HORMONE REPLACEMENT—MEN

Hormone Replacement Therapy relates to the age related decline in bioavailable testosterone. Starting already in the twenties, Testosterone declines about 10% every decade. The ubiquitous exposure to xenobiotics like plastics, Bisphenol-A, flame-retardants and pesticides that act as ”endocrine disruptors,” accelerates the process. This environmental exposure is also seen as the reason why Testosterone levels in men have been declining rapidly worldwide - about 1% per year since the 1980s. 

Low testosterone can lead to a variety of symptoms:

• Loss of muscle mass and strength

• Increase in body fat 

• Low libido

• Erectile dysfunction and loss of morning erections

• Fatigue and loss of vitality 

• Indecisiveness, mood swings and depression 

• Low concentration and cognition

• Osteoporosis

• Gynecomastia (breast enlargement)

• Anemia

• Loss of body hair     

Testosterone can be easily measured through a blood test for total and free/bioavailable testosterone. The lab should include DHEA and Pregnenolone, which are precursors to testosterone, and a PSA test. Due to variations in the sensitivity of hormone receptors, testosterone levels do not necessarily correlate with symptoms. One might feel great and show no signs of low testosterone despite a low levels. 

Testosterone Replacement therapy should be integrated into a comprehensive nutritional and lifestyle program that addresses diet, exercise and stress. 

Testosterone Deficiency is treated by weekly or bimonthly intramuscular injections or by daily skin applications. Men have to be aware that creams and gels can be transferred to children and partners through skin contact. 

Like every medical treatment, testosterone replacement therapy needs to be evaluated regarding its potential risks and benefits. Testosterone does not increase the prostate cancer risk, but is contra indicated in men who do have prostate cancer. Also in men who have a genetic tendency for increase blood clotting. Despite many studies showing the exact opposite, the FDA has concluded that there is a possibility of an increased cardiovascular risk (myocardial infarctions and strokes) associated with testosterone use. 

In younger men with low testosterone, we focus on increasing their body’s testosterone production. Otherwise Testosterone replacement therapy will, through hormonal feedback, further suppress the body’s own testosterone and sperm production. The focus here is on treating adrenal burnout, insomnia, nutritional deficiencies and detox for chemicals and heavy metals. 

Testosterone replacement can cause the following adverse effects: 

• Elevated Estrogen which can lead to and enlarged breasts 

• Oily skin or Acne

• Hair loss

• Overproduction of red blood cells 

• Fluid retention

• Worsening of sleep apnea

• Testicular shrinkage

• Benign prostatic hypertrophy

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After initiating therapy, the lab is repeated to ensure the Testosterone level is in therapeutic range and that there is no elevation of estrogen or red blood cells.