Men’s Hormone Replacement Therapy

Men's Health
Andropause Male Menopause Treatments GenLife Miami

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.

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, such as androstenedione. Testosterone replacement therapy, prescribed by a physician, 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
  • infertility
  • high blood pressure
  • osteoporosis
  • hypoactive sexual disorder (sexual difficulties)
  • decreased libido
  • erectile dysfunction
  • muscle atrophy or loss
  • cognitive decline
  • insomnia
  • irritability and mood swings
  • depression
  • anxiety
  • weight gain
  • wrinkles
  • 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 to 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.

Lifestyle Concerns

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 ‘catch-22’ situation creates a detrimental cycle that is difficult to reverse. 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 mitigates or 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.