Testosterone replacement: A cautionary taleHormone therapy programs aren't only for women. Men experience a more gradual loss of hormones, mainly testosterone. The result is andropause, known as the "male menopause. This hormone replacement therapy men, medically supervised program includes natural HRT for men, as well as customized fitness and nutrition programs for millions of men suffering from hormonal imbalance. These expert bioidentical hormone doctors provide a natural treatment for the symptoms of andropause, helping men regain their health and confidence. Hormonal imbalances in men are womens bodybuilding dead the root of many chronic health problems replacemebt can increase the risk of serious disease.
Hormone Replacement Therapy in Men (BHRT) | BodyLogicMD
As this happens, there will be a dramatic increase in age-related health problems too, including cancer, strokes, heart disease and hormone deficiency. Although the health risks associated with age-related hormonal decline in women, termed menopause, have been thoroughly addressed, it has now been shown that hormonal changes in the aging male are associated with significant health problems.
Specialty board certified Dr. To learn more about male hormone replacement, please select one of the following topics. If you are ready to schedule a consultation with Dr. Turek, please request a consultation here. There is a progressive decline in testosterone production in men with age.
Despite the fact that it is not as rapid a drop in hormones as women get with menopause, it certainly is just as real. This has been termed male menopause, male climacteric, andropause, or more appropriately, partial androgen deficiency in the aging male PADAM. Serum testosterone levels in men fall progressively from the third decade to the end of life, mainly due to a decline in the cells in the testis that make the hormone Leydig cells.
One issue with testosterone that complicates matters is the fact that it exists in several different forms in the blood, and each form has different hormonal activity Figure 1. What is usually measured in a blood draw is the total testosterone, which is a combination of the free and protein-bound forms.
An analogy to explain this is to think of the total testosterone as all of the cars in a parking lot. Importantly, though, only the cars that can start or drive are useful or active.
Free testosterone comprises all of the cars that can start and be driven away, but the protein-bound testosterone are those cars that may or may not start, and those that may or may not be able to be driven away.
So, aging is associated with 1 lower total testosterone production fewer cars in the lot and 2 higher levels of certain proteins that bind testosterone sex hormone-binding globulin, SHBG , such that even fewer cars can start and run, and it is this combination of events that leads to declining testosterone activity with age.
Thus, the complex physiology of testosterone balance often clouds the interpretation of age-related declining levels of the hormone. Testosterone affects the function of many organs in the body Table 1.
In the brain, it influences libido or sex drive, male aggression, mood and thinking. Testosterone can improve verbal memory and visual-spatial skills. It as also been shown to decrease fatigue and depression in men with low levels.
It is responsible for muscle strength and growth, and stimulates stem cells and blood cells in bones and kidneys. Penile growth, erections, sperm production, and prostatic growth and function all depend on testosterone. It also causes body hair growth, balding, and drives beard growth.
Thus, testosterone makes us who we are, and influences how we look. In men with low testosterone levels, testosterone can improve bone mineral density and reduce bone fractures, an effect similar to that found in postmenopausal women on estrogen replacement. Testosterone results in increases in lean body mass, possibly strength and can decrease fat mass. By stimulating erythropoietin, testosterone increases blood counts. It appears to improve lipid profiles and dilates blood vessels in the heart but no data has yet shown that it reduces heart attacks or strokes.
It appears not to alter LDL or total cholesterol levels. Sexual function also improves with testosterone. Most studies agree that sexual drive is improved by testosterone. Penile erections may be improved with testosterone, but only in men with low testosterone levels. To make an accurate diagnosis of low testosterone, symptoms or findings must accompany a blood draw showing a low testosterone level.
This combination makes treatment worthwhile to pursue. Symptoms include decreased sexual desire and erectile dysfunction, changes in mood associated with fatigue, depression and anger, and decreases in memory and spatial orientation ability.
On examination, there may be decreased lean body mass with reduced muscle volume and strength, and increases in abdominal girth. Decreased or thinning of facial and chest hair and skin alterations such as increases in facial wrinkling and pale-appearing skin suggestive of anemia may also be noted. Testicles that have become smaller or softer may also be present. Finally, low bone mineral density with osteopenia or osteoporosis may also suggest a problem.
Not all of these findings need to be present at the same time to diagnose the problem. In fact, many of these symptoms can be attributed simply to the natural and unavoidable consequence of aging. For example, frailty may be due to many causes, some of which include loss of muscle strength, bone fractures, decreased mood, and impaired cognition, symptoms typical of testosterone deficiency. However, the association of such symptoms along with a low testosterone certainly implicates this as a problem.
