Testosterone, the chief male hormone, is essential for libido and erectile function, and plays a crucial role in mood, energy, bone health, and body composition.
Testosterone levels decline with age, usually beginning in a man’s mid-30s. Diminishing testosterone levels have been linked with disorders such as depression, fatigue, obesity, and cognitive decline.
Low testosterone levels increase the risk of coronary heart disease, osteoporosis, fractures and frailty. men with low testosterone levels are more likely to die from cardiovascular disease and all causes compared with men who have higher levels.
Restoring testosterone to youthful levels offers men a wealth of health benefits, including benefits for heart health, body composition, mood, and memory.
Bioidentical testosterone has not been found to have adverse effects on the healthy prostate gland—in fact, it may help improve prostate symptoms in men with low-normal testosterone levels. Testosterone therapy is usually not given to men with prostate cancer.
Regular blood testing can help you and your physician decide if testosterone therapy is right for you. Optimizing testosterone levels requires a multi-pronged approach that includes optimal diet, proper nutrition, nutritional supplements, exercise, and bioidentical testosterone, if necessary.
Testosterone appears to affect fat cell metabolism and fat loss in several ways through:
- Inhibiting fat storage by blocking a key enzyme called lipoprotein lipase that is necessary for the uptake of fat into the body’s fat cells. When fat cells are exposed to testosterone in a test tube, the activity of lipoprotein lipase is dramatically reduced.
- Stimulating fat burning by increasing the number of certain receptors on the fat-cell membrane that release stored fat.
- Increasing insulin sensitivity and improving lipid and insulin metabolism, while enhancing growth of muscle fibers and decreasing fat deposits.
All of these effects benefit body composition by promoting lean body mass and reducing fat mass.
Besides T creams and injections, we also utilize HCG and Clomid to restore testosterone levels in men. We even do T Pellets.
Medications used to treat erectile dysfunction, such as sildenafil (Viagra®), vardenafil (Levitra®), and tadalafil (Cialis®), improve erectile function by inhibiting the PDE5 enzyme, allowing an erection to persist. These medications provide only temporary benefits and may cause minor to severe side effects such as headache, indigestion and visual disturbances. However, approximately one-third of men with erectile dysfunction do not respond to PDE5 inhibitors; Men whose erectile dysfunction is not improved by PDE5 inhibitors may have low testosterone levels.
Erectile dysfunction is the inability to achieve or sustain a penile erection sufficient for satisfactory male sexual performance. The condition affects up to 30 million American men, and is typically age-dependent. Erectile dysfunction can cause substantial emotional distress by negatively impacting intimate relationships, self-esteem, and overall quality of life.
The underlying physiology of erectile function is tied very closely to cardiovascular health. Therefore, men who wish to perform at their sexual peak must take steps to optimize their blood vessel health.
An erection is triggered by a complex interplay between the sympathetic and parasympathetic nervous system, with local sensory stimulation of the genital area and/ or central psychogenic stimulation resulting from visual, tactile, auditory, olfactory, and/or imaginative input. The endothelial cells that line the blood vessels of the penis produce vasoactive factors that dilate blood vessels, one of the most important being nitric oxide. Nitric oxide, by initiating production of another chemical messenger called cyclic guanosine monophosphate (cGMP), triggers a biochemical cascade leading to expansion (vasodilatation) of penile blood vessels and allows for increased blood flow into the corpus cavernosum, the two columns of spongy tissue that run along the top length of the penis. As the corpus cavernosum fills with blood it stretches, compressing the primary site where blood exits the penis, called the subtunical venules. This compression causes resistance to blood flow out of the penis, producing and maintaining an erection
TREATMENT OF ERECTILE DYSFUNCTION
Testosterone restoration can lead to improved erectile function and libido in men with low androgen levels. When PDE5 inhibitors fail, the addition of testosterone therapy is associated with substantial improvement in erectile function among men with low testosterone and may eliminate the need for PDE5 inhibitors altogether.
