Testosterone Deficiency: Male Menopause Which Is HARDly The Pause That Refreshes!

Everyone has heard about menopause for women.  This is due to a decrease in estrogen production from the ovaries.  Men also have a fall in their testosterone, the male hormone produced in the testicles, also decreases a small amount after age 30 but becomes symptomatic around age 50.  The problem affects millions of American men who have decreased sex drive, lethargy, loss of muscle mass, decrease in bone density, and even irritability\depression.  This blog will discuss the problem of male menopause or andropause.

Men losing testosterone is a steady decline, like a leak in a swimming pool you never refill. Over time, you empty out all your stores, creating a constellation of problems.

The constellation of problems compound each other, too. The apathy comes in part from the decline in hormones, which results in loss of lean muscle mass, depression, and forgetfulness. But it becomes a downward cycle, as the less lean muscle mass a person has, the faster he or she gains weight, which leads to more depression.

The seriousness of the problem of male depression tied to aging cannot be denied, as middle-aged and older men account for more than 20 percent of suicides, as compared to about 5 percent for women. Older white males represent 70 percent of suicides.  Before starting anti-depressants, doctors caring for older men with symptoms of depression should get a serum testosterone level and replace the hormone with testosterone replacement therapy before initiating anti-depressants.

Most of my physician referrals come from psychiatrists and neurologists, as men are seeing them because of depression and memory issues. Psychiatrists and neurologists know what a reduction in testosterone does to emotional well-being and brain function. These specialists want their patients to be tested for low testosterone before trying anti-depressants or other prescription therapies.

The reason more general physicians don’t think of, or want, to go the hormone testing route? Testosterone therapy got a bad rap a few years ago when there was a lot of misinformation with regard to testosterone being dangerous and possibly being linked to an increase in prostate cancer and heart disease.

There have been poorly designed studies, just as there were poorly designed studies with women’s hormone studies, such as the Women’s Health Initiative, indicating that it might be dangerous for women to take hormone replacement therapy. The result is that these defective studies resulted in a lot of men are not doing testosterone optimization correctly. There is a big difference between what is considered a normal level of hormones, which in America, is often abused to build super-normal muscle mass, and those levels at which men literally come back to life again.

Ideally men need to have their testosterone levels drawn in the morning when the testosterone levels are the highest. If the man has the symptoms described above and has a low testosterone level, they are candidates for hormone replacement therapy using injections of testosterone, topical gels containing testosterone, or testosterone pellets that are inserted under the skin every 4-6 months.

Many of these men come in saying they feel like half a man; well they are, because they are trying to live on half the amount of testosterone they had when they were younger. When they feel better, they make changes such as losing weight, or changing careers, because with the low level of testosterone, they didn’t care enough to do it before.

Bottom Line: If you don’t feel the same way about yourself or your partner, and you are in your 40s, 50s, or 60s, it may well be that one or both of you have hormonal issues. It makes sense to try and fix that with a brief history, physical exam and a testosterone blood test.

Androstenedione: Is It Safe and Effective?

I am often asked by men if taking androstenedione is a substitute for testosterone in those who have symptoms of low T and don’t want to take testosterone.

Androstenedione (ASD) is a steroid hormone used by the body to make testosterone and estrogen. Studies on men taking 100-300mg\day have not shown any increase in muscle strength, muscle size, or lean body mass when used for 2-3 months in connection with weight training. ASD does not increasing energy or improve sexual desire and function.

In addition to not being effective ASD is POSSIBLY UNSAFE for most men when taken by mouth. Some side effects experienced by men include reduced sperm production, shrunken testicles, painful or prolonged erections, breast development, behavioral changes, heart disease, and others. ASD can increase the chances of getting cancers of the breast, prostate, or pancreas; and it is poisonous to the liver. Certainly if you have liver disease, don’t take ASD. Even if you don’t have liver disease, it’s best to get liver function tests if you take androstenedione.

Bottom Line: ASD has not shown to be helpful for men with low T or symptoms of low T. ASD may also be dangerous to your health and probably should be avoided by men with low T.

