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:
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 of Testosterone Replacement Therapy in Adult Hypogonadal Men (age 50 or older):
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.
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.
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.”