Dehydroepiandrosterone (DHEA) is a precursor to testosterone. As with testosterone, aging is associated with decreased levels of DHEA. Circulating levels of DHEA can decline by up to 80% from age 25 to 80. Low DHEA levels have been linked to erectile dysfunction. Studies have shown that oral DHEA supplementation may improve sexual performance, as measured by erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction in some men. An optimal target blood level for DHEA-sulfate of 350 – 490 µg/dL
Physicians versed in male hormone restoration know that exogenous administration of testosterone may increase estrogen (estradiol) levels in aging men, in particular aging men with significant amounts of visceral fat. The conversion of testosterone into estrogen is called aromatization and is mediated by an enzyme called aromatase. Aromatase inhibitors (eg, anastrozole [Arimidex®]) are drugs that inhibit the activity of the aromatase enzyme, thereby reducing the amount of testosterone converted into estradiol.
When used concurrently with testosterone supplementation, aromatase inhibitors allow testosterone levels to rise without being converted into excess estrogen. Reports suggest that aromatase inhibitor therapy can improve sexual function in men.
Maintaining healthy testosterone/estrogen balance has other important implications for aging males. For example, in a study among men with heart failure, both low and high estradiol levels were associated with significantly increased chances of death compared to “balanced” levels Although PDE5 inhibitors are generally well tolerated, they can cause a number of side effects including headache, indigestion, visual disturbances, priapism (ie, painful, prolonged erection lasting more than 6 hours), and even blindness. Furthermore, the use of PDE5 inhibitors is limited in some men by contraindications such as cardiovascular disease. These drugs can also interact with other medications (eg, nitrates) and cause negative reactions. PDE5 inhibitors only improve erectile function, not overall sexual function.
In men who are not good candidates for or do not respond well to PDE5 inhibitors, intracavernosal vasodilating medications are a second-line treatment option. These treatments are delivered via self-injection into the cavernosum. Adverse effects may include pain, prolonged erection, and fibrosis. Alprostadil is synthetic prostaglandin E1, which is a biochemical signaling molecule with vasodilatory properties. Studies show alprostadil to be effective in about 70% of men with erectile dysfunction. Alprostadil can now be delivered via topical cream as well, which has demonstrated a success rate similar to injectable forms. Papaverine, a compound derived from the poppy plant, nonspecifically inhibits phosphodiesterase enzymes and modulates calcium signaling. It does not possess opiate properties like some other poppy derivatives. Studies suggest a patient satisfaction rate of about 44%. Papaverine use may increase liver function tests with the potential for hepatotoxicity. Phentolamine blocks alpha-1 and -2 adrenergic receptors. This helps facilitate erection by impairing muscle constriction. Phentolamine alone is not sufficient to trigger and sustain rigid erection, so it is used in combination with other intracavernosal agents for an additive effect. Because phentolamine is expensive and needs to be refrigerated, it may be less convenient. Another alternative is utilizing a vacuum device (VED) to artificially increase penile blood flow. These devices consist of plastic cylinders that are placed over the penis and vacuumed by a pump to negative pressure to allow cavernosal expansion and erection. Constriction rings are then placed at the base of the penis to retain blood. Vacuum erection devices provide a relatively safe and efficacious alternative for those unresponsive to or unable to take oral medications. Disadvantages include lack of penile stability, which may interfere with sexual performance, and inhibited ejaculation.
L-arginine supplementation is an essential amino acid with numerous metabolic actions. It plays a significant role in erectile function by contributing to the formation of the vasodilator nitric oxide. Supplementation with L-arginine has been shown to restore erectile quality and increase sexual satisfaction by boosting nitric oxide bioactivity and improving penile blood flow. The efficacy of L-arginine, combined with Pycnogenol, a bioactive compound derived from French maritime bark with vasodilatory properties, has been tested and been shown to improve male sexual function. This combination is called Prelox. L-arginine supplementation has also been shown to attenuate endothelial dysfunction associated with high cholesterol and coronary heart disease. Since endothelial dysfunction diminishes the effects of PDE-5 inhibitors, L-arginine supplementation may be a useful add-on therapy for men who do not respond to these drugs.
