Andropause - Hormone Replacement Therapy for Men
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Men, especially men over 35 also experience issues related to hormone imbalance. The natural decline of testosterone contributes to problems with sexual dysfunction as well as muscle weakness, depression, bone loss and other symptoms associated with andropause (also called "male menopause"). Testosterone replacement therapy is safe and can provide dramatic benefits. Andropause is a deficiency disease. Half of healthy men between the ages of 50-70 years have low levels of testosterone.
This condition signifies the midlife retreat of the hormones known as androgens: DHEA, and testosterone. In contrast to the "roller coaster" effect so common to women in menopause, the symptoms of andropause appear gradually and can be much less obvious. Some of the first signs a man may be experiencing this change are subtle downward shift in strength and energy, and loss of enthusiasm for the challenge of work, competition, and sexual activity.
Along with the aging process, excessive stress, weight gain, and lack of exercise can further lower testosterone, which will impact stamina, drive and virility. This is a very common condition, but it is often under-diagnosed and under-treated.
Through hormone testing and working with a physician qualified to treat imbalance, a man can address the effect of andropause as well as hidden deficiencies.
Some men may go through a rather sudden change in testosterone levels that might correlate with the hormonal changes that women experience at menopause. However, most men have a slower and more subtle hormonal decline experiencing symptoms over a period of time. Bio-identical testosterone replacement is central to the treatment of andropause.
The indication for testosterone replacement therapy requires the presence of a low testosterone level, and signs and symptoms of low testosterone (medically termed hypogonadism). When hormones are replaced or restored back to physiologic levels (considered normal for younger males), men may experience dramatic reversal of many of these changes. The diagnosis of hypogonadism is based on the presence of signs and symptoms and must be confirmed by laboratory testing. Screening for potential risks of androgen therapy should be performed prior to the initiation of treatment. Proper monitoring of laboratory values and clinical response are essential for optimal testosterone replacement therapy.
Testosterone USP is a natural testosterone that has been approved by the United States Pharmacopoeia. Upon a prescription order, compounding pharmacists can use pure Testosterone USP to compound numerous dosage forms. The information that follows should be considered as practitioner, patient and pharmacist work together to meet the specific needs of each patient. Better to administer is daily testosterone rather than using long-lasting injections. Testosterone is well absorbed from topical creams and gels. Other dosage forms include sublingual drops, buccal and sublingual troches or tablets triturates. Compounded preparations can have many advantages. For example the medication can be administered as a single dose and usually there is no skin irritation from the use of creams or gels.
Again, bio-identical testosterone must not be confused with synthetic derivatives or "anabolic steroids", which are used by athletes and body builders have disastrous consequences, such as heart problems and cancer. The term "testosterone" is often used generically when referring to numerous synthetic derivatives, as well as natural testosterone. The confusion surrounding testosterone transcends the lay person; it is responsible for conflicting data in the medical literature about the benefits and risks of testosterone therapy. Studies must be reviewed carefully to determine the form of testosterone that was used before. For example use of synthetic non-aromatizable androgens, like stanazol or methyltestosterone, causes profound decreases in HDL-C ("good cholesterol") and significant increase in LDL-C ("bad cholesterol"), and has been associated with serious heart disease. Yet, hormone replacement therapy with bio-identical testosterone (aromatizable androgen), results in lower total cholesterol and LDL-C cholesterol levels, while having little or no impact on HDL-C cholesterol levels. Therefore, methyltestosterone for example (synthetic and non-aromatizable), causes a rise in liver enzymes, as well as cholesterol and serious liver problems, and is not recommended.
Men experience a more gradual decline in hormone levels than women. It is much less sudden than female menopause. For example, men are losing approximately 1% of their testosterone, and 2.5% of their DHEA per year beginning at age 30 and is getting lower every year. Testosterone protects men as estrogen protects women.
Men suffer frequently in silence. Andropause is not a topic often written about in magazines or newspapers. Men frequently experience decline in testosterone levels that correlate with the hormonal changes that women experience with menopause. However, men typically have a slower and more subtle hormonal decline, and develop symptoms over a period of time. When hormones are replaced and restored back to physiologic levels, considered normal for younger males, men may experience a dramatic reversal of many of these changes. In clinical trials, testosterone replacement therapy has produced improvement in psychological well-being and mood, improvement in erectile dysfunction and libido, increased muscle mass, strength, and stature, and preservation of bone mass.
