Testosterone Replacement Therapy For Men
Women have been undergoing hormone replacement therapy for menopause since Premarin hit the market in the 1940’s. Although most people are aware that a woman’s hormone levels change drastically at menopause, men also go through a similar decline in their hormones frequently referred to as Andropause. The decrease in testosterone in males is much less abrupt however and frequently men blame their symptoms on their busy lifestyle and accept it as a consequence of aging.
With the arrival of Viagra and other erectile dysfunction medications coming on the market there has been a resurgence of interest in male sexual health and hormonal balance. Many men are seeking testosterone replacement therapy to help their decreased libido keep up with their new found ability to maintain quality erections. Although the medical research is replete with positive health and quality of life benefits with testosterone therapy, there are still many in the lay press and medical community that warn against the use of exogenous hormones. Your very own primary care physician may be among the naysayers. So, in some instances it will be up to you to gather as much information that you can and share in the responsibility in making an educated decision about your own health and well-being.
If you are visiting our website, you have demonstrated that you are at least a little inquisitive about the benefits of testosterone therapy in men. The goal is to help expand your knowledge base as to the benefits and potential risks of the testosterone replacement therapy so you can make a well-informed decision about your own healthcare.
What Is Testosterone?
Testosterone has always been known as the male sex hormone. Many women are surprised to find out that they too produce testosterone however in a much smaller capacity than men. Testosterone is derived from cholesterol as are most of our hormones. Its chemical structure is very similar to that of cholesterol and with only minor adjustments to this base structure other hormones such as estradiol (estrogen), progesterone, cortisone, DHEA and androstenedione are also produced. The vast majority of testosterone is produced in the testicles under the influence of a releasing hormone called Luteinizing Hormone (LH). LH is produced in the pituitary gland. LH is released in a pulsatile manner and spurts of testosterone are released throughout the day. There is typically a surge in the morning which can account for morning erections in men. The testosterone that is in our blood stream is mostly bound up by a protein called sexual hormone binding globulin. This bound testosterone is inactive. The fraction of the testosterone that is not bound is called free testosterone. It is the free testosterone that is able to diffuse into the target tissues and exert its function. Only about 2-3 percent of the body’s testosterone is unbound and free.
Testosterone Deficiency (Low T)
A male’s testosterone is estimated to decrease 1-3% a year starting in his thirties. Unlike women that have an abrupt onset of their hormonal decline in menopause, the decline in a male’s testosterone is so gradual it is difficult to delineate a specific time when he knows his levels are “low”. It is estimated that in men over the age of 55 approximately 50% of them will have testosterone levels below the lowest normal range for young men. As mentioned in the hormone optimization section, “normal” is a relative term. It is derived for a population of a wide array of ages. An average level for all subjects tested is determined and then two standard deviations from the mean identifies the “normal” range. For testosterone the range is typically defined as 300 – 1100 ng/dL.
What Are The Symptoms Of Low T?
- Depressed mood
- Decreased sense of well being
- Breast development
- Decreased libido
- Sleep difficulties
- Decreased morning erections
- Joint pain/muscle aches
- Decreased strength
- Erectile Dysfunction
- Weight gain/belly fat
- Decreased mental clarity and focus
Who Should Get Treated?
In a man that has a total testosterone below 300 there is no controversy as to whether or not his level is considered “low” or whether or not he should be treated. But what about the symptomatic 48 year old that has a level of 550 that may have had a level of 850 when he was in his twenties? Should he start replacement therapy? Or, should he wait until his level drops below the magic lower limit of “normal” of 300? Testosterone Deficiency (Low T) is a clinical diagnosis based off of symptoms and there is no universally accepted lab level that makes the diagnosis. It is a syndrome that is not clearly understood by all primary care providers. It is up to the patient to make an educated decision and seek out a physician well versed in the current literature that can explain the benefits and potential risks involved with testosterone replacement therapy.
How will testosterone Replacement Therapy Help?
The medical literature supports replacing testosterone levels to optimal physiologic levels (upper end of the normal range). It has been shown to increase energy, improve sleep, increase lean muscle mass, decrease body fat, increase libido and increase an overall sense of well-being. All of which improve a man’s quality of life. The health benefits associated with optimized testosterone levels include: decreased risk of cardiovascular disease, strokes, Alzheimer’s disease, diabetes and osteoporosis.
Does Testosterone Replacement Therapy Cause Prostate Cancer?
The common myth that is perpetuated in the lay press and sometimes even in the medical community is that testosterone causes prostate cancer. This stems from a study of two patients in the 1940’s by Dr. Charles Huggins. The findings of his study have been debunked several times over and I would encourage the reader to look up “destroying the myth about testosterone replacement and prostate cancer” in a search engine and find the article written by Abraham Morgentaler, MD. It is rather informative and goes beyond the scope of this section.