Epimedium is a genus of over 50 distinct species of plants. It is colloquially referred to as horny goat weed because it was observed that goats who ate it subsequently engaged in intense sexual activity. Epimedium has been used in traditional Chinese medicine for centuries as a natural aphrodisiac and for the treatment of erectile dysfunction. Research has shown that icariin, a bioactive component derived from the aerial portion of the Epimedium plant, improves erectile and sexual function when administered orally. Laboratory data show that icariin can inhibit PDE5, improve penile blood flow, and support endothelial integrity. Icariin also has testosterone-like properties and is associated with increased intracavernosal pressure and nitric oxide levels.
Yohimbine, a compound derived from the bark of the Yohimbe tree, has been utilized in the treatment of erectile dysfunction for over 70 years. Yohimbine’s mechanism of action is thought to be its ability to enhance smooth muscle relaxation, thereby promoting penile erection. It is thought to accomplish this by blocking the effects of neurotransmitter receptors called alpha-2 adrenergic receptors, which promote smooth muscle contraction when activated. Clinical studies of yohimbine, alone or in combination with L-arginine, have shown improved erectile function. In one clinical trial, yohimbine was effective for up to 84% of male volunteers, depending on the type of erectile dysfunction. Compared to placebo, yohimbine was more effective at improving self-reported sexual function and penile rigidity. Another study found that yohimbine improved erectile function in 42% of men with erectile dysfunction, compared to 27% of subjects taking placebo. Additionally, yohimbine may be particularly effective among type 2 diabetics and those with non-biological causes of erectile dysfunction. Yohimbine may cause some side effects including heart palpitations, anxiety, fine tremor, and high blood pressure. These occur infrequently and are usually reversible.
Ginseng belongs to the genus Panax, which is a group of slow-growing perennial plants with distinctively fleshy roots. Five thousand years after it was first used for the treatment of erectile dysfunction in ancient China, ginseng continues to be a popular natural aphrodisiac. An estimated 6 million Americans have used ginseng for the improvement of sexual dysfunction. Ginsenosides, the principle active constituents in ginseng, have cardio-protective, immune-stimulatory, anti-fatigue, hepato-protective, and antioxidant effects. In addition, they also increase the synthesis of nitric oxide. In animal studies, ginsenosides have been shown to relax penile smooth muscle tissue (through the release of nitric oxide) and potentially affect chemical pathways involving cGMP and testosterone. A 2009 clinical study showed that 1000 mg of Panax ginseng twice daily improved erectile function and overall sexual satisfaction among men with erectile dysfunction. The study also found that ginseng potentially increased testosterone levels. The authors concluded that ginseng could be effective for improving erectile function regardless of age and severity of dysfunction. Another study showed that ginseng significantly improved penile rigidity, libido, and satisfaction among men with erectile dysfunction.
Maca (Lepidium meyenii) is a root vegetable belonging to the mustard (ie, Brassica) family. Ancient Peruvians have cultivated maca for millennia and taken advantage of its aphrodisiac properties. The dried root of the maca plant is a rich source of amino acids, iodine, iron, and magnesium. Scientific studies support the aphrodisiac activity of maca, and show that it stimulates metabolism, helps control body weight, increases energy, improves memory, and reduces stress and depression. It also shows androgen-like effects in animals. Human clinical studies suggest that maca enhances the production of sex hormones, increases libido, and improves well-being. The aphrodisiac activity of maca may be due to local effects on erectile function and/or central nervous system effects.
