It is rare to find a man over 45 who does not have low Testosterone levels. However, the correct tests need to be ordered. And in case you were wondering, yes, men experience a kind of Male Menopause which is affectionately named Male Andropause.
Testosterone isn’t just for sex any more. Yes, it does increase libido in men and women. Remember that any hormone, whether it is Testosterone, DHEA, Human Growth Hormone (HGH), Estrogen, Human Chorionic Gonadotropin (HcG), Estradiol, Estrone, Estriol, Progesterone, etc. has literally hundreds of mechanisms of action (things they do). Testosterone also converts fat to muscle (we are losing a pound a year with aging), sharpens memory, improves sleep quality, increases bone density, and improves heart function.
Actually, there are more receptors on your heart for Testosterone than anywhere else you may have imagined them to be. In Europe, Testosterone is a first line heart medication. The heart is a muscle. You have Testosterone receptors from your brain to your toes.
So, how does one know if they have a deficiency or insufficiency of Testosterone. The following laboratory studies are necessary:
CBC, Chem Profile, Lipid Profile with VAP, Homocysteine, hsCRP, (looking for anemia, heart function and inflammatory status), liver function tests with GGT
DHEA-S (Dehydroepiandosterone Sulfate) please note that DHEA is THE most abundant hormone, you have receptors for DHEA on every cell of your body
Vitamin C (if low, Testosterone converts to Estrogen)
5-DHT (Dihydrotestosterone -Testosterone can convert into 5-DHT and then Androstenediol)
Estradiol, Estrone (Testosterone can convert into Estrogen)
HgbA1C (Indicates what your blood sugar has averaged over three months)
HcG (Human Chorionic Gonadotropin) (helps reprime your hypothalmus to produce Testosterone, and lose weight)
HGH (Human Growth Hormone, also known as IGF-1 or Somatocedin C)
FSH, LH (Indicator of Hypothalamus (brain) function)
Fasting Insulin (Receptors for Insulin become resistant with aging and overeating)
Progesterone (If low, Testosterone converts to Estrogen)
Prolactin (if high, major cause of erectile dysfunction and loss of libido)
PSA, %Free PSA (Prostate test)
RBC Zinc (if low, Testosterone converts to Estrogen)
SHBG -Sex Hormone Binding Globulin (if high, binds your Testosterone)
Free Testosterone (Testosterone which is available for use)
TSH, T3, T4, Free T3, Free T4, TBG, reverse T3, Antithyroperoxidase Abs, Antithyroglobulin Abs
So you can see that getting Testosterone from some unknown source requires monitoring by someone who is medically sound. I also hope that you are beginning to realize that how well nourished you are affects whether we will get the desired result. It may surprise you that your Estrogen levels need to be measured. More specifically, estradiol and estrone. And even more specifically the ratio of 2 hydroxyestradiol to 16 hydroxyestradiol. Most of my male patients have higher estrogen levels than my women patients. Why would men have more Estrogen?That is a good question. And that is one reason why you need to be monitored when you take Testosterone.
Have you noticed that aging men have breasts, abdomens that resemble pregnancy, that they are not able to get that V look, that their waist is bigger than their hips (which is one definition of obesity for men), and that they look puffy? Of course, eating the standard American diet (SAD) does not help our cause.
What is actually happening biochemically is that the aging male’s Testosterone is converting into Estrogen. Testosterone converts into Estrogen because of the following reasons:
abdominal obesity contains inflammatory hormones that convert Testosterone to Estrogen
decreased Zinc (which results from eating refined white flour and sugar) converts Testosterone to Estrogen
decreased Vitamin C (you do not need mega doses) converts Testosterone to Estrogen
insufficient Omega 3 Fatty Acids (see The Good Fats section of website) converts Testosterone to Estrogen
increasing Aromatase and 5 Alpha Reductase enzymes (from being too chubby) convert Testosterone to Estrogen
increased alcohol consumption converts Testosterone to Estrogen (sorry)
liver dysfunction secondary to diet, environment, golfing, alcohol, medications, surgeries, etc. converts Testosterone to Estrogen
progesterone deficiency converts Testosterone to Estrogen
Some Benefits of Bioidentical Testosterone Replacement are:
enhanced libido (so you were right to think that Testosterone helps your sexuality)
conversion of fat to muscle
blood sugar control
optimal immune function
partial protection against SDAT (Senile Dementia Alzheimer\’s Type)
decreased CVD (Cardiovascular Disease)
decreased Insulin requirements
increased Insulin Receptor activity
After all these lists, I think a story is in order. The Hertoghe Family is a family of four generations of European Endocrinologists. Great Grandpapa, Grandpapa, Father, and now Son and Daughter – are Endocrinologists. In the 1910s, Great Grandpapa extracted bull testicles and implanted them in aging males to determine the life enhancing properties of Testosterone. It worked. Unlike women, men produce 90-95% of their Testosterone in their Leydig Cells (in the testicles). Women don’t have Leydig Cells because most women don\’t have testicles. But I may have met a few.
Dr. Hertoghe, the son, hosts medical seminars all over the world. Finally, his book entitled The Hormone Solution which is amazingly broad in scope, has been translated to English. I have had the honor of training with Dr. Hertoghe, reading the French, and now the English version of hormonal replacement in the aging male and female. On the first day, we spent twelve hours discussing just the Thyroid. The Europeans replace all of the hormones in low physiologic doses, not big pharmacologic doses. Also, whenever possible, replacement is accomplished with bioidentical compounded hormones.
Now, let\’s say you have a deficiency or insufficiency. Testosterone may be obtained via your local pharmacy as the scrotal patch or gel to be applied to your chest (a lot, and it\’s messy). If you are working with an Integrative Medical Physician (MD or DO), they may prescribe compounded gels (more concentrated, requiring very little), or periodic injections into your buttocks. Gels and injections bypass the necessity for liver detoxification. Compounded hormones are made by pharmacists who specialize and make bioidentical hormones in individualized doses, and in various forms: creams, gels, troches, injectibles, etc.
Of special note is that we are NOT discussing the anabolic bad boy Testosterone that weight lifters and bigorexic men use. Men who use the wrong kind of Testosterone may develop LVH (Left Ventricular Hypertrophy), eventually leading to Congestive Heart Failure and consequent inability to pump blood from the heart to the remainder of the body, resulting in death. Other symptoms of synthetic overdosing of Testosterone are sterility, erectile dsyfunction, testicular atrophy, liver enzyme elevation, and red man syndrome.
A note about the woman in your life. Women produce one tenth the amount of Testosterone as men until their mid thirties when their adrenal production falls dramatically. In women, Testosterone is produced in the ovaries and adrenal glands. Since women produce a tiny amount of Testosterone, women may leave their consultation with a low dose prescription. Husbands have been known to send me flowers. Please know I prefer plants because they continue living. Men have told me I returned their wife to them. That meant more to me than all the plants in the universe.
Follow up is important as the goal is to keep you in physiologically normal ranges. That is, a forty year old level, forever. We don’t want you becoming rammy or chasing people you don’t know down the street. Nor is the goal is to make you a giant little man. Just a hot aging man with an edge.
Updated by Roberta Foss-Morgan, DO on June 10, 2010