Testosterone replacement therapy

Testosterone replacement therapy

Testosterone is a rejuvenating hormone.
Happy couple in love.

Testosterone deficiency can be successfully treated with topical bio-identical testosterone replacement therapy.  That is our expertise spanning 22 years treating thousands of men.  Here is what you want to know and why testosterone replacement therapy may be right for you.

Will Testosterone Replacement Therapy Help Me?

Testosterone deficiency is the basis of Andropause.   You may be experiencing a loss of sexual vigor and performance, poor self confidence, loss of purpose, decisiveness, courage and motivation. A creeping sense of depression.  The Dwindles.

The good news is this is a treatable and manageable condition.   You do not need to suffer these symptoms any longer.   You can regain your old self again.

Men enter this period of andropause — poorly termed male menopause — at a later age.   Typical onset is between 54-56 although it can be much sooner.  You experience more subtle and gradual changes than do women.  But, in the end, the changes are no less profound than those symptoms associated with classic menopause.

The case for andropause is imperative.  Unfortunately, men just don’t seek medical attention until their health is quite obviously shaken. So the public clamor for research and methods of approaching and treating this poorly recognized condition has been given less attention and validity than menopause in women.

In part, men are responsible for this dilemma.  A woman is much more likely to seek medical attention than a man.

Men find themselves 15-20 years behind in the general recognition and acceptance of these non-cardiac issues.

Our acceptance of physiologic replacement of testosterone and androgen replacement in aging men is more recent.   It has been less widely accepted in conventional medical circles.   That has changed with FDA approvals.   The choices and arrays of modalities that are available to women is much richer.

So the short answer is, yes, testosterone therapy can substantially improve your quality of life.   For you, for your partner, and for your performance at work.

The Testosterone Paradox

In glancing at figure 1, you will see that with increasing age, the levels of testosterone fall while, at the same time, in figure 2, the incidence of prostatic hypertrophy is increasing.   This is an inverse relationship.     That infers no cause and effect.

Some argue that this is a cumulative effect but if you look at the area under the curve, the years with the highest levels of testosterone (the second, third and fourth decades) are where most of the exposure has occurred. This is associated  with the lowest risk of prostate dysfunction.

(See also the recent long term Finnish Study concluding there is a little correlation between testosterone levels and eventual prostate cancer)

Decline in testosterone levels with advancing age

fig 1


Incidence of Prostate disease with advancing age

fig 2

We reference Bruno deLignieres, an impeccable French researcher and Thiery Hertoghe, MD, fourth generation in the most distinguished family of endocrinologists in Belgium.  They have postulated the notion that rising estrogen levels are more likely to be  the initiator of the process.  And testosterone and DHT may then be a secondary player (promoter).  In more recent writings and lectures, The question of testosterone causing prostate cancer has finally been laid to rest.  There never was proof of this cause and effect.   It was only an assertion.   Hence, the above diagrams (and 15 years of lecturing on this subject) have been validated.

(Jonathan Wright and Eugene Shippen have written excellent, and popular books, discussing these more inclusive notions.

Testosterone is a Pro-Hormone

Now look at the fig 3 and fig 4 and you will see the true role of testosterone as a “pro-hormone.”   A precursor.   The active metabolite DHT (dehydrotestosterone) is the hormone you experience.

Testosterone Metabolism to DHT (Dihydrotestosterone)

fig. 3

DHT (dihydrotestosterone) is the Active Hormone

Testosterone is converts to DHT with the enzyme 5-a-reductase.    That had been thought to be the real cause of prostate problems.  Taking Saw Palmetto, Pygeum and Pumpkin seeds instead of Proscar (Finesteride) is a more “natural” way of  blocking this enzyme.   But DHT is essential for sexual vigor.  So blocking this step usually has unintended consequences!

On the other hand, Testosterone can also convert to estradiol by aromatase (producing the aromatic ring). This occurs increasingly with age in the liver but most importantly … in the fat stores.

Now you see the connection.  As we age, and frequently gain increasing fat stores, we are feeding the aromatase connection, increasing our estradiol levels and if this theory holds, increasing the promotion of prostate disease.

It also raises the interesting possibility, that we find absent in all other discussions, that blocking the 5-a-reductase step may actually exacerbate the problem by further increasing estrogen levels which may be the initiator of the problem.

fig. 4

Estrogen vs DHT stimulation of the Prostate

Finally, fig 4 shows a richer picture of the varied influence the estrogens (estradiol and estrone) and testosterone on the prostate gland.  Our goal is to re-establish more youthful balance.  We can achieve a more youthful and vigorous balance by diminishing estrogen and increasing testosterone.    We have re-balanced the T/E ratio.

As with the 25-30 year old issue of estrogen replacement in women, we now see the androgen issue with men with the same risk:benefit issues.  Small risk, with potentially important and consequential benefits.

Now you see.   We offer our male patients androgenic support from DHEA to carefully compounded topical testosterone cream forms in an array of safe and physiologic doses.  Occasionally, we use small dose aromatase inhibitors.  This further enhances testosterone by diminishing estrogen conversion.   The enhanced T/E ratio is more youthful and regenerative.

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