Extracts of leaves from the Ginkgo biloba tree have been used for centuries in the treatment of asthma, fatigue, circulatory problems, and vertigo. It has more recently been associated with enhanced sexual desire, excitement, orgasm, and resolution, as well as neuroprotective properties. The sexual benefits of ginkgo were discovered serendipitously when male geriatric patients taking Ginkgo biloba for memory enhancement reported improved erections. In addition to experimental data showing that Ginkgo biloba can enhance sexual behavior in rats, clinical studies have revealed it can increase penile blood supply and improve erectile function in humans. Ginkgo contributes to increased blood flow by increasing nitric oxide bioavailability to vascular smooth muscles of the penis. In one study, 120-240 mg of Ginkgo biloba extract was associated with a 76% improvement in sexual dysfunction among men being treated with antidepressants.
Muira Puama, also known as potency wood, is an herb that comes from a small bush in the rain forests of Brazil. It has been associated with enhanced erectile function and orgasm in aging men suffering the effects of fatigue or age-related complaints. In one study of 262 men suffering from poor sexual desire, more than 60% reported improvements with Muira Puama supplementation. In addition, more than half of the men with erectile dysfunction reported that Muira Puama was beneficial. While Muira Puama’s mechanism of action remains unknown, its actions may be related to its plant sterol content. Plant sterols may contribute to increased synthesis of testosterone.
The bioflavonoid chrysin is a natural aromatase inhibitor that helps minimize the conversion of testosterone to estrogen. Although chrysin has low oral bioavailability, its bioavailability may be improved by co-administration with the black pepper extract piperine, thus enhancing its actions as an aromatase inhibitor.
Carnitine (including acetyl-L-carnitine [ALC] and propionyl-L-carnitine [PLC]) are natural amino acid compounds. Studies have linked carnitines to a variety of positive effects among men with low testosterone, including improved erection quality/function, orgasm, and general sexual well-being. Carnitines may have testosterone-like effects in the body. A 2012 study showed that 250 mg of PLC daily for 3 months (in combination with 2500 mg of L-arginine and 20 mg of niacin) successfully improved erections in 40% of men with erectile dysfunction, while nearly 77% of men reported a partial response. Carnitines may improve endothelial function by acting as antioxidants in these cells. For this reason, carnitine supplementation may be generally beneficial for cardiovascular health. Carnitine may also have a place as a combination therapy with PDE5 inhibitors, especially among patients whose erectile dysfunction is caused by underlying endothelial disorders, such as diabetes.
Vitamin D insufficiency (as defined by serum levels <30 ng/mL) affects over 75% of the United States population. Vitamin D deficiency may be a risk factor for erectile dysfunction, since it contributes to arterial stiffness and vascular dysfunction. Researchers have theorized that optimizing vitamin D levels could reduce certain risk factors for erectile dysfunction, such as arterial stiffness, diabetes mellitus, hypertension, and inflammation of the endothelium. Vitamin D has also been shown to stimulate the production of nitric oxide.
B vitamins – Inadequate intake of B vitamins, especially folate, B6, and B12, can contribute to elevated levels of homocysteine. Homocysteine is a metabolic amino acid derivative that can damage endothelial cells and contribute to cardiovascular disease. In one study, homocysteine impaired carvernosal smooth muscle relaxation. The authors proposed homocysteine as a risk factor for erectile dysfunction. B vitamin supplementation can help keep homocysteine levels in a healthy range; therefore, may be helpful in reducing erectile dysfunction.
Vitamin E – Erectile dysfunction is often associated with oxidative stress, which impairs endothelial function and reduces nitric oxide bioavailability. Both experimental and clinical data has shown that vitamin E may be beneficial for erectile dysfunction, since it enhances endothelial cell function, scavenges free radicals, improves nitric oxide-mediated relaxation, preserves nerve function, and increases intracavernosal pressure. Through these various actions, vitamin E has shown promising results in experimental models of erectile dysfunction caused by aging and hypertension. Vitamin E may also be beneficial when added to PDE5 inhibitor treatment, especially if treatment with a PDE5 inhibitor alone has not been successful in the past.