Testosterone therapy may not only treat hypogonadism, but may also have tremendous potential to slow or halt the progression from metabolic syndrome to overt diabetes, or cardiovascular disease via beneficial effects on insulin regulation, lipid profile and blood pressure. Bio-identical testosterone must not be confused with synthetic derivatives or "anabolic steroids", which when used by athletes and body builders have caused disastrous effects. Hormone balancing for men may also include DHEA, DHT, chrysin, zinc, selenium and other supplements.
Signs and symptoms of andropause may include:
- increased anxiety, irritability, memory or concentration problems
- reduced sex drive or libido, erection or potency problems, decreased desire and sexual fantasies, longer recovery time between orgasms, decreased intensity of orgasms
- loss of fitness-withering muscles
- increase in fat tissue
- loss of energy, decreased workout effectiveness
- loss of managerial skills, loss of self-confidence
- reduced cognitive function
- fatigue, depression, loss of ambition, edginess
- generalized weakness
- reduced sleep
- heart disease ( increased rate of heart attacks, poor circulation)
- slow wound healing
- prostate problems
- impaired immune cell formation (ill at ease)
- joint stiffness and muscle pain
- increased aging of the heart and brain
- decreased memory and intelligence
- increased dementia and Alzheimer's disease
- less muscle, more fat
- depression, mood changes
- unnecessary worry
- thoughts of self-destruction
- attempted suicide
Male Hormone Panel
Even recently it was believed that age-related male hormone changes were not considered problematic because fertility in men persists until advanced age. Significant enough hormonal changes usually begin in the fourth and fifth decades of life and lead to a condition which is called andropause, and may be considered the male equivalent of menopause.
Optimal health is dependent on the balanced of hormones, and not just on a single one. Currently, men with low androgen hormones can benefit from bio-identical hormone replacement therapy.
Androgens (of which most important is testosterone) are supplemented in states of deficit and can produce many positive effects on the well-being of men. Those positive effects include increased libido and increased levels of good cholesterol, reduced fat and change in its distribution, reduced levels of bad cholesterol and risk osteoporosis, enhanced lean body mass. Stamina, passion for life, memory, decisiveness, enthusiasm, strength, vigor and energy are the other benefits derived from hormone supplementation. It also improves insomnia, nervousness, depression, hair loss or hair thinning, corrects erectile dysfunction, urinary symptoms or enables losing weight.
Using your saliva sample we can measure DHEA, androstenedione, testosterone, DHT, estrone and progesterone. Active fractions found in saliva are superior, more affordable and less expensive to blood and urine total hormone levels in diagnosis and treatment. Results can lead to an individualized and customized treatment plan using bio-identical hormones. One can minimize overdosing and under dosing. This will ensure the use of only the proper hormones in the appropriate amounts, thus minimizing the guesswork.
Symptoms alone are not a substitute for measuring hormone levels because many symptoms may involve non-hormonal factors.
Measurements of hormones can be used in two ways. First, baseline measurements will show levels and ratios of distinct hormones, allowing an objective treatment plan for the individual. Second, therapeutic monitoring measure levels of hormones after supplementation . This is crucial in establishing the appropriate dosing regimen in and reducing the chance of undesirable side-effects and maximizing beneficial effects. Monitoring is especially important in older males.
It is worth mentioning that testosterone therapy may of little benefit unless problems affecting cortisol production are addressed as well. The body's response to stress is mediated by increased cortisol production, and this prepares the body for "fight or flight" by shutting down other processes, including testosterone production. It is now known that testosterone itself does not cause either benign prostatic hypertrophy or prostate cancer, it is thought to have the potential to exacerbate the problem when already present.
Saliva is an excellent way to assess sex and adrenal hormone levels in men and there is a good correlation with symptoms. However, in individuals who produce very little saliva, saliva collection may not be possible and in those who use hormones in sublingual or troche formulations, saliva hormone testing in not appropriate and blood spot testing is a better choice.