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A53 New delivery systems for hormone replacement therapy
A53 (cant)
A53 NEW DELIVERY SYSTEMS FOR HORMONE REPLACEMENT THERAPY Ian S Fraser,
First generationsubdermalimplants,severaltransdermalsystems and an intrauterinesystemhave beenavailablefor sometime, but there is considerable scopefor further developmentof all of these. Thereis alsoenormouspotentialfor the developmentof intravaginal rings delivering a range of dosesof estradiol with or without A wide range of different delivery systems is now under simultaneousprogestogens in a mannerwhich gives the woman developmentfor use with HRT througha numberof routes. These completecontrol over a very convenientbut long-actingdelivery areaimedat improvingthe ease,convenience,efficacy andsafetyof system. long term useof HRT. It is becomingclearthat mostwomenonly The aimof ongoingdevelopments is to provide womenwith a wide take HRT for relatively shortperiodsof time, eg. 6-12 months.The rangeof individualchoicesto suit their own particularmedicaland wide range of reasons for early discontinuation includes personalneedsand preferencesin a safe,effective and convenient inconvenienceor dislike of daily dosage,progestogenside-effects, manner.Educationof the generalpublic andthe medicalprofession persistingmenstruation,the fear of “weight gain”, mediascaresand aboutthe rangeof choices,andcounsellingof individualwomen,are the feelingthat it is “unnatural”. Different delivery systems canoffer an integralpartof the optimaluseof suchchoices. different combinations of attributesincludinglessfrequentandmore convenient dosage, the delivery of “natural” oestradiol and progesterone, more constantand lower blood levels, avoidanceof “first-pass”effect through the liver and reduction of somesideeffects. Someof these systemsare relatively “high-tech” and at present requirerelatively sophisticated medicalsupervisionfor counselling, initiation and removal, while others are under closer “personal” control by the womanherself. The effectsof thesesystemsmay be different dependingon the route of hormonedelivery, anddifferent tissuesmay havediffering requirements for hormoneexposure. Sydney Centre for ReproductiveHealth Research,Departmentof Obstetricsand Gynaecology, University of Sydney. NSW 2006, Australia
Continued
A54
A55 THE CONSEQUENCESOF LONGEVITY
FACTORS DETERMINING ANDROGEN LEVELS IN AGING MALES
M Lachowsky,
in chargeof the PsychosomaticUnit, HBpital Bichat, UniversitC A Vermeulen, J M Kaufman, Endocrine Section, Medical Clinic, University Hospital. De DenisDiderot,Paris,France. Pintelaan185,Gent(Belgium) Longevity is like life itself. ((F)T) levelsdecreasewith It is newandold. it isa conceptanda reality, it bringsandit takes,it In healthymenmean(free) testosterone is full of promisesbut alsofraughtwith risks. age, as documentedby crosssectionalas well as by longitudinal Longevity is life, life againstdeath,and this is why we doctorsand studies, but in all age groups, interindividual variations are scientistsfeel proud and- why not ? - happywhenlookingat those importantand somemenover 80yrs old have T levelswell within freshnewstatisticswhereold peopleseemto get evenolder. the normalrangefor young adults. Amongfactorsplaying a role in Womenused to last lessthan men,not dueto an innatedefect,but this variability, we mention body massindex, GH and/or IGF-1 by giving birth and enlarginghumanity in anotherdimensionthey concentration, insulin resistance, albumin concentration, chronicstress,mood,dietary andsocial(cigarettes, hadto go throughperilousadventures,adventureswheredeathstill atherosclerosis, lurks in somecountries. Now, menseemto be the fragile species, alcohol)factors. Moreover, chronic diseases (rheumatoidarthritis, andmaybeenjoyingthat turn of events... chronichepaticdisease,renal insufficiency,ischemicheart disease Inventingeverydaya newdeviceto maimor kill eachother,a part of etc.), are often accompaniedby decreasedT levels. Whereasa mankindseemsto be battling againsta life the other part is trying decrease in total T levelsmay be the consequence of changesin the hard to protect and prolong. But we all know longevity doesnot binding capacity of SHBG or primary testicular dysfunction, a meanimmortality,sowhy shouldwe not be simplysatisfiedwith the decreaseof FT, in the presenceof an adequatereservesecretory bonuswe arenow offered? capacity of both gonadotrophsand Leydig cells, implies an Maybe that is the core of the issue: is it a bonus,or is it a new impairmentof pulsatileG&H; this was shownto be the casein problem,arising- asalways! - from our unceasingdiscoveriesand normal elderly men, in obese men and in stresssituations. progress? Discussingthat aspectof longevity, with the dreadof Prevalenceof hypogonadalT levelsincreases with age,from 7% in sickness and solitude,comesbackto what our societyconsiders asa the group 40-60 yrs, to over 30% in the group over 80 yrs old. fate worsethandeath: ageandaging. Thesesubjectsmaybe candidatesfor HRT but the decisionwhether How to live longerwithout gettingolder,thenew Sphynxriddle... to treat shouldbe basedon the balancebetweenexpectedbenefits andpossiblesideeffects. Continued