Men & Estrogen
Many men who can boast normal levels of testosterone nonetheless exhibit characteristic symptoms of the male menopause. They find their energy diminishing and their sexual life faltering. If this situation is due to a hormonal imbalance, it may not be related to testosterone. Frequently it is in the level of estrogen, the female hormone, where the trouble is.
Men react with surprise when they learn the male body contains its own natural supply of estrogen. They are equally unprepared for the news that estrogen is a normal aspect of their hormonal makeup. The male body actually manufactures the female hormone from testosterone. An enzyme in the body, aromatase, converts a small portion of testosterone into estrogen, a process necessary for the healthy functioning of estrogen – sensitive tissues in a man’s body.
It is likely that estrogen is beneficial to the male brain. Estrogen is definitely important in influencing certain natural sexual functions through its effects on brain chemistry. The very areas of the brain involved with sexual function require estrogen for its special purposes in those specific locations. When it comes to estrogen levels, however, the effective range in the male body is very narrow. Too little estrogen will neuter a man just as effectively as too little testosterone. Too much estrogen can displace testosterone at various cellular receptor sites, switching off important cellular activities.
As we grow older aromatase levels tend to increase, resulting in greater estrogen production. In addition, methods for eliminating estrogen, once it has been created, decline. Consequently, the middle-aged man becomes estrogen dominant. By the time a man reaches his fifties the estrogen level in his body may actually exceed that found in a menopausal woman on estrogen replacement therapy. The changing ratio of estrogen to testosterone is a major factor underlying a common form of male menopause known as metabolic andropause.
Estrogen dominance develops slowly in men. Some common reasons for midlife estrogen elevation in males include:
- Age-related increases in aromatase activity
- Alteration in liver function
- Zinc deficiency
- Overuse of alcohol
- Drug-induced estrogen imbalance
- Ingestion of estrogen-enhancing food or environmental substances
High estrogen levels are associated with increased risk of heart attacks in males – the exact opposite of its effect in females, in whom it has cardioprotective effects, dilating the coronaries, decreasing clotting factors and revving up the body’s natural clot-busting system. Increasing levels of estrogen in men may adversely affect the prostate gland. Some studies have found that men with higher estrogen levels are more likely to develop benign prostatic hypertrophy. In many men, high estrogen levels cause an actual reduction in testosterone production, and reduce the effective availability of testosterone. A relative excess of estrogen to testosterone diminishes male sexuality.
If upon testing your hormone levels, we discover a relatively high estrogen level, we might resolve the problem of this metabolic andropause by first addressing the common causes of elevated estrogen. If you are overweight, we may reduce your caloric intake and have you follow a Mediterranean-type diet. Fat cells convert testosterone to estrogen. Moreover, obesity is associated with lower testosterone levels. As the pounds drop off, so will many of the symptoms of male menopause. Increasing consumption of cruciferous vegetables, such as broccoli and cauliflower, will stimulate removal of excess estrogen. The phytoestrogens in a diet rich in soy compete with estrogen receptor sites, block its actions, and stimulate the liver to process and excrete excess estrogen. Avoid grapefruit, as it tends to inhibit the liver’s breakdown of estrogen. Alcohol significantly inhibits clearance of estrogen from the blood and reduces zinc levels. Consider reducing your consumption of alcohol or give up drinking altogether.
Some nutritional supplements have been found to help restore a proper balance of testosterone to estrogen. Many men can reduce estrogen levels by supplementing with zinc, which inhibits the conversion of testosterone to estrogen. Vitamin C and chrysin may further improve the testosterone to estrogen ratio.
You can also begin a regular program of resistance training exercise, after receiving medical clearance from your physician. Heavy weight training stimulates increased levels of testosterone.
Many prescription and over-the-counter medications have the potential to increase your levels of estrogen. They include some drugs within the following categories: anti-inflammatory drugs, cholesterol lowering drugs, anti-depressants, heart and blood pressure medicine, antibiotics and antifungal agents. If you are on one of them, we should find an effective substitute.
