One of the major reasons we age is because our hormones decline

Male menopause is called Andropause and the onset can take decades, unlike women who experience menopause rapidly

The consequences of not replacing Testosterone is severe regarding long term medical and psychological consequences

To determine if there is decreased bioavailable Testosterone requires the correct tests, after which a rather complicated equation is done to determine the man’s level of Testosterone
to do calculation see http://wwwissam.ch/freetosto.htm

Symptoms of Male Menopause:

Increased aging of heart and circulation (the heart has more receptors for Testosterone than anywhere else in the body)
Increased MIs and CVAs
Decreased hemodynamic function
Increased brain aging
Decreased memory
Decreased intelligence
Increased Dementia and Alzheimer’s
Loss of drive and competitive edge
Stiffness and pain in muscles and joints
Falling level of fitness, decreased effectiveness of workouts, and longer recovery time
Sarcopenia (muscle loss which is replaced with fat)
Osteoporosis
Anemia
Fatigue
Depression, mood changes
Irritability
Dysphoria
Reduced libido and potency
Decreased desire and fantasies
Decreased morning erections (Testosterone is highest in the morning)
Decreased erectile tension
Longer recovery time between orgasms
Decreased intensity of orgasms

Testosterone begins to decline slowly in a man’s 30s

Andropause is a lethal disease as it affects a man’s brain, heart, bone, inflammation, and cancer

A ten year prospective study reported that appropriately high levels of Testosterone corresponds with low mortality

Paradoxically, the fear of prostate cancer keeps many men from T treatment, even though the studies demonstrated that with appropriately high levels of Testosterone did not correspond with
any increase of prostate cancer

Studies purporting an association between Testosterone and prostate cancer did not measure Estradiol levels. Testosterone can convert to Estradiol if treatment is not appropriate. Estradiol
hypertrophies (grows) prostate cells which then are able to replicate. Estradiol levels need to be reported and optimized, and the studies need to study a large population. The University of
Pennsylvania is presently doing a 40 million dollar study on Testosterone. Again, the methodology of the research needs to be pristine, the biochemistry needs to be understood, the
studies cannot be “industry sponsored”, and the size of the sample needs to be respectful

An exhaustive bibliography of the literature is available by Abraham Morganthaler, M.D. who wrote Testosterone for Life

The laboratory “Reference Ranges” are not “Optimal ranges” – this has been well illustrated as the ranges for normal Thyroid have been changed seven times in my lifetime

The present reference level for what is appropriate is adjusted for age, actually, the goal is to keep a man’s T within the normal range of a much younger man

Reference ranges are not optimal ranges, the entire medical history must be considered

SHBG (Sex Hormone Binding Globulin) binds Testosterone (more than Estrogen). Hence SHBG levels for men should be lower.

The following increase SHBG: Thyroid, Estrogens, Progesterone, (in pharmacologic doses which is never the goal), Aging, Low Insulin

The following decrease SHBG: Testosterone, DHEA, Growth Hormone, High Insulin

Free Testosterone is the fraction of Testosterone that is unbound to Albumin and SHBG

Testosterone is loosely bound to Albumin

To obtain accurate levels of FREE Testosterone use the T calculator at http://www.issam.ch/freetesto.htm

Problem with Free Testosterone level is that it does not include “useable” loosely bound to albumin

Heretofore, Anastrozole (Arimidex) 0.5 mg 1-3 x per week has been prescribed to lower Estradiol. Arimidex is a breast cancer medication. Estrogen in the male must not get too low as Estrogen is necessary for a man’s brain, heart, and bone

A less toxic way to lower high Estrogen levels in men is to inhibit Aromatase with the following: Chrysin (a bioflavinoid) 250 mg po BID or TD, Zinc Citrate 30 mg TID, Progesterone 5-10
mg TD, AND decrease belly fat. Those 12 month pregnancies I see in men increase the conversion of Testosterone to Estradiol

Intramuscular Testosterone is self administered and peaks in 48 hours

Oral Testosterone is NEVER a consideration as it is hepatotoxic (liver toxic)