Testosterone Replacement In Men Who Wish To Continue Family Planning

Testosterone Replacement In Men Who Wish To Continue Family Planning

Millions of men have testosterone deficiency. Most of the men are middle age and older and, therefore, family planning is not an issue. However, if younger men have a low testosterone level and wish to continue family planning, the usual replacement with testosterone injections, gels or pellets is contraindicated because testosterone can reduce the sperm count making fertility difficult or impossible. This blog will discuss treatment of low T in younger men who wish to continue to have a family.

Function of Testosterone

Testosterone is the most important sex hormone or androgen produced in men. The function of testosterone is primarily the producing the normal adult male characteristics. During puberty, testosterone stimulates the physical changes that constitute the attributes of the adult male.

Throughout adult life, testosterone helps maintain sex drive, the production of sperm cells, male hair patterns, muscle mass and bone mass. Testosterone is produced in men by the testes and in the outer layer of the adrenal glands.

The hypothalamus controls hormone production in the pituitary gland by means of gonadotropin-releasing hormone (GnRH). This hormone tells the pituitary gland to make follicle-stimulating hormone (FSH) and Luteinizing hormone (LH). LH orders the testes to produce testosterone. If the testes begin producing too much testosterone, the brain sends signals to the pituitary to make less LH. This, in turn, slows the production of testosterone. If the testes begin producing too little testosterone, the brain sends signals to the pituitary gland telling it to make more LH, which causes the testes to make more testosterone.

Symptoms of Low Testosterone

The failure of the testes to produce a sufficient level of testosterone in the adult male results in a low testosterone level. Physical signs of low testosterone in men may include:

Declining sex drive,
Erectile dysfunction (ED),
Low sperm count
Decrease in lean muscle mass
Insomnia or sleep disorder
Depression
Chronic fatigue.
Conditions Causing Male Testosterone Deficiency

Testosterone deficiency can be caused by different conditions: 1) effects of aging; 2) testes based conditions; 3) genetics; and 4) conditions caused by the pituitary and hypothalamus.

The effects of aging on testosterone production
Testes disorder
Pituitary/Hypothalamus disorder
Genetically-based condition
Function of Testosterone Therapy

The function of testosterone hormone replacement therapy is to increase the level of testosterone in the adult male diagnosed with testosterone deficiency (low testosterone) or hypogonadism. Testosterone replacement should in theory approximate the natural, endogenous production of the hormone. The clinical reasons for treatment of testosterone deficiency in men include:

Increased male sex drive
Improve male sexual performance
Enhance mood in men
Reduce depression in men
Increased energy and vitality
Increase bone density
Increased strength and endurance
Reduce body fat
Increase body hair growth
Reduce risk of heart disease
Develop lean muscle mass with exercise
Function of HCG Therapy is to Stimulate the Testes to Prevent Loss of Natural Testosterone Production and Avoid Testicular Atrophy while the Male Patient is Undergoing Testosterone Hormone Replacement Therapy

The hormone HCG is prescribed for men in this therapy to increase natural testosterone production during the course of therapy as a result of the stimulation of the testes by the HCG. No testosterone medication is administered in this treatment. The treatment objective is to cause the male testes to naturally produce a higher volume of testosterone by HCG stimulation of his testes with the result that the patient experiences a continuing higher blood level of testosterone while on treatment. Another treatment objective is to avoid the use of any anabolic steroid and its adverse side effects upon the patient.

HCG Therapy normally increases natural testosterone production by the male testes while HCG is administered to the patient during the treatment period However, HCG Therapy can also result in a continuation of increased testosterone production and a resulting higher level of testosterone in the bloodstream after treatment is completed when the cause of the patient’s low natural LH secretion by the pituitary is not due to the patient’s natural genetics, aging process, injury to or loss of one or both testes; a medical disorder or disease affecting the testes, or castration.

HCG Therapy can result in a continuing higher level of natural testosterone production by the testes after HCG Therapy is completed when the underlying cause of the low LH secretion and resulting low testosterone production (1) is due to the prior use of one or more anabolic steroids by the patient or (2) due to the administration of testosterone in a prior hormone replacement therapy without the required concurrent HCG Therapy to prevent the patient’s endocrine system (hypothalamus pituitary-testes axis) from shutting down the natural production of testosterone by the testes and causing testicular atrophy.

