WHAT MEN NEED TO KNOW ABOUT TESTOSTERONE REPLACEMENT THERAPY

Testosterone replacement therapy (TRT) is a great treatment option for men with hypogonadism – a condition in which the body fails to produce enough of the hormone testosterone.

Hypogonadism can be a result of either illness or as part of normal aging.

Whether or not men with hypogonadism should receive TRT remains debatable. This is mainly because hypogonadism is still not fully understood and also because TRT may lead to other health risks in some cases. Nevertheless, TRT is considered a revolutionary treatment for men having suboptimal levels of a very important male hormone.

What does it mean to have low testosterone?

According to Abraham Morgentaler, MD, the Director of Men’s Health Boston with over 20 years of experience in treating male hypogonadism, The Endocrine Society considers low testosterone levels to be a total of testosterone (T) below 300ng/dl.

However, he also warns that there is no definitive agreement on what constitutes normal T levels. The situation is further complicated by the fact that half of the circulating T is not available to the cells due to testosterone binding to a glycoprotein called sex hormone–binding globulin (SHBG).

Luckily, we’re now able to measure total free testosterone levels which is a precise indicator of the biologically available levels of T in a man’s blood. Other than testing for blood testosterone levels, doctors also look for symptoms of hypogonadism because some men don’t develop problems from having low T levels and treatment may not be needed in such cases.

Is TRT successful?

Just a little over 15 years ago, TRT was not as successful as it is today because the available formulations were not efficient in reproducing the pattern at which T is naturally secreted by the body. These therapies have resulted in either too low or too high T levels the following administration.

Nowadays, the situation is quite different as TRT is efficient enough to provide men with ideal levels of T similar to those naturally produces by the testes according to an article published in the Current Pharmaceutical Design.

Today’s TRT involves either injection, topical gels, and patches with the latter being the best treatment option for achieving a uniform level of blood T for men receiving treatment for low testosterone. Because of the hypothalamus and the pituitary gland release hormones that stimulate the testes to produce T at daily intervals, it’s always best to mimic the natural way T is released in the human body.

Which men are candidates for TRT?

Men who present with the symptoms of male hypogonadism such as a low sex drive, erectile dysfunction, infertility, central obesity, osteoporosis, loss of muscle mass, and who are tested for low testosterone levels are usually candidates for TRT.

The reason why men develop TRT are many, and the underlying causes should also be looked into before suggesting TRT. For instance, some men may develop hypogonadism due to pituitary tumors and treatment of these tumors usually result in the improvement of T levels.

On the other hand, older men usually have lower T levels than they did in their youth and whether or not T would benefit them is a matter of debate. These men also worry that TRT may put them at risk of developing prostate cancer. Although this idea may seem logically plausible, Dr. Morgentaler states that there is no real evidence to support such claims.

What are the benefits of TRT?

Just like estrogen provides a protective effect on women’s general health status, so does testosterone on men. Dr. Morgentaler believes that the therapeutic effect of TRT will be recognized in the near future not for just improving the patient’s well-being but also in protecting the patient against heart disease and all-cause mortality.

Men receiving TRT may see improvements in their overall functioning and feelings of well-being. Their energy levels may improve, their sex drive may rise, and their body composition may also improve. These benefits are best achieved by consulting a medical professional licensed to treat men with hypogonadism, but there are also claims that natural nutraceuticals may also do the trick. However, men should be aware that these products are not regulated and pose a health hazard in some cases according to a recent study published in the Journal of Dietary Supplements.

Conclusion

Most men will experience a decline in their T levels with age, and although this decline is completely normal, it can and does cause uncomfortable symptoms in some men.

Furthermore, men with illnesses that affect the functioning of their reproductive system and testosterone production may greatly benefit from TRT. Most treatment options today are both safe and effective in restoring normal T levels when administered by a certified physician.

On the other hand, men wishing to boost their T levels with alternative methods may find herbal supplements beneficial as some studies found that herbs and other plants have the potential to stimulate sex hormone production in some cases.

A Perimenopause Survivor’s Guide - The truth about hormone fluctuations and treatment options.

When it comes to menopause, there is some good news: It only lasts for a day. After 365 days menstruation free, the 366th is menopause, and then women are considered postmenopausal. The experience of all the months leading up to it are actually the effects of being perimenopausal. 

“As women finish their childbearing years, the ovaries slowly stop producing estrogen, progesterone and testosterone,” says Dr. Elizabeth Louka, an OB-GYN, “They gradually taper off and, in that transitional period, some women experience erratic fluctuations of hormones that create symptoms, some of which are severe.”

Symptoms can include insomnia, acne, weight gain, irregular periods, hot flashes and night sweats. While the average age for menopause is 51, women can begin feeling perimenopausal symptoms in their late 30s. By age 45, most are getting at least a taste of them. 

Because “perimenopause” is a little-used term, women don’t immediately understand what’s happening. Some patients think they may be pregnant or re-experiencing puberty. The reality is that the climate has changed. You’re at a new level of the mountain. You need new boots and a new map.

