Testosterone Replacement

Men’s Hormone Imbalances

In my practice I almost always screen my patients for hormone imbalances, it’s just part of my standard workup. As a result, I have seen a wide variety of total serum testosterone levels, and more often than not these levels are less than what I consider optimum.

When men finally come into the doctor’s office, usually forced by their spouse or partner, one of their most common complaints is fatigue, followed by weight gain, anxiety, insomnia, and depression. Men really like to blame their health complaints on aging, and as long as the hardware is still working, testosterone levels are not high on their list of concerns.

But everyone is a little different, and despite what you read on the internet, not everyone has the same symptoms when it comes to low testosterone.

Some men might experience any of the following:

• Weight gain
• Loss of muscle mass
• Insomnia
• Depression
• Anxiety
• Or even simple fatigue

Erectile dysfunction and sexual performance problems also occur, but usually by that time lots of other things are going on with their health, including diabetes, hypertension, and elevated cholesterol. What you might find surprising is that testosterone protects against these outcomes.

Men with good levels of testosterone tend to have better HDL cholesterol, lower blood pressure, and more stable blood sugar. They also tend to have more energy, sleep better, have a more stable mood, and a better body habitus.

Another surprising fact is that it’s not just older men that have low testosterone.

I have encountered a number of young men (some in their early teens) who have lost interest in dating, struggle with weight, and complain of feeling tired or anxious all the time. It turned out that they had very low levels of testosterone!

That’s right, low levels of Testosterone can happen at any age.

So how do we treat low levels of Testosterone?

I always spend extra time getting to know my patients and do a thorough workup. Raising testosterone is not always about prescribing direct hormone replacement, in fact for younger men its rarely recommended. Sometimes simple lifestyle changes can be enough to get T back up, or doing a combination of lifestyle coaching and supplements. There are even some herbs that might be helpful as well.

Lifestyle changes might mean adding weight-bearing exercises like weightlifting or yoga, or looking for food intolerance and other forms on inflammation.

When those don’t work, then I start thinking about prescribing a hormone called human chorionic gonadotropin, or hCG. This simple hormone, which mimics the bodies natural testosterone signaling hormone, does a good job of raising testosterone. hCG is also the go-to hormone for helping with fertility issues.

 

Finally, there is good old direct testosterone replacement therapy.

This is generally reserved for more mature men who know they no longer want children. The reason for this? Giving direct testosterone makes men infertile by shutting down the T and sperm factories in the testicles. Thus the testicle shrinkage. After all, you are taking away their jobs, and as the saying goes, use it or lose it.

Sometimes men don’t want that side-effect, so I do a combination of testosterone and hCG. By doing this you are preserving testicular function, but also giving some extra help in the form of direct hormone replacement.

The reason this isn’t always done, is that hCG is only given as an injectable, done three times a week, and lots of men don’t wish to do this.

Most of the time I prescribe the injectable form because of the decreased chance of contaminating others in the house. Contamination with topical creams can be a big concern for women and growing children, something that can be easily be avoided. Some men don’t want to inject themselves, which is fine, the Tualatin office offers injection appointments, and for a small fee you can have a medical assistant give the injection.

 

Whatever we do in order to increase testosterone it requires close observation, meaning that once we start we need to recheck your levels in 6 to 8 weeks. This is to ensure that we are getting the response we want, not too little and not too much.

One way men get rid of extra testosterone is by converting it to estrogen.

This is done by an enzyme called aromatase, so we term the conversion aromatizing, and it’s something that we try to prevent. Sometimes this happens because the dose was a little to robust, but it can happen even with appropriate dosing. Either way, I almost always add an herb constituent, which blocks this action.

In addition, I also suggest adding progesterone to help protect the prostate and balance out the testosterone.

 

As you have probably figured out by now, this is not a one answer fits all sort of scenario. I hope you have found this information useful. If you are interested in finding out about your own testosterone levels, or have any other health questions, please make an appointment by calling the office or scheduling online.