nanograms per deciliter, while others cite 300. Men in their 20s and 30s typically have testosterone levels in the 600 range. But a low number by itself is not enough. “Every man is different,” said Dr. Erik Castle, a urologist with the Mayo Clinic in Arizona. “You may have a 70-year-old who is healthy, never smoked, eats right, has low testosterone, but is fine. You have another, maybe he didn’t live so cleanly and now is unhealthy and not feeling well.” For that guy, Castle says, you have to look closer.

What are you looking for?
Erectile dysfunction. Reduced sex drive. Fewer morning erections.

Doctors also often look for fatigue, problems walking long distances, bending or stooping. And even if you have low testosterone and you’re tired, your problem could be something else entirely – diabetes, thyroid issues, a side effect from medication or alcohol abuse.

Hormone therapy poses risks
Doctors once addressed andropause only when a man complained that his sex life was suffering, Mayo Clinic’s Castle said.
“But over the last 10 years, the emerging evidence is that this may not just be a quality of life issue because they can’t get erections,” Castle said, “Now we think it could be a health issue as well.” He said men with truly low testosterone levels can have lower bone density, and may be at greater risk of diabetes or coronary artery disease.

Now men and their doctors can consider replenishing the testosterone if those health risks are in play. But proceed with caution.

Google “male menopause” and you may be steered to a screen full of “health centers” touting hormone therapy for a myriad of ills.

“You really want to seek out a center where you can work with a urologist, an endocrinologist,” Hakim of Cleveland Clinic said. “It’s part of the bigger picture. These places tend to focus on one thing – not the big picture.”

And, just as women must consider the risks of hormone therapy, so should men, advises the Mayo Clinic.

In its primer on male menopause, the clinic notes “Testosterone therapy has various risks.”

Such therapy could contribute to sleep apnea, put you at greater risk for heart disease, cause skin problems or stimulate the growth of existing prostate cancer.

Tan, the author who first published on the topic a decade ago, says he can’t help but notice how the public awareness of andropause has grown.

“There has been more interest, scientific work and certainly more patients coming forth with symptoms and treated successfully.”

By Sonja Isger
Palm Beach Post Staff Writer
Source: THE PALM BEACH POST July 27, 2010

When MALE MENOPAUSE
kicks in …

Some men have lower than normal testosterone without signs or symptoms. But others may experience:

CHANGES IN SEXUAL FUNCTION.
This can mean less desire, fewer spontaneous erections, erectile dysfunction.

CHANGES IN SLEEP PATTERNS, for example insomnia.

PHYSICAL CHANGES.
More fat, less muscle bulk and strength, swollen or tender breasts, hair loss, less energy or hot flashes.

EMOTIONAL CHANGES.
Feeling sad or depressed, difficulty concentrating or remembering things.

Source: The Mayo Clinic




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