Archive for the ‘topical estrogen’ Category

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

November 21, 2015

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.

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Using Hormone Therapy To Reduce Recurrent UTIs in Women

April 13, 2015

Women often experience recurrent UTIs after menopause. The cause is often a result of reduced estrogen levels that is so common after menopause. This blog will discuss the use of topical estrogens to reduce the frequency to recurrent urinary tract infections.

Topical hormone replacement therapy (HRT) was associated with a lower incidence of urinary tract infections (UTIs) compared with both oral HRT or even no HRT.

UTIs are a frequent problem among postmenopausal women necessitating antimicrobial use, and resistance is increasing. Every year, 8–10% of postmenopausal women have 1 episode of a urinary tract infection; of these, 5% will have a recurrence in the next year.

Studies have demonstrated use of oral estrogens does not reduce the incidence of UTIs, but topical HRT reduced the number of UTIs in two small studies.

To determine whether a difference existed in incidence of UTIs in women 60–75 years of age, a study compared the number of UTIs per patient per year over 1 year in 3 groups of postmenopausal women: topical HRT, systemic HRT, and control (n=75 per group).
Women aged 60–75 years with a history of UTI (n=448) were identified from retrospective charts (2011–2013). Patients were excluded if they were taking antibiotics for UTI prophylaxis, treated with antibiotics for reasons other than UTI for 2 or more weeks, were on both topical and systemic HRT, or on chronic methenamine hippurate.
The number of UTIs per patient per year was significantly different among the 3 groups. There was a significant difference between topical HRT and systemic HRT, and topical HRT and control, but not systemic HRT and control. The control group had an average of 1.24 UTIs per patient per year, compared with 1.01 in the systemic group and 0.65 in the women who used topical estrogen replacement.

Bottom Line: Topical estrogens may be beneficial when other preferred agents cannot be utilized.