The problem of estrogen dominance may not simply be a result of natural metabolic changes in hormone conversion and in hormone excretion. The environment and many foods we consume expose us to numerous synthetic estrogens. Many herbicides and pesticides produce an estrogenic effect. Several of the chemicals given to livestock and poultry are estrogenic.
Men who intend to live a long, vital, and healthy life should address, at some point, hormone levels just as seriously as things like cholesterol, blood sugar and blood pressure. Maintaining an optimum balance of hormones, including estrogen, is one of many lifestyle choices available for men aspiring to reach peak health and to prevent aging-related declines. You cannot retain the energy of youth, or expect to maintain functional ability and resilience without a life in balance.
Andropause – Male ‘Menopause’
Andropause, also known as male androgen deficiency syndrome, is the male equivalent of female menopause. It results from diminished levels of testosterone in the body, and exhibits a similar symptom complex to female menopause.
Testosterone is a hormone secreted by the ovaries, adrenal glands and testes. It is the primary male sex hormone, responsible for male sexual development and critical in maintaining erectile function, libido, normal energy levels, and mood. Testosterone also controls a whole range of physiological functions throughout the body.
Testosterone levels decline with age, beginning when a man is in his thirties. By the age of 80 it is only 1/5 of what it was in youth. In addition to aging, stress can also play a role in declining testosterone levels. While the total testosterone does not drop drastically, the free testosterone, which is the biologically active form, does decline significantly with age. Increased estrogen levels (due to obesity, a high-fat diet, alcohol consumption, and low levels of serum zinc) and insulin resistance in men can further reduce free testosterone levels.
The number of men in the U.S., between the ages of 45 and 70 years, is expected to increase from 46 million in 1990 to 81 million by 2020. Currently more than 5 million men in the United States suffer from the effects of hypogonadism or low testosterone levels.
Because the drop in testosterone is more gradual, the symptoms of andropause, male ‘menopause,’ appear over a longer period of time compared to the female menopause. Symptoms present slowly, with a loss of overall energy, thinning bones and muscles, increased body fat, depression, and impaired sexual function. Testosterone deficiency has also been linked to hypertension, obesity and increased risk of heart disease. Men with heart attacks often have lower levels of testosterone and higher levels of estrogen. Low free testosterone is an independent predictor of the degree of coronary artery disease in men. Low testosterone is also a common characteristic in men suffering from heart failure.
Testosterone replacement has been shown to increase cardiac output in some men with congestive heart failure (a good thing).
One way to help maintain (if not actually increase) testosterone levels is by reducing excess body fat. Weight- training is another way to raise testosterone levels in both males and females. Additional lifestyle changes include avoiding excess alcohol and high-fat diets, increasing intake of soy products, taking caution with drugs which impair liver function, and managing stress. Avoid over-the-counter agents promising to improve testosterone levels. Testosterone replacement therapy, in your hands, can dramatically augment the benefits of these lifestyle changes. In general, when natural testosterone is replenished for andropausal men it has the potential to prolong the quality-of-life by decreasing the diseases of aging. Testosterone protects against cardiovascular disease; it can raise HDL cholesterol, and lower LDL cholesterol levels. It may decrease blood pressure, excess body fat, and symptoms of arthritis. Testosterone replacement stimulates the cardiovascular system, the neurologic system, muscles, and bones. It may protect against Alzheimer’s dementia, type II diabetes, osteoporosis, muscle wasting, loss of libido and erectile function, inflammatory-related diseases and a range of cardiovascular diseases.
Dr. Mahl is a qualified preventive- aging physician with expertise in the diagnosis and treatment of this common condition.
Andropause, or the chronic reduction of testosterone and other vital hormones in the body, is a phenomena that affects millions of aging men yearly and can begin as early as age 30. Similar to menopause in women, andropause can result in age-related ailments such as declines in libido (sex drive) and sleep quality, along with serious conditions like osteoporosis (loss of bone).