Because testosterone is found in several forms in the blood, there is debate as to what test is best to diagnose testosterone deficiency. In general, a total testosterone is ordered first. Turek then follows the algorithm in Figure 2. Presently, measuring testosterone byproducts such as dihydrotestosterone DHT , estradiol and dihydroandrosteindione DHEA is not that useful in making the diagnosis. In addition, a DEXA scan is an accurate, quick and painless procedure for measuring bone density or bone loss.
Bone density assessments can also be performed periodically during testosterone replacement to assess the bone response to treatment. Certainly an evaluation for prostate cancer with a PSA and rectal examination is indicated in men who are at risk prior to testosterone treatment.
The ideal testosterone therapy maintains normal concentrations of the hormone without having significant side effects. Several kinds of hormone replacement are currently available at The Turek Clinic, including oral, injectable, transdermal and buccal mucosal systems as outlined in Table 2. Types of testosterone therapy in the US. Risk of liver problems Intramuscular Testosterone cypionate Testosterone enanthate Testosterone cypionate Testosterone enanthate Deep intramuscular injection.
Gives very high and low levels; mood fluctuations. Subdermal implant Testopel gms Nonsurgical procedure to place implant.
Transbuccal pill Striant 30mg buccal tablet Take twice daily. Gum or mouth irritation. Testosterone replacement is generally considered a long term therapy and patients need to be monitored regularly as outlined in Table 3. Prior to starting treatment, a digital rectal examination and serum PSA are important. Within a month or two after treatment is started, symptoms and testosterone levels should be assessed. During the first year of therapy, patients should be followed regularly to assess clinical response.
After the first year, patients who are stable may be followed annually. Annual evaluations should include testosterone, hemoglobin, liver function tests, lipid profile and PSA tests. Bone density and psychological evaluations can be done depending on the original reasons for treatment. The natural androgen DHT is a metabolite of testosterone. It is a selective androgen because, unlike testosterone, it cannot be converted to estrogens.
It is also a potent androgen, binding to receptors more avidly than testosterone. DHT has an effect on several target tissues, including external genitalia, prostate and skin.
DHT deficient men have normal muscle mass and are not osteoporotic. It is a steroid hormone made by the adrenal gland and its level progressively declines beginning the third decade of life and beyond. Clinical trials looking at DHEA for multiple conditions have been inconsistent. Placebo-controlled studies suggest that doses of mg of oral DHEA may produce physiologic androgen levels.
However, its value in older men is not well established. There are decreases in growth hormone and insulin-like growth factor-I with age in both men and women. In addition, treatment of young GH-deficient adults with growth hormone improves body composition, muscle strength, physical function, and bone density, and reduces blood cholesterol and cardiovascular disease risk. Some of these improvements are in health domains similar to those affected by testosterone.
However, growth hormone treatment is often accompanied by carpal tunnel syndrome, peripheral swelling, joint pain and swelling, breast tenderness, glucose intolerance, and possibly increased cancer risk. In older individuals, growth hormone treatment improves lean body mass and reduces body fat.
However, clinically significant functional benefits, prolongation of youth, and life extension have not been demonstrated. This may lead to hypertension, leg swelling, or worsening heart failure.
Weight and blood pressure monitoring are important for at-risk patients on therapy. Testosterone therapy of any type generally leads reduced sperm production. Sperm counts usually rebound within months after therapy is stopped. Patients on testosterone should be informed that fertility will be impaired during treatment. Excessive red blood cell count polycythemia was a commonly observed side effect in a meta-analysis of clinical trials of testosterone therapy.
Blood counts hematocrit levels above 50 have been associated with an increased risk of stroke. Polycythemia is most commonly seen with injectable testosterone.
Monitoring blood counts is important for patients on testosterone replacement. In addition, testosterone may suppress clotting factors II, V, and VII, and worsen bleeding in patients on anticoagulation. Liver damage has been reported with oral treatments. However, it is very rarely observed with injectable, transdermal and transbuccal formulations. Although it does not cause sleep apnea, testosterone therapy can worsen existing sleep apnea. Men at risk of sleep apnea include elderly and obese men, and those with chronic obstructive pulmonary disease.
Painful breast enlargement gynecomastia due to high levels of estrogen which comes from testosterone can develop during therapy. Medications call estrogen receptor blockers can treat this side effect.
Testosterone therapy is not thought to affect total cholesterol or LDL cholesterol, but the affect on high-density lipoprotein HDL levels remains unclear. It is reasonable to follow lipid levels during treatment.