Types of Testosterone Therapy for Men

A good male testosterone replacement therapy produces and maintains physiologic serum concentrations of testosterone and its active metabolites without significant adverse side effects.

The leading types of testosterone therapy for men include:

Testosterone Injection with HCG
Testosterone Transdermal Cream with HCG
Testosterone Transdermal Gel with HCG
Benefits of HCG Therapy for the Male Patient Undergoing Testosterone Hormone Replacement Therapy

Increases natural testosterone production by the testes
Prevents loss of natural testosterone production by the testes while the male patient is undergoing testosterone hormone replacement therapy
Prevents atrophy of testes while male patient is being treated with testosterone replacement therapy
Increases physical energy and elimination of chronic fatigue
Improves sex drive
Improves sexual performance
Improves mood
Reduces depression
Increases lean muscle mass
Increases strength and endurance as a result of exercise
Reduces body fat due to increased exercise
Increases sperm count and therefore male fertility
HCG Therapy can also result in a higher level of natural testosterone production after HCG Therapy is completed when the cause of a man’s current low testosterone production is the prior use of anabolic steroids that shut down or reduced the pituitary gland’s production of LH and decreased testosterone production.
Human Chorionic Gonadotropin (HCG)

HCG is compounded by a compounding pharmacy or manufactured by pharmaceutical company in 10,000 IU (International Units) for reconstitution with sterile water for injections in 10 cc vials.

HCG is a natural protein hormone secreted by the human placenta and purified from the urine of pregnant women. HCG hormone is not a natural male hormone but mimics the natural hormone LH (Luteinizing Hormone) almost identically. As a result of HCG stimulating the testes in the same manner as LH, HCG therapy increases testosterone production by the testes or male gonads as a result of HCG’s stimulating effect on the leydig cells of the testes.

The Decline in Gonadal Stimulating Pituitary Hormone LH (Leutenizing hormone)

The natural decline in male testosterone production that occurs with aging is attributed to a decline in the gonadal stimulating pituitary hormone LH (Luteinizing hormone). As a result of the hypothalamus secreting less gonadoropin-releasing hormone (GhRH), which stimulates the pituitary gland to produce LH, the pituitary gland produces declining amounts of LH. This decrease in the pituitary secretion of LH reduces the stimulation of the gonads or male testes and results in declining testosterone and sperm production due to the decreased function of the gonads. The decreased stimulation of the testes by the pituitary’s diminished secretion of LH can also cause testicular atrophy. HCG stimulates the testis in the same manner as naturally produced. HCG Therapy is administered medically to increase male fertility by stimulating the testes to produce more sperm cells and thereby increase sperm count or Spermatogenesis.

The decreased stimulation of the testes by the pituitary’s diminished secretion of LH can also cause testicular atrophy. HCG stimulates the testis in the same manner as naturally produced. HCG Therapy is administered medically to increase male fertility by stimulating the testes to produce more sperm cells and thereby increase sperm count or Spermatogenesis.

How HCG Therapy Increases Plasma Testosterone Level in Men with Low Testosterone Production

HCG therapy uses the body’s own biochemical stimulating mechanisms to increase plasma testosterone level during HCG therapy. It is used to stimulate the testes of men who are hypogonadal or lack sufficient testosterone. The male endocrine system is responsible for causing the testes to produce testosterone. The HPTA (hypothalamic-pituitary-testicular axis) regulates the level of testosterone in the bloodstream. and . The hypothalamus produces gonadotropin-releasing hormone (GnRH), which stimulates the pituitary gland to release Leutenizing hormone (LH).

LH released by the pituitary gland then travels from the pituitary via the blood stream to the testes where it triggers the production and release of testosterone. Without the continuing release of LH by the pituitary gland, the testes would shut down their production of testosterone, causing testicular atrophy and stopping natural testosterone produced by the testes.