Unfortunately, there’s no forecast for perimenopause. The unpredictability of perimenopause only adds frustration. Blood and saliva tests can give a snapshot of hormone levels, but they’re constantly in flux. “Studies have looked at estrogen levels, and it’s not a steady decline,” says Louka. “They can be elevated one day and decreased the next day. Progesterone and testosterone are not in unison with each other, either. I think that’s what makes the symptoms so expressed.”

Dr. Lisa Freedman, who practices holistic medicine in Villanova, explains that estrogen, progesterone and testosterone are not the only hormones that create perimenopausal symptoms. Cortisol, follicle-stimulating hormone (FSH), dehydroepiandrosterone (DHEA) and lutropin (LH) affect ovulation and women’s overall health. “Of course, it’s a complicated, delicate system,” Freedman says. “We’re women.”

Women who have their weight, blood pressure, cholesterol and heart rate under control may have an easier time dealing with perimenopause. On the other hand, there are superwomen out there, raising their family and/or working and taking care of everyone but themselves. They hit a wall and crash, so to speak.

Natural bioidentical hormone therapy is one of the most effective treatments for symptoms. Available in oral capsules, injectables, and creams, bioidentical hormones are made at compound pharmacies. Dosages are tweaked based on patients’ responses. 

Hormone therapy initially proved controversial when a Women’s Health Initiative study abruptly stopped it in 2002 because participants were determined to be at elevated risk for heart disease and breast cancer. That study only reviewed synthetic hormones produced by large pharmaceutical companies.  Since then, additional research has been conducted, and the WHI released its full findings in 2013. That the report clarified when hormone therapy should be used and for which patients.  Generally, bio-identical hormone therapy (BHRT) doesn't cause the potential adverse side-effects of synthetic hormones.

How Doctors Today Are Screening Smarter for Prostate Cancer

Before prostate-specific antigen (PSA) tests came along in the late 1980s, most men newly diagnosed with prostate cancer were incurable. Within a few years of using PSA, however, we saw an amazing shift: By the mid-1990s, most men newly diagnosed with prostate cancer were curable.

Since then, studies have shown that while PSA screening reduces a man’s likelihood of dying from prostate cancer, it does not reduce overall mortality. The problem has been with how we use PSA tests.

In the last two decades, we’ve learned that following traditional screening guidelines — screening all men annually beginning at age 50, or age 45 if higher risk — frequently results in the detection of non-life-threatening cancers (called overdiagnosis) that don’t need to be treated. Overdiagnosis often leads to overtreatment, where men not destined to die of their cancer get treated anyway and suffer the downtime, recovery issues and side effects of therapy.

To avoid overdiagnosis and overtreatment, we need to be smarter about how we use PSA testing. Recommendations for screening have already begun to change.

Here are two ways to screen smarter for prostate cancer:

1. Men should have a baseline PSA test at age 50
Knowing your baseline PSA level can help predict your lifetime risk of prostate cancer and indicate how frequently you need to have future PSA tests.For example, if your baseline PSA is below 0.7 ng/mL (the average for men at age 50), your lifetime risk of developing prostate cancer is less than 10 percent. It’s probably safe to be screened less often than previously recommended. I recommend a PSA only every five years.

On the other hand, if your baseline PSA level is above 0.7 ng/mL, evidence suggests your lifetime risk of developing prostate cancer is greater than 10 percent. More frequent screening makes sense, and I recommend a PSA test every two years. If you have high-risk factors, such as having a family history of prostate cancer or being African American, I still recommend screening yearly.

Furthermore, data shows that men age 60 and older who have PSA levels 2.0 ng/mL and lower have a very low risk of prostate cancer. I recommend stopping PSA screening for them or doing them less frequently. If we do screenings this way, it’s likely that we’ll reduce the risk of overdiagnosis as well as the overtreatment of non-lethal prostate cancer.

2. PSA screening should be supplemented with new, more specific, screening tools
Prostate cancer antigen 3 or “PCA3” (a urine test), OPKO 4Kscore™ (a blood test) and Prostate Health Index (a blood test) are three tools that provide accurate results than a PSA test — which can’t distinguish between prostate cancer, noncancerous prostate enlargement and prostate inflammation due to another condition.

These new diagnostic tools can help us detect more biologically significant prostate cancers, the ones that need to be treated. MRI-guided biopsy (also known as fusion or targeted biopsy using a combination of MRI, ultrasound and needle biopsy) is another tool that helps us identify aggressive prostate cancer tumors that need to be treated, versus low-grade tumors that can be managed with active surveillance.

Genomics and genetics soon will play a more significant role in detecting prostate cancer risk, much like mutations in BRCA genes indicate risk of breast cancer. We’re not there yet, but we’re getting closer. New genomic tests already on the market can tell if a newly diagnosed cancer can be safely watched or needs treatment.

We need to get the word out to patients and primary care physicians, who are on the front lines of PSA screening.

While traditional standards haven’t been perfect, PSA tests still play an important role. Talk to your doctor about when and how frequently you should have one.