Transdermal Testosterone is commercially available. Avoid the scrotum as it increases DHT (high Dihydrotestosterone will cause ED), avoid getting on females and children,
can increase hair growth in area of application (unfortunately not on head), Testosterone levels can actualy decrease on laboratory studies with TD gels, some men do not absorb gel well

HCG – aka Human Chorionic Gonadotrophin:

Hypogonadism can be treated with HCG injections if there is no Leydig cell failure

2000-5000 units per week SQ divided

One advantage is no decrease in testicular size or sperm count (if patient desires children)

Can treat TRT (Testosterone Replacement Therapy) but measure free T to confirm success or cycle with TRT every 6 months

Alternative TRT program is to use low dose of 250 units SQ daily

If FSH and LH are already relatively high, probably will not work, as this is evidence of Leydig cell failure

Avoids the TRT side effects of loss of testicle volume and decreased sperm count

There is some concern that there will be more aromatization

In one study, using 3000 units every 2 weeks, the Total, Free and Bio-available increased about 25%

Another study reported that HCG always increased libido, the Nitric Oxide receptors were up regulated, and erectile function usually improved , results may require 6 months of treatment

Testosterone and the brain:

T increases cognitive function and prevents the production of beta amyloid precursor protein (in men)

The higher the Bioavailable T, the lower the risk for developing Alzheimer’s

T effective when psychiatric drugs do not work in patients with low T

T increases nocturnal and spontaneous erections and improves mood

High Free T was associated with better performance on tests of memory, executive function, and spatial ability

Traumatic Brain Injury and Testosterone:

Nearly everyone has had some closed head injury, it is rare to take a history and find a patient who has never injured their head (hence the present study of NFL players and head trauma)

After brain trauma, which does not require one be rendered unconscious, T is suppressed 100%, IGF-1 is suppressed 77%, and Growth Hormone is NON-MEASURABLE in 38%

Testosterone and the heart:

The lower the T, the more likely there will be a coronary artery disease diagnosis

T improves exercise induced ST depression

T dilates coronary arteries

T improves angina threshold, most likely as a result of the vasodilatation

With T replacement there are LESS inflammatory cytokines TNF, IL-lbeta, and MORE anti-inflammatory cytokines IL-10

T improves Insulin resistance

Studies indicate that there is an inverse relationship between blood pressure and Testosterone

Testosterone and Prostate Cancer:

Refer to Testosterone and Prostate Cancer: An Historical Perspective on a Modern Myth. European Urology 2006 Jul 26

When T is prescribed, one must monitor the Estrogen

Men need a little Estrogen, just like women need a little Testosterone

But too much Estrogen hypertrophies (makes big) prostatic cells

One particular kind of Estrogen called Estrone, is found in fat cells of men, and causes Prostate Cancer and Benign Prostatic Hypertrophy

Testosterone and Frailty Syndrome:

When you touch a man’s back as he ages you usually feel loose skin that previously covered MUSCLES

Frailty Syndrome is what we presently call natural aging, namely, accelerated osteoporosis, decreased muscle mass, anemia, cognitive decline

Progesterone increases neuronal stem cells via allopregnolone

T also increases growth hormone by 5-10%

Potential adverse side effects of T treatment:

Increased RBCs, Gynecomastia (measure Estradiol!), possible decrease( in testicular size, decreased sperm count (do not prescribe if man desires a larger family), possible decrease
in testicular size

Testosterone Rx increases ENDOTHELIAL PROGENITOR CELLS (EPCs): Note that EPCs are stem cells

EPCs are the mechanism of action to reverse Erectile Dysfunction
Testosterone normalizes EPCs in about six months
Androgen receptor is expressed on EPC’s
Clinical studies demonstrate that there are a reduced number of circulating Endothelial Progenitor Cells in hypogonadal men
T increases circulating EPCs from Bone Marrow which cause vascular repair

RFM comments that hypogonadism (low Testosterone) is alarmingly more frequent in men as young as 30

Testosterone Rx improves ED and can resolve ED with PDE5 inhibitors that previously didn’t work

INCREASED SHBG = Estrogen, Thyroid, low Insulin, Progesterone

DECREASED SHBG = Testosterone, DHEA, Growth Hormone, high Insulin

Written by Roberta Foss-Morgan, D.O. on November 26, 2010