As men age the volume of hypothalamus produced gonadotropin-releasing hormone (GnRH) declines and causes the pituitary gland to release less Luteinizing hormone (LH). The reduction if the volume of LH released by the Pituitary gland decreases the available LH in the blood stream to stimulate the testes to produce testosterone.

In males, HCG mimics LH and increases testosterone production in the testes. As such, HCG is administered to patients to increase endogenous (natural) testosterone production. The HCG medication administered combines with the patient’s own naturally available LH released into the blood stream by the Pituitary gland and thereby increases the stimulation of the testes to produce more testosterone than that produced by the Pituitary released LH alone. The additional HCG added to the blood stream combined with the Pituitary gland’s naturally produced LH triggers a greater volume of testosterone production by the testes, since HCG mimics LH and adds to the total stimulation of the testes.

HCG Clinical Pharmacology

The action of HCG is virtually identical to that of pituitary LH, although HCG appears to have a small degree of FSH activity as well. It stimulates production of gonadal steroid hormones by stimulating the interstitial cells (Leydig cells) of the testis to produce androgens.

Thus HCG sends the same message and results in increased testosterone production by the testis due to HCG’s effect on the leydig cells of the testis. HCG therapy uses the body’s own biochemical stimulating mechanisms to increase plasma testosterone level.

Following intramuscular injection, an increase in serum HCG concentrations may be observed within 2 hours; peak HCG concentrations occur within about 6 hours and persist for about 36 hours. Serum HCG concentrations begin to decline at 48 hours and approach baseline (undetectable) levels after about 72 hours.

HCG is not a steroid and is administered to assists the body in the continuing production of its own natural testosterone as a result of LH signals stimulating production of testosterone by the testis.

This LH stimulates the production of testosterone by the testes in males. Thus HCG sends the same message as LH to the testes and results in increased testosterone production by the testes due to HCG’s effect on the leydig cells of the testes. In males, hCG mimics LH and helps restore and maintain testosterone production in the testes. If HCG is used for too long and in too high a dose, the resulting rise in natural testosterone will eventually inhibit its own production via negative feedback on the hypothalamus and pituitary.

HCG therapy uses the body’s own biochemical stimulating mechanisms to increase plasma testosterone level during HCG therapy. It is used to stimulate the testes of men who are hypogonadal or lack sufficient testosterone

Testopel for Hormone\Testosterone Replacement Therapy In Men

Millions of American men suffer from low T or decreased testosterone levels. The symptoms include a decrease in libido or sex drive, lethargy, decrease muscle mass, decrease in bone density, and even depression.

Treatment options include injections of testosterone, which can be done at the doctor’s office or by the man in his own home, testosterone gels, which are applied every day to the skin, and testosterone pellets or Testopel. Testopel is the only FDA-approved testosterone treatment on market designed to continually deliver testosterone for 4 – 6 months.
The three treatment options include injections of testosterone every two to three weeks, topical gels, and injections of pellets or Testopel under the skin which will last for 4-6 months.
The pellets are inserted under the skin using a local anesthetic. The procedure takes approximately 10-15 minutes for the insertion process. The procedure requires the creation of a small opening in the buttocks area and using a special insertion device to insert from 9-12 pellets. The number of pellets is dependent upon the testosterone level.

Testopel is contraindicated in men with an elevated PSA or who have an abnormal digital rectal exam.

Men have to discontinue the use of any blood thinners such as aspirin, Plavix, Coumadin, and even fish oil prior to the insertion of the pellets.
There is a small possibility that the pellets may exit the insertion site and that the insertion site may become inflamed and require the use of antibiotics.
There may be a small amount of pain at the injection site which can usually be controlled with Advil or Tylenol. The pain can also be reduced by applying ice to the insertion site.
It is important to understand that men receiving Testopel will need to monitor their PSA, blood counts, testosterone levels, and possibly his liver functions on a regular basis.
Men with breast cancer should not use Testopel. In patients with breast cancer, Testopel may cause elevated calcium levels in the blood.

Men who have or might have prostate cancer or have had an adverse reaction should not use Testopel .

Men treated with Testopel may be at an increased risk for developing an enlarged prostate and prostatic cancer.