Suffice it to say, at physiologic replacement levels/optimal levels which is the range we strive for at Prestige Medical Rejuvenation Center, there is no evidence of an increased risk of prostate cancer. In fact, it has been shown that at low levels (below 300) is when a man is at an increased risk of prostate cancer. Although testosterone does not cause prostate cancer it has the potential to cause an undetected prostate cancer to grow to a limited extent. We screen all of our male patients with a total Prostate Specific Antigen (PSA) and in those that are elevated we check a percent free PSA test to determine if they need to see his urologist for a potential prostate cancer workup. We monitor these levels annually as well.
Does Testosterone Replacement Therapy Cause Heart Attacks?
There are those that also link testosterone replacement with an increased risk of cardiovascular disease. Some of this stems from the fact that men have a much higher level of testosterone than women and men also have higher incidence of heart disease. The ill-informed may then draw the conclusion that elevated testosterone causes heart disease. It is important to stress that an association between two things does not prove causation. The medical research actually shows the opposite effect and the incidence of heart disease is higher in men with low testosterone compared to men with high testosterone. In fact, testosterone has been shown to be a vasodilator and there are studies showing it can relieve the symptoms of angina when given intravenously. Testosterone replacement has also been shown to decrease total cholesterol and increase the good cholesterol known as HDL.
Types of Testosterone Replacement Therapy
Testosterone comes in several forms whether it be a cream, gel, oral pill, injection or subcutaneous pellets/implants. We prefer to not use the oral or injectable synthetic testosterone as it gets metabolized by the liver which raises cholesterol levels and can also alter blood clotting factors. The transdermal and subcutaneous implants avoid this liver metabolism and have been shown to decrease your cholesterol level. At Prestige Medical Rejuvenation Center we offer the subcutaneous pellets/implants from BioTE Medical. They are consistently 98-99% pure bioidentical testosterone and this purity is unmatched in the industry.
Why Are Testosterone Pellets The Best?
The benefit of the pellets over topical creams/gels is the improved serum levels obtained with the pellets; the steady state obtained in the levels vs. peaks and troughs; not needing to remember to apply the cream/gel daily and no need to worry about accidentally transferring any of the testosterone to your family members or pets.
Although one can achieve physiologic levels with the injectable synthetic forms of testosterone, the rollercoaster effect with peaks and troughs seen in the creams/gels is also seen with the injectable form. This roller coaster effect is due to the fact that the injectable form and transdermal forms are time released. One will get a spike in the testosterone level shortly after it is injected or applied and then the level gradually declines over time until the next application or shot. With the pellets, the absorption is not time released. Once the implants are placed under the skin, small blood vessels called capillaries surround them. The testosterone is then absorbed by these capillaries. There will be a slight delay in reaching physiologic levels compared to injections and transdermal forms as the body develops these new blood vessels surrounding the pellets. However, once the peak level is obtained a steady state remains for several months. The further release of the testosterone from the pellets is not time released as previously mentioned. Rather, it is dependent on the patient’s cardiac output. When the patient is awake and active, there is more blood flow going through the capillaries that surround the testosterone pellets. With more blood flow comes more testosterone absorbed and this mimics our natural physiology. When one sleeps there is less blood flow and less absorption of the testosterone.
Patient compliance is always a concern when having to give yourself an injection once or twice a week or to remember to apply a cream/gel daily. With the pellets, they are placed through a small incision under the skin of your buttocks and they are slowly absorbed over the next 4 – 6 months. The patient doesn’t have to remember to do anything else to achieve optimal serum testosterone levels.
How Does Testosterone Effect Estrogen Levels?
Testosterone can get converted/aromatized to estradiol (estrogen) and this conversion rate varies for each individual. Some men require an estrogen blocking medication to keep this level in the optimal range. Estradiol is important for the health of man’s brain, bones, skin and vascular system. Estradiol also has beneficial effects on the cholesterol levels as it increases HDL and decreases LDL. Too much estradiol can cause worsening moods, swollen and sore nipples, breast development (gynecomastia) and over stimulation of the prostate. If the estrogen is blocked unnecessarily and the level is too low, one can experience joint pain and less commonly one can experience irritability and aggressiveness known to some as “roid rage”. Because of this we also follow your estradiol (estrogen) levels and keep you in the optimal range.
How Does One Get Started With Testosterone Replacement Therapy?
The initial step is checking your blood levels of total testosterone, free testosterone, prostate specific antigen, and estradiol (estrogen) to see if you are indeed a good candidate. If you are a candidate and choose to go ahead with the procedure your dose is individualized based on age, body weight, activity level as well as your baseline blood levels. Four weeks following the procedure we verify the dosing by rechecking your serum levels. If your levels are not in the optimal range we will offer you a booster implant/pellet for no extra charge.
Get optimized and get your life back by calling Prestige Medical Rejuvenation Center today at (402) 334-5433.