I inadvertently started the blog with “Hi ladies”, when men’s health is just as important.
My first topic is going to be on Testosterone Replacement in Men- What to Test and How to Replace.
Typically, when we think of testosterone replacement, one assumes you test the levels of testosterone and if low- replace it. However, there is actually more involved. Low testosterone can result in an unhealthy lifestyle and can cause symptoms such as depression, weight gain, lethargy, low libido and erectile dysfunction. There are other factors to consider when looking at testosterone replacement therapy. We need to look at Dhea, LH (Luteinizing Hormone) and estrogen levels as well. Lifestyle changes may also need to occur. Exercise is important to a healthy lifestyle for men and smoking and excessive alcohol can inhibit modification. Estrogens are important, as well, and are often overlooked. Estradiol and estrone levels need to be assessed. When levels of these hormones are constant or increased, it offsets the androgen/estrogen balance. The use of an aromatase inhibitor may be necessary to decrease the levels of these estrogens. LH and FSH (Follicle Stimulating Hormone) should be monitored as well, since high estrogen levels can cause a decrease in these hormones. SHBG (Sex Hormone Binding Globulin) is a hormone that binds testosterone and decreases its”™ availability when estrogen levels increase. This should be tested along with hemoglobin, hematocrit and a PSA test.
There are different ways to boost testosterone levels, but for now we will discuss testosterone supplementation. Once assessed and testosterone supplementation is approved by your provider, there are different ways to use testosterone. The most common is IM injection. These monthly injections can result in high levels of testosterone the first week that continue to decline over the month. Practitioners will often increase the dose after testing testosterone levels, not realizing that the testosterone injections cannot maintain a steady state of release. This form is also associated with gynecomastia (abnormal enlargement of male breasts). It is worthwhile to consider lower dosing at weekly intervals to maintain a more constant level of hormone release.
Topical administration of hormones seems to be the most effective way to dose testosterone. This can be in the forms of gels, creams or lotions. Because gels are alcohol based they can dissolve testosterone formulations at higher concentrations. These gels are highly absorbed through the skin. Creams and lotions work well also, but gels have been shown to more directly transport the testosterone to the blood vessels. There is a risk of transferring testosterone to a female or child with this method, and necessary precautions need to be taken.
Giving testosterone through a sublingual route is also available. However, like the injections and unsteady levels, testosterone levels are high and spike during the first few hours and rapidly decline. The dosing, therefore, needs to be given in multiple intervals at 3-4 times daily. This kind of dosing is typically bad for compliance. Sublingual dosing may be useful in men already supplementing with testosterone, but need an extra boost for sexual enhancement.
There are also implantable pellets available. This allows the patient to not worry about daily dosing, but rather implant a pellet every 3-5 months. This procedure is done at a doctors office and is more expensive as the pellets need to be compounded by sterile procedures. The problem with pellets is that there is no way to adjust the dose once inserted.
Oral dosing of bio-identical testosterone is inefficient. There is an oral form of a synthetic form of testosterone called methyltestosterone. This synthetic version is associated with liver toxicities.
In summary, there is a lot involved in treating male hypogonadism. Testosterone plays a key role in men’s health and well-being. A compounding pharmacy can tailor the hormones to meet your individual needs. Talk to the men in your lives to discuss the health benefits of testosterone replacement. It’s a key hormone for heart, brain and bone health as well as sexual and mental wellness.