Swelling of the ankles, feet, or body with or without heart failure may be a serious problem in patients treated with Testopel who have heart, kidney, or liver disease. In addition to your doctor stopping treatment with Testopel, your doctor may need you to take a medicine known as a diuretic

It is also a possibility that gynecomastia (enlarged breasts in men) frequently develops and occasionally persists in patients being treated for hypogonadism

Because Testopel pellets are placed under the skin it is more difficult for your doctor to change the dosage compared to medicines taken by mouth or medicines injected into the muscle (intramuscular injection). Surgical removal may be required if treatment with Testopel needs to be stopped.

In addition, there are times when the Testopel pellets may come out of the skin

While taking Testopel, your doctor may periodically do tests to check for liver damage. Your doctor may also check for increased red blood cells if you are receiving high doses of Testopel

Side effects of Testopel include more erections than normal or erections that last a long time, nausea, vomiting, changes in skin color, ankle swelling, changes in body hair, male pattern baldness, acne, suppression of certain clotting factors, bleeding in patients on blood thinners, increase in libido, headache, anxiety, depression, inflammation and pain at the implantation site and rarely anaphylactoid reaction (a sudden onset of allergic reaction)

Bottom Line: Androgen or testosterone deficiency is a common problem in middle age and older men. Help is available and Testopel is one solution.

Testosterone Deficiency-Treatment Puts a Tiger in Your Tank

As men age, the testosterone, the male hormone produced in the testicles, decreases just as a woman’s estrogen levels decrease at the time of menopause. Low testosterone can dramatically affect a man’s sex drive and sexual performance. Also low testosterone can reduce your ability to have satisfying sex. Lack of sex drive and erectile dysfunction are sexual problems that can result from low testosterone. If low testosterone is the cause, effective treatment is available.

Researchers haven’t unraveled the mystery of just how testosterone increases libido. It’s normal for a man’s sex drive to slowly decline from its peak in his teens and 20s, but libido varies widely between men. Also, sex drive changes within each man over time and is affected by stress, sleep, and opportunities for sex. For these reasons, defining what’s a “normal” sex drive is next to impossible. Usually, the man himself identifies a lack of sex drive as a problem. Other times, his partner may complain and send the man scurrying to his doctor for help or the partner may not consider the low sex drive to be an issue and they live happily ever after without an abundance of sexual intimacy.

In a large study of men in Massachusetts, about 11% overall said they had a lack of sex drive. The researchers then tested all the men’s testosterone levels. About 28% of men with low testosterone had low libido. These men were relatively young, with an average age of 47; older men might have worse sexual symptoms.

Low testosterone is only one of the causes of low libido. Stress, sleep deprivation, depression, and chronic medical illnesses can also sap a man’s sex drive.

Surprisingly, low testosterone by itself rarely causes erectile dysfunction, or ED. Low testosterone alone — with no other health problems — accounts for a small minority of men with erectile dysfunction.

Erection problems or ED are usually caused by atherosclerosis — hardening of the arteries. If damaged, the tiny blood vessels supplying the penis can no longer dilate to bring in the strong flow needed for a firm erection. Diabetes, high blood pressure, and high cholesterol are the three main causes of atherosclerosis and erectile dysfunction.
At the same time, low testosterone is a frequent accomplice to atherosclerosis in creating erectile dysfunction. About one in three men mentioning ED to their doctor have low testosterone. Experts believe that in men with other factors causing erectile dysfunction, low testosterone can strongly contribute, making a difficult situation even worse.

Strengthening the connection, low testosterone is linked in some way with many of the conditions that lead to erectile dysfunction:
• Metabolic syndrome
• Obesity
• Endothelial dysfunction
• Diabetes

Although low testosterone isn’t known to cause them, the associations between other medical conditions and low testosterone can be significant.
Testosterone therapy improves sex drive and satisfaction with sex in many men. Treatment consists of injections of testosterone every 1-2 weeks, daily application of a testosterone gel, or the insertion of a testosterone pellet beneath the skin and then repeating the insertion every 4-6 months.

Most men with decreased testosterone levels can be helped. A simple blood test makes the diagnosis and treatment usually restores a man’s sex drive, energy level, and sexual performance.