17
A53 NEW DELIVERY SYSTEMS FOR HORMONE REPLACEMENT THERAPY Ian S Fraser,
First generationsubdermalimplants,severaltransdermalsystems and an intrauterinesystemhave beenavailablefor sometime, but there is considerable scopefor further developmentof all of these. Thereis alsoenormouspotentialfor the developmentof intravaginal rings delivering a range of dosesof estradiol with or without A wide range of different delivery systems is now under simultaneousprogestogens in a mannerwhich gives the woman developmentfor use with HRT througha numberof routes. These completecontrol over a very convenientbut long-actingdelivery areaimedat improvingthe ease,convenience,efficacy andsafetyof system. long term useof HRT. It is becomingclearthat mostwomenonly The aimof ongoingdevelopments is to provide womenwith a wide take HRT for relatively shortperiodsof time, eg. 6-12 months.The rangeof individualchoicesto suit their own particularmedicaland wide range of reasons for early discontinuation includes personalneedsand preferencesin a safe,effective and convenient inconvenienceor dislike of daily dosage,progestogenside-effects, manner.Educationof the generalpublic andthe medicalprofession persistingmenstruation,the fear of “weight gain”, mediascaresand aboutthe rangeof choices,andcounsellingof individualwomen,are the feelingthat it is “unnatural”. Different delivery systems canoffer an integralpartof the optimaluseof suchchoices. different combinations of attributesincludinglessfrequentandmore convenient dosage, the delivery of “natural” oestradiol and progesterone, more constantand lower blood levels, avoidanceof “first-pass”effect through the liver and reduction of somesideeffects. Someof these systemsare relatively “high-tech” and at present requirerelatively sophisticated medicalsupervisionfor counselling, initiation and removal, while others are under closer “personal” control by the womanherself. The effectsof thesesystemsmay be different dependingon the route of hormonedelivery, anddifferent tissuesmay havediffering requirements for hormoneexposure. Sydney Centre for ReproductiveHealth Research,Departmentof Obstetricsand Gynaecology, University of Sydney. NSW 2006, Australia
Continued
A54
A55 THE CONSEQUENCESOF LONGEVITY
FACTORS DETERMINING ANDROGEN LEVELS IN AGING MALES
M Lachowsky,
in chargeof the PsychosomaticUnit, HBpital Bichat, UniversitC A Vermeulen, J M Kaufman, Endocrine Section, Medical Clinic, University Hospital. De DenisDiderot,Paris,France. Pintelaan185,Gent(Belgium) Longevity is like life itself. ((F)T) levelsdecreasewith It is newandold. it isa conceptanda reality, it bringsandit takes,it In healthymenmean(free) testosterone is full of promisesbut alsofraughtwith risks. age, as documentedby crosssectionalas well as by longitudinal Longevity is life, life againstdeath,and this is why we doctorsand studies, but in all age groups, interindividual variations are scientistsfeel proud and- why not ? - happywhenlookingat those importantand somemenover 80yrs old have T levelswell within freshnewstatisticswhereold peopleseemto get evenolder. the normalrangefor young adults. Amongfactorsplaying a role in Womenused to last lessthan men,not dueto an innatedefect,but this variability, we mention body massindex, GH and/or IGF-1 by giving birth and enlarginghumanity in anotherdimensionthey concentration, insulin resistance, albumin concentration, chronicstress,mood,dietary andsocial(cigarettes, hadto go throughperilousadventures,adventureswheredeathstill atherosclerosis, lurks in somecountries. Now, menseemto be the fragile species, alcohol)factors. Moreover, chronic diseases (rheumatoidarthritis, andmaybeenjoyingthat turn of events... chronichepaticdisease,renal insufficiency,ischemicheart disease Inventingeverydaya newdeviceto maimor kill eachother,a part of etc.), are often accompaniedby decreasedT levels. Whereasa mankindseemsto be battling againsta life the other part is trying decrease in total T levelsmay be the consequence of changesin the hard to protect and prolong. But we all know longevity doesnot binding capacity of SHBG or primary testicular dysfunction, a meanimmortality,sowhy shouldwe not be simplysatisfiedwith the decreaseof FT, in the presenceof an adequatereservesecretory bonuswe arenow offered? capacity of both gonadotrophsand Leydig cells, implies an Maybe that is the core of the issue: is it a bonus,or is it a new impairmentof pulsatileG&H; this was shownto be the casein problem,arising- asalways! - from our unceasingdiscoveriesand normal elderly men, in obese men and in stresssituations. progress? Discussingthat aspectof longevity, with the dreadof Prevalenceof hypogonadalT levelsincreases with age,from 7% in sickness and solitude,comesbackto what our societyconsiders asa the group 40-60 yrs, to over 30% in the group over 80 yrs old. fate worsethandeath: ageandaging. Thesesubjectsmaybe candidatesfor HRT but the decisionwhether How to live longerwithout gettingolder,thenew Sphynxriddle... to treat shouldbe basedon the balancebetweenexpectedbenefits andpossiblesideeffects. Continued
17