Male Testosterone Replacement

Facts about Bio-identical Hormone Pellet Therapy for Men:

In treatment of men, testosterone is the only hormone utilized in pellet form.  When administered, several pellets are easily implanted under the skin in a quick, almost painless, in-office procedure that leaves virtually no trace after a short healing period. They provide a consistent release of the hormone lasting five to six months. This is a great, long-term solution for men who find they must stay on testosterone replacement therapy continuously. At her clinic, Dr. Keller employs blood tests to monitor patients and help determine the initial dose of testosterone. Men often report a substantial improvement in mood, cognition, sexual desire and function, as well as loss of body fat with improvement in lean body mass. Men with diabetes may notice that, with the weight loss that occurs with bio-identical testosterone replacement therapy, their need for insulin or diabetes medications can decrease over time. Testosterone therapy also assists the bones to build, so can therefore decrease the risk for osteopenia and osteoporosis.

When is Testosterone Hormone Replacement Therapy Indicated for Men?

Men can experience decreases in testosterone as early as their 30’s. The symptoms may not become significant until the 40’s, 50’s or even 60’s. At LiveAgelessly, Dr. Keller treats symptomatic patients with hormonal decline, regardless of age.

Hypogonadism is a clinical condition which will be diagnosed based on low serum levels of testosterone in association with specific signs and symptoms that may cause Erectile Dysfunction (ED).

Why is Testosterone Hormone Replacement Therapy Indicated for Men?

Population-based studies done in the last 10 years indicate that a low testosterone level is associated with an increase in the risk for developing type 2 diabetes, metabolic syndrome, heart disease and even a reduction in how long a man lives.

Low testosterone may be a predictive marker for those at high risk of cardiovascular disease. When testosterone is low, there can be negative effects on the cholesterol causing a low HDL, (the good cholesterol), an elevated LDL, (bad cholesterol), and elevated triglycerides.

Low testosterone is also associated with increasing levels of fibrinogen, a protein made in the liver that increases the clotting in blood. Low testosterone, at the same time, increases another protein in the blood called plasminogen activator inhibitor-1, (PAI-1), which inhibits clots from breaking down. PAI-1 is primarily produced by cells lining blood vessels. The combination of elevated proteins that increase clot formation and another that stops them from breaking down can be a dangerous environment inside blood vessels. This explains why there is increased risk for heart disease with low testosterone, especially when there is abnormal cholesterol levels mixed with elevated proteins that create an inflammatory response in the body. Also, excessive levels of fibrin from fibrinogen will lead to a clog-like effect inside of blood vessels which can cause a flaccid penis.

Cardiovascular disease is the number one killer of men and women. Low testosterone can increase one’s risk for cardiovascular disease, type 2 diabetes and metabolic syndrome. Metabolic syndrome is a combination of medical disorders that, when occurring together, increase the risk of developing cardiovascular disease, diabetes and an almost 50% increase in mortality over a seven year period. Testosterone decreases the expression of inflammatory markers. Studies in men have proven that testosterone replacement reduces cardiovascular risk by reducing insulin resistance, lowering cholesterol and improving control of blood sugar in type 2 diabetes. Testosterone will increase lean body mass by itself and adding a good diet and exercise program at the same time can  decrease weight further and increase the lean body mass and the other diabetic and cardiovascular benefits even more.

Signs and Symptoms of Low Testosterone in Men- “Andropause”:

Andropause is caused by declining testosterone levels. Men may experience waning libido (sex-drive), difficulty in achieving orgasm, erectile dysfunction (ED), weakened intensity of orgasm, reduced sexual penile sensation, impaired cognition, diminished muscle mass, decreased bone density leading to osteopenia or osteoporosis and an increase in central body fat. Other symptoms such as forgetfulness, difficulty concentrating, insomnia and a lowered sense of well-being are also sometimes present.

Diagnosis of Low Testosterone/Andropause:

Low testosterone levels when combined with several of the symptoms of deficiency of testosterone is also known as andropause. Thus the diagnosis of andropause includes demonstration of a low total or free testosterone levels and clinical symptoms of several of the following: ED, decreased muscle mass and strength, increased body fat, breast enlargement, hot flushes, sleep disturbances, decreased bone mineral density and osteoporosis, decreased vitality,(depression, fatigue) and decreased intellectual capacity,(poor concentration, forgetfulness).

Testosterone Deficiency Questionnaire for Men

  • Have you had a decrease in libido or sex drive- is your interest in, and enthusiasm for, sex at an all time low?
  • Are you experiencing a decrease in your ability to perform sexually?
  • Are the erections you are having not as strong as they once were?
  • Do you have a lack of energy?
  • Have you noticed a decreased enjoyment of life”?
  • Are you abnormally sad and/or grumpy?
  • Do you have an unusual lack of energy?
  • Have you noticed a recent deterioration in performance where you feel that you are getting less done or achieving less?
  • Are you falling asleep after dinner?
  • Are you experiencing an increased need for sleep?
  • Are you experiencing reduced muscular and physical strength?
  • Are you experiencing inexplicable joint and muscular pain?
  • Are you having excessive sweating with unexpected or sudden episodes of sweating?

Benefits of testosterone replacement therapy

  • Improved sexual desire and function
  • Improved mood, energy and quality of life
  • Weight loss regardless of exercise, results are best with healthy diet and exercise
  • Change in body composition and improve muscle mass and strength
  • Enhanced cognitive function with improved brain concentration and memory
  • Less agitation or irritation with a better response to stressful events
  • Improved fat and sugar metabolism
  • Increases in coronary blood flow in patients with coronary heart disease and beneficial effects on blood vessel function and coagulation. The net effect is a reduction in risk of clotting and improvement in circulation.
  • Testosterone is also been shown to increase the ejection fraction of the heart, meaning more blood is pumped with each beat.
  • Increased bone mineral density with decreased risk for osteopenia and osteoporosis

Studies have proven that testosterone replacement therapy reduces insulin resistance and improves blood sugar in diabetic men, insulin resistance is improved and body fat is also reduced. Together these improvements resulted in overall reduction in cardiovascular risk.

Risks of testosterone replacement therapy

Though rare, risks relating to testosterone replacement therapy in men do exist. Testosterone may stimulate growth of already existing prostate cancer and male breast cancer. Testosterone can increase estradiol levels and this can stimulate breast tissue to grow, a condition called gynecomastia. Gynecomastia is completely avoidable by using estrogen blocking agents and monitoring hormone levels.

Men who are trying to have a child should not use testosterone due to it causing testicular atrophy and infertility. If childbearing is not an issue then this would not be a concern. It is reversible if therapy is stopped.

In rare cases testosterone may cause or exacerbate sleep apnea. Testosterone does not cause prostate cancer. Liver cancers have occurred when testosterone was used at super physiologic levels, however it also has not been proven that testosterone replacement when used in therapeutic doses can cause the development of cancer.

Testosterone replacement therapy, if done correctly, provides more benefits than risks