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Testosterone

Testosterone is probably the most well-known of all the hormones, commonly thought of as the man hormone. In reality testosterone is found in both males and females although in vastly different amounts. The effect that testosterone has on the body is profound both mentally and physically. Testosterone therapy can be in many different forms in males I feel the best option is injectable. This gives the mail the option to titrate his levels and keep them optimal at all times. With other forms of testosterone treatment we find that there is big fluctuations in levels of testosterone and this can be associated with side effects. Other forms of testosterone used by males are both topical, which often fails to give optimal results and pellets which are commonly used in low " T " centers.

Females have options as well, those being topical, injectable and again pellets. Females results with topical testosterone can be optimal due to the fact that optimal levels are much lower than in males. I have found using injectable testosterone with small insulin syringes, injecting subcu in abdominal fat twice weekly, gives excellent results and allows you the ability to regulate your testosterone perfectly. Pellets have not been incorporated into this program do to the inability to tightly regulate dosing.

Some males have the option when fertility is desired to use other forms of biweekly injections that can stimulate their own production of testosterone. Although this treatment option is slightly more expensive it does not suppress spermatogenesis or any other function of the testes.

               Benefits of Testosterone

1) increase lean muscle mass

2) increase bone density

3) decrease visceral fat

4) increase energy

5) improve memory

6) improved concentration

7) increase in libido

8) feeling of well-being

9) increased insulin sensitivity

10) lowering of cholesterol

11) dilation of coronary arteries

12) endothelial health

13) reversal of small plaque

14) improve sleep

15) in males decreased incidence of prostate cancer

Testosterone Replacement

Testosterone replacement aims at obtaining optimal levels. Ideal testosterone replacement therapy produces and maintains optimal physiologic serum concentrations, without significant side effects or safety concerns.  There are different variations ways to replace testosterone, the most common being intramuscular, sub Q, transdermal and via the pellet procedure.

Types of Testosterone Replacement Therapy:

Oral Testosterone

Oral agents may cause elevations in liver function tests. For this reason oral testosterone is not used at the Thompson Clinic

Intramuscular Injections (IM)  Testosterone

Injected into the muscle, and then absorbed into the bloodstream over days.  This is the most popular preparation secondary to its highly accurate dosing and insignificant hepatotoxicity levels.. Fluctuations in testosterone levels may yield variations in libido, sexual function, energy, and mood.

Transdermal (Topical)

Testosterone preparations can be made in cream or gel forms and are rubbed into the skin, then absorbed through it.  Transdermals can be provided in different strengths ranging from 10 mg to 200 mg per milliliter.  For optimal benefit, twice daily doses are recommended once upon waking, and again later in the day at consistent times.

Sub-Q  

This type of injection is similar to the injections used by diabetics and is typically done twice weekly. Women can use the insulin syringes and a 31 gauge needle, men require a slightly larger needle due to volume required for replacement.

Pellets

A relatively new technique requiring an in office procedure to place hormones under the skin. This typically is done 3-4 times yearly.

Monitoring Patients On Testosterone Replacement Patients on testosterone replacement therapy should be evaluated on a regular basis with blood tests to check levels of testosterone, PSA, CBC, estradiol, and dihydrotestosrterone.

Benefits of Testosterone Replacement Therapy

The benefits of testosterone replacement therapy have been recorded, including better stability with moods, energy levels, and libido. Testosterone replacement has also been shown to enhance libido, the frequency of sexual acts and sleep-related erections. More specifically, testosterone replacement therapy has been shown to improve positive mood parameters, such as feelings of friendliness and reduction of negative mood parameters, such as anger and irritability.

Testosterone replacement therapy is also associated with potentially positive changes in body composition. In hypogonadal men, testosterone replacement therapy has demonstrated a number of effects, including an increase in lean body mass and decrease in total body fat.

Improvements in bone density have also been shown with testosterone replacement therapy. Increases in spinal bone density have been realized in hypogonadal men, with most treated men maintaining bone density above the fracture threshold.

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Estrogens

Estrogens as a group often prescribed alone or in combination to re-establish optimal physiologic balance. (ERT). Estrogens are effective for the treatment of menopausal symptoms, the treatment of postmenopausal problems. They are also increase bone density, decrease improve heart health and decrease the incidence of colorectal cancer.

Conjugated equine estrogens, Premarin, are derived from pregnant mares’ urine; however, these are never naturally produced by humans. Research has shown that the risk of breast cancer is increased with the long term and the risk is further increased when the synthetic progestin Provera (medroxy-progesterone acetate) is added. The 2012 Hormone Therapy Position Statement of The North American Menopause Society.

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Androgens

Testosterone and dehydroepiandrosterone (DHEA) may be added to a woman’s hormone program to help fight osteoporosis, loss of immune function, obesity, diabetes, improve cholesterol, regenerate endothelium, improve memory, increase lean muscle and increase quality of sleep.

Men frequently experience declines in testosterone levels that correlate with the hormonal changes that women experience at menopause; however, men typically have a slower and more subtle hormonal decline, and develop symptoms over a period of time. When hormones are replaced or restored back to physiologic levels considered normal for younger males, men may experience a dramatic reversal of many of these changes.

 Testosterone has similar effects on males as females as well as decreasing the incidence of prostate cancer.

the American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Evaluation and Treatment of Hypogonadism in Adult Male Patients.

Natural testosterone must not be confused with synthetic derivatives or “anabolic steroids,’ which when used by athletes and body builders can cause disastrous effects. Hormone balancing for men may also include  DHEA, zinc, saw palmetto, and other supplements as well as aromatase inhibitors such as chrysin, anastrozole, and tamoxifen.

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Progesterone

Progesterone is normally perscribed with estogen to avoid “estrogen dominance.” It decreases the risk of endometrial cancer in women who are receiving estrogen.

Progesterone and synthetic progestins have generally indistinguishable effects on endometrial tissue (i.e., both prevent hyperplasia of the lining of the uterus, which can progress to endometrial cancer). However, in other body systems, natural progesterone has diffent effects than synthetic progestins. Progesterone has a calming effect and is taken in the even promoting better sleep.

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Thyroid

Symptoms of hypothyroidism  included fatigue, cold and heat intolerance, hypotension, fluid retention, dry skin and/or hair, constipation, headaches, low sexual desire, infertility, irregular menstrual periods, aching muscles and joints, depression, anxiety, slow metabolism and decreased heart rate, memory impairment, enlarged tongue, deep voice, swollen neck, PMS, weight gain, hypoglycemia, and high cholesterol and triglycerides. Yet, more than half of all people with thyroid disease are unaware of their condition.

T4 (thyroxine) is an inactive form of thyroid hormone that is converted in the body to T3, the active form. Some hypothyroid patients remain symptomatic on T4 therapy and T3 may also be required for optimal thyroid replacement therapy. However, the only commercially available form of T3 is the synthetic drug Cytomel  in an immediate release formulation which is rapidly absorbed and may potentially cause serious side effects including heart palpitations.

Research indicates that to avoid adverse effects, patients and their physicians may wish to consider the use of sustained-release T3 in the treatment of hypothyroidism, particularly when the response to the synthetic T4 drug Synthroid has not been complete. Another option is to use a physiologic blend of T4/T3 commonly reffered to as Armour thyroid.

 

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