Feelings of weakness and lethargy could be a sign of deficiencies in testosterone and other androgens. If you notice that small cuts or wounds are healing slowly, this can also be a warning indicator. Hormones orchestrate much of what takes place within the body, so it is in the best interest of men experiencing these warning signs to have their hormone levels tested as soon as possible, particularly if they are 35 or older.
Imbalances in hormone levels are associated with:
- atherosclerosis and other forms of cardiovascular disease
- chronic fatigue
- high blood pressure
- hypoactive sexual disorder (sexual difficulties)
- decreased libido
- erectile dysfunction
- muscle atrophy or loss
- cognitive decline
- irritability and mood swings
- weight gain
- other disorders
Andropause can manifest as a gradual decline in quality of life, or as rapid fluctuations in hormone levels that mirror the swings women undergo during menopause. Sudden fluctuations in mood and state due to hormone instability are less common in men, but are still possible.
The most effective treatment for andropause is bio-identical hormone replacement therapy. Bio-identical hormones are perfect molecular matches for those found in the human body, and do not present the same risks as the synthetic or animal-derived variants.
Before bio-identical hormone replacement is prescribed, a battery of tests is conducted to assess deficiencies and design a customized formulation that delivers the missing androgen compounds in the precise quantities needed. Through this process of individual customization, side-effects of hormone replacement such as aggression and mood swings can be avoided, returning the patient to a more vital state of being.
The changes experienced following a hormone replacement regimen can be very pronounced. When a man’s body chemistry is returned to a more youthful state, many aspects of performance and health improve to similarly youthful levels. Dramatic increases in energy, libido, strength, and focus are common advantages of treatment.
In most men, testosterone levels begin to drop at the age of 30, and in some cases these undesirable changes manifest even earlier. As males pass their fifties, their risks of unhealthily low androgen levels skyrocket.
We use strict laboratory testing to confirm levels of bioavailable testosterone, estradiol, cholesterol, prostate-specific antigen, complete blood count (CBC), hematocrit, hemoglobin, and other indicators related to male health. These tests, along with screenings for susceptibility to treatment risks, are conducted in advance of any hormone replacement treatment. Factors of concern can include the presence of benign prostatic hyperplasia, prior instances of prostatic carcinoma, arrhythmia (heart disease), and a history of sleep apnea. These and other potential contraindications are considered in the preliminary physical examination.
Optimal results hinge on due diligence, and we closely monitor the hormone levels of our patients throughout the course of treatment.
Androgen Replacement – Performed to the Highest Specifications
In our practice, a prescription is formulated in the precise quantities needed and compounded by industry certified pharmacists. We have taken the guesswork out of natural treatment, bringing you the best in modern medicine while considering your whole-body wellbeing. We use either injections, creams, gels, pellets or sublingual troches. The best method of delivery is determined by your history and physical and blood panels. We do not use or prescribe testosterone orally because it would be primarily absorbed through the intestinal walls and into the blood stream in a manner that would allow the liver to metabolize it too quickly for it to achieve any efficacy.
How Much Testosterone Does a Man Need?
Healthy adult males secrete between 8 and 15 milligrams of testosterone every day, with the upper range of that spectrum being optimal. This range is taken closely into account when we formulate your dosage. Optimization of testosterone is beneficial, but too much can lead to excess conversion to estradiol, which is not beneficial. This is one of the causes of undesirable side effects observed in people taking anabolic steroids without medical supervision – the body cannot store excess testosterone, and the estrogen-mimicking byproducts of metabolized testosterone can lead to weight gain, gynecomastia (male breasts) and other complications. Because of this, custom dosing is not only vital, it is absolutely necessary for the long-term health of patients. This customized dosing procedure is often referred to as the “physiologic dose”.
While drawbacks are significantly minimized by using bio-identical hormones, androgen replacement carries risks in patients with a history of enlarged prostate, cardiovascular disease, infertility, skin disease, or gynecomastia (male breast enlargement, sometimes caused by steroid abuse).
