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Bio-Identical Hormones for Men

Believe it or not, men do have hormones as well! Testosterone deficiency is often referred to by medical professionals as “andropause” or “male menopause.” Unlike women, when men experience hormone decline it is much more subtle and tends to happen at a much slower rate that is difficult to identify. Medical professionals sometimes incorrectly attribute hormone decline symptoms to other problems or diseases. Low testosterone levels lead to many different symptoms including:

  • Irritability
  • Reduced Libido
  • Osteoporosis
  • Low Sperm Counts
  • Reduced Cognitive Function
  • Weakness
  • Slow Wound Healing
  • Depression/Anxiety
  • Fatigue
  • Heart Disease
  • Reduced Muscle Mass
  • Disturbed Sleep
  • Insomnia
  • Erectile Dysfunction
  • Prostate Problems
  • Memory Impairment
  • Atherosclerosis
  • Impaired Blood Cell Formation

Symptoms of testosterone deficiency affect approximately 1 in 200 men and may include:

  • weakness
  • fatigue
  • reduced libido
  • osteoporosis
  • depressed mood
  • loss of energy
  • erectile dysfunction
  • aches and pains

This condition is commonly referred to as “Andropause” and less often as “Androgen Deficiency in the Aging Male” (ADAM).

A man may be considered hypogonadal at any age if total testosterone is less than 200 ng/dl, or bioavailable testosterone is less than 60 ng/dl. Basaria and Dobs of Johns Hopkins University recommend that elderly men with symptoms of hypogonadism and a total testosterone level < 300 ng/dl should be started on hormone replacement

Hormone Therapy for Men

Symptoms of testosterone deficiency affect approximately 1 in 200 men and may include:

  • weakness
  • fatigue
  • reduced libido
  • osteoporosis

This condition is commonly referred to as “Andropause” and less often as “Androgen Deficiency in the Aging Male” (ADAM).

A man may be considered hypogonadal at any age if total testosterone is less than 200 ng/dl, or bioavailable testosterone is less than 60 ng/dl. Basaria and Dobs of Johns Hopkins University recommend that elderly men with symptoms of hypogonadism and a total testosterone level < 300 ng/dl should be started on hormone replacement.

Goals and Therapy

Goals of Testosterone Replacement Therapy in Adult Hypogonadal Men (age 50 or older)

  • Improvement in psychological well-being and mood
  • Improvement in erectile dysfunction
  • Improvement in libido
  • Increased muscle mass
  • Increased strength and stature
  • Preservation of bone mass
  • Possible decrease in cardiovascular risk

A man may be considered hypogonadal at any age if total testosterone is less than 200 ng/dl, or bioavailable testosterone is less than 60 ng/dl. Basaria and Dobs of Johns Hopkins University recommend that elderly men with symptoms of hypogonadism and a total testosterone level < 300 ng/dl should be started on hormone replacement.

Supporting Literature

Men have relative levels of free circulating estrogens that actually increase with age which increases estrogenic action in the prostate gland. Bioavailable testosterone levels lower in the aging male due to slowed production by the testes and increased sex hormone binding globulin (SHGB) levels which is the result in free circulating lower testosterone. Additionally, an increase in adipose (fat) cells and body weight due to age can result in higher levels of aromatase which peripherally converts androgens into estrogen. It has been proposed that higher estrogenic stimulation of the aging male prostate may lead to reactivation of growth and subsequent neoplastic transformation. Estrogen effects on the prostate gland may be indirectly mediated through changes in other serum hormones. Estrogens excite the pituitary release of PRL and some of the estrogenic effects have been ascribed to direct PRL action on the prostate. Furthermore, estradiol exerts negative feedback on the hypothalamic-hypophyseal-testicular axis, blocking luteinizing hormone (LH) secretion and testicular steroidogenesis of androgens (chemical castration). This feedback regulation was the reason for high therapy doses of estrogen of prostate cancer for a long time.
Steroids. 2008 March; 73(3): 233–244.
The Role of Estrogens and Estrogen Receptors in Normal Prostate Growth and Disease
Prins GS and Korach KS.
Click here to access the PubMed abstract of this article.

J Clin Endocrinol Metab. 2004 Mar;89(3):1174-80.
Effects of aromatase inhibition in elderly men with low or borderline-low serum testosterone levels.
Leder BZ, Rohrer JL, Rubin SD, Gallo J, Longcope C.
Click here to access the PubMed abstract of this article.

Nat Clin Pract Endocrinol Metab. 2008 Jul;4(7):415-9.
Treatment of male infertility secondary to morbid obesity.
Roth MY, Amory JK, Page ST.
Click here to access the PubMed abstract of this article.

Testosterone Replacement Therapy for Men and Treatment of Depression

Ther Clin Risk Manag. 2009 Jun;5(3):427-48.
The benefits and risks of testosterone replacement therapy: a review.
Click here to access the PubMed abstract of this article.