Anabolic steroids differ significantly from natural, bio-identical testosterone alternatives. These synthetic forms of testosterone have been associated with cancer and cardiovascular disease, and have caused a great deal of confusion regarding hormone replacement therapy. This confusion has not only affected laypeople – it has pervaded scientific literature. When professionals and laypeople review studies on the topic, it is important that they pay close attention to the form(s) of testosterone used.
Many synthetic androgens are not metabolized in the same manner as natural testosterone, and they can wreak havoc on a patient’s lipid profile. High density lipoproteins (HDL), otherwise known as good cholesterol, are decreased, and bad cholesterol, or low density lipoprotein (LDL), skyrocket. This process leads to arterial blockages that significantly raise blood pressure.
An exciting fact is that bio-identical hormone replacement therapy has been shown on many occasions to have just the opposite effect. A balanced infusion of natural hormones can leave HDL levels intact, lower bad cholesterol, and improve key health indicators.
Older pharmaceutical preparations such as methyltestosterone are unsafe in doses sufficient to replace an aging male’s hormone levels, having been shown to place a strain on the liver.
When formulating treatments for andropause, several factors must be taken into account:
- Dehydroepiandrosterone, or DHEA: This compound has been found to cause small but measurable increases in lean body mass in andropausal males and is useful.
- Dihydrotestosterone, or DHT: This compound has been associated with benign prostatic hyperplasia, but the culpability of exogenous infusions is dubious. As more tests are needed to confirm a lack of causality, we approach the administration of bio-identical DHT with due care.
- 5-alpha reductase and aromatase inhibitors: These compounds have been shown to increase blood quantities of bioavailable testosterone by blocking the synthesis of estrogen.
Proper amounts of rest, diet, and exercise have been found to promote higher and healthier levels of testosterone and other beneficial hormones. Unfortunately, when quantities of these hormones have already fallen, it becomes more difficult to sustain an active lifestyle, which exacerbates hormone deficiencies. This is where bio-identical hormone replacement really shines – it sets a process in motion that can foster self-perpetuating health.
We encourage our patients to abstain from overeating and excessive alcohol use, as these habits can lead to higher body fat percentages. Excess fat can absorb and store available testosterone, making it unavailable for the body’s use. Hormone bioavailability can also be negatively impacted by certain diseases, so be sure to discuss any concerns with us during your consultation. We can help you construct a full weekly regimen that accounts for exercise, diet, and nutritional supplementation.
Benefits of Hormone Replacement Therapy
Again, we offer our bio-identical hormone replacement prescriptions in a variety of dosage formulations that are customized to the needs of each individual patient. Benefits of treatment include:
- Increased libido and sexual function
- Improvements in body composition, i.e. increased muscle mass and loss of visceral and other excess fat
- Reduced cholesterol and blood triglycerides
- Lowered blood glucose levels
- Normalized blood clotting
- Improvements in strength and posture
- Enhanced cognitive abilities
- Normalization of circadian rhythms
- Improved mood and general quality of life
- Increased bone mineral density, which equates to a total or partial reversal of symptoms of osteoporosis (While fractures caused by osteoporosis tend to occur later in men than in women, losses in bone density begin with andropause and the risks increase with time.)
- Reduction of female hormones such as estriol, estrone, progesterone, and estradiol
Bio-identical hormone replacement reduces the risk of atherosclerosis and other types of cardiovascular disease. Studies have demonstrated conclusively that increasing free testosterone has also partially eliminated risk factors for diabetes, such as the accumulation of visceral fat.
Low testosterone levels have been linked to a variety of serious health complications, including type 2 diabetes mellitus and its precursor, metabolic syndrome. Depression is also a common side effect, as a lack of bioavailable testosterone can lead to irritability and sudden mood swings, similar to menopause in women. This situation is not helped by the lack of sexual function in men that are severely affected. Studies have found that depressed men between the ages of 50 and 89 have lower androgen levels than their happier counterparts. This would suggest that testosterone supplementation could have a mood-elevating effect, and this hypothesis has borne out in further studies.