J Clin Psychiatry. 2009 Jul;70(7):1009-16.
A randomized, double-blind, placebo-controlled study of testosterone treatment in hypogonadal older men with subthreshold depression (dysthymia or minor depression).
Click here to access the PubMed abstract of this article.

J Clin Psychopharmacol. 2009 Jun;29(3):216-21.
Effects of testosterone replacement in middle-aged men with dysthymia: a randomized, placebo-controlled clinical trial.
Click here to access the PubMed abstract of this article.

Arch Gen Psychiatry. 2008 Mar;65(3):283-9
Low free testosterone concentration as a potentially treatable cause of depressive symptoms in older men.
Click here to access the PubMed abstract of this article

Low Testosterone Increases Mortality Risk in Men

http://www.medscape.com/viewarticle/576267   (accessed 1/13/2012)
This UCLA research concluded that transdermal testosterone (T) gel replacement improved mood and sexual function , increased muscle strength, and lean mass (principally in the legs), and lowered fat mass in hypogonadal men with less skin irritation and discontinuation compared with the recommended dose of the permeation-enhanced T patch.

J Clin Endocrinol Metab. 2000 Aug;85(8):2839-53
Transdermal testosterone gel improves sexual function, mood, muscle strength, and body composition parameters in hypogonadal men. Testosterone Gel Study Group.
Click here to access the PubMed abstract

J Clin Endocrinol Metab 2000 Aug;85(8):2670-7
Effects of testosterone replacement in hypogonadal men.
Click here to access the PubMed abstract

Am J Med 2001 May;110(7):563-72
Hypogonadism and androgen replacement therapy in elderly men.
Click here to access the PubMed abstract

Drugs Aging 1999 Aug;15(2):131-42
Risks versus benefits of testosterone therapy in elderly men.
Click here to access the PubMed abstract

Diabetes Care 2000 Apr;23(4):490-4
Testosterone, sex hormone-binding globulin, and the development of type 2 diabetes in middle-aged men: prospective results from the Massachusetts male aging study.
Click here to access the PubMed abstract

Am J Psychiatry 1998 Oct;155(10):1310-8
Age-associated testosterone decline in men: clinical issues for psychiatry.
Click here to access the PubMed abstract.

Med Hypotheses 1999 Jan;52(1):49-51
The hypogonadal-obesity cycle: role of aromatase in modulating the testosterone-estradiol shunt-a major factor in the genesis of morbid obesity.
Click here to access the PubMed abstract.

J Clin Endocrinol Metab 1999 Feb;84(2):573-7
Bioavailable testosterone and depressed mood in older men: the Rancho Bernardo Study.
Click here to access the PubMed abstract

Urology 2000 May;55(5):755-8
Serum dehydroepiandrosterone sulfate concentrations in men with erectile dysfunction.
Click here to access the PubMed abstract

Sublingual sildenafil in the treatment of erectile dysfunction: faster onset of action with lower dose

Int J Urol. 2004 Nov;11(11):989-92
Sublingual sildenafil in the treatment of erectile dysfunction: faster onset of action with less dose.
Click here to access the PubMed abstract of this article.

The International Journal of Pharmaceutical Compounding [March/April 2007;11(2):121] reported a formula for Sildenafil 20mg Troches (flavored) with a recommended beyond-use date of 180 days.

 Testosterone vs. Synthetics

What is the Optimal Form of Testosterone for Replacement Therapy?

Testosterone USP is a bio-identical natural testosterone that the United States Pharmacopoeia has been approved. This is currently available as a bulk chemical. With a prescription order from the physician, our compounding pharmacists can prepare a number of dosage forms with Testosterone USP.

Natural Testosterone Replacement is extremely important to the treatment of all areas of andropause. The term “testosterone” is used generically when someone is referring to anatural bio-identical testosterone as well as a number of synthetic derivatives. Conflicting data throughout the medical literature about risks and benefits of testosterone is due to confusion. Everything must always be careful studied to discover which form of testosterone was used. Synthetic derivatives also known as anabolic steroids cannot be confused with natural testosterone. When synthetic derivatives are used by body-builders or athletes, terrible effects happen. A great example of this is, administration of synthetic non-aromatizable androgens, like methyl testosterone or stanozolol, causes large increases in LDL-C (“bad cholesterol”) and deep decreases in HDL-C (“good cholesterol”). Hormone replacement with aromatizable androgens, like testosterone, results in lower total cholesterol and LDL cholesterol levels while having very little if any impact on serum HDL cholesterol levels. Making sure proper steps are being taken to monitor clinical response and laboratory values is very important when prescribing testosterone replacement therapy.

The only contraindications that are absolute in regards to androgen replacement therapy are the presence of breast or prostate cancer. “Although it is known that the clinical course of prostate cancer is accelerated by testosterone, its incidence is not increased by [testosterone] administration… There is even no clear evidence that testosterone replacement accelerates the development of BPH.”