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Q & A Testosterone Therapy


Q. What is Testosterone replacement therapy?

Testosterone Replacement Therapy (TRT) is necessary only if Testosterone (T) levels are below normal. There are two forms of testosterone in the human body. The Total or bound testosterone level (TT) and the Free Testosterone (FT). Free T levels can be detected by salivary testing. Over 75% of the T in saliva is in the FT form. FT drives the normal sex drive in both men and women.

Q. What are some of the signs of low levels of Testosterone that I may feel?

The best-known signs of low FT (hypogonadism) are fatigued for no reason, loss of drive or interest in sports or sex, pot belly and increased fat shrinking penis and decreasing libido. Perhaps the most dangerous sign of Hypogonadism is heart attacks (MI).

Q. Why is Testosterone good for your heart? I thought it raised cholesterol?

Testosterone (T) is made from cholesterol in the body. It does not cause cholesterol to form. Natural testosterone has actually been shown to lower the "bad cholesterols" and decrease clotting of the blood. In patients who suffered heart attacks, T levels were almost a hundred points lower in than in those who had not. (Conrad Swartz, 1987) Low testosterone levels increase the risk of both prostate cancer and severe heart disease (CAD or CHD). Very high blood levels of testosterone might protect against  Coronary heart disease or CHD, especially in men over age 60.

Q. Is testosterone replacement therapy safe?

Natural Testosterone (T) can be used safely in large doses by men who are deficient . Normal healthy doses present no health risks to men. Only if the levels of T metabolites, like DHT or E2 rise above physiologic range can problems occur. These include baldness, prostate enlargement, shrinking of testicles, increased acne and loss of sex drive with moodiness and   emotionality.Testosterone USP is a white odorless powder which dissolves in alcohol or organic solvents. It can penetrate intact skin if applied without a carrier agent but only a small amount is absorbed. T has been available since the 1940’s. Bioidentical testosterone can be made in the laboratory from saponins found in soybeans and yams. TestoCreme, AndroGel and Androderm/Testoderm patches are made with micronized USP-T, which has been finely ground to disperse evenly .

Q. Why use a cream as opposed to an injection or T patch ?

Self-administration of T by plastic patches is safe but awkward for hormone replacement in men. A new testosterone gel, AndroGel 1% was released in August 2000 is now available pharmaceutical. T cream is more convenient to use and is invisible. T pellets ( Testopel®) are used for long term T replacement in men and can be inserted beneath the skin of the stomach to deliver testosterone (T) over a 3 month period. Both creams/patches or gels are prescription items and need to be applied once daily. Women have been using estrogen patches for 15 years. The hormones estrogen and testosterone are naturally derived from a food source, Soybeans or a Mexican yams . They are bioidentical to that same hormone secreted by the testicles or the ovaries.

Q. Will the use of testosterone cause a female to exhibit signs that are typical of males?

Estrogen has catabolic (tissue breakdown) activity. Testosterone has anabolic ( tissue repairing and building ) action. T protects again MI ( heart attacks) and osteoporosis in both men and women. Estrogen levels in women are ten times that in men and vice versa for T levels. If a woman uses T at men’s levels, she will become masculine and develop a beard, deep voice, and lose her breasts. These effects are not reversible and are used in transgender reassignment surgery.

Q. What other problems does testosterone seem to be helpful in?

Testosterone is life saving for AIDS patients suffering with AIDS wasting Syndrome (AWS ) in both men and women. T increases their appetite, stimulates their immune system and helps them pack on muscular tissue. These medical uses of T to stimulate red blood cell production, improve immune system function and increase the appetite and ability to gain weight are most effective in these patients. Other uses include the stimulation of protein build up in major traumas such as burns and cancer. Sexual  effects of T in men and women are similar and desirable in the treatment of Impotence and sexual libido decrease in both sexes. T helps women with Osteoporosis and both Fibrocystic Breast Disease and Breast Cancer. Testosterone is even used in children who are deficient to stimulate bone growth in adolescence and encourage the formation of secondary sexual characteristics, eg. penile growth and pubic and axillary hair in boys who have delayed puberty due to genetic diseases. T is used to treat dry eyes and weakness in older men and women who are frail and at risk for breaking a bone if they fall. T injections will reverse a deadly attack of angioedema which is a severe allergic reaction threatening breathing. In some men T will stop their snoring and in others it may increase it.

Q. There are negative effects for estrogen, what are the negative effects of testosterone?

The negative effects of too much T such as increased snoring, baldness and loss of sex drive are mild and very similar to those same reactions which occur when there is too little testosterone. The negative effects of estrogen (E) which include increasing all types of cancer activity, increasing body fat and decreasing T levels needed for a normal sex drive in older men seem much worse. The negative effects of supranormal T include acne, increased aggression and risk taking behaviors, rapid weight gain and thickening of the blood due to too much iron pigment or hemoglobin (Hgb). Men as they age become very feminized due to not enough T and too much E. Estrogen also increases the clotting of blood, with damaging effects on men by increasing the risk of stroke and high blood pressure. Estrogen increases cancer risk and raises blood pressure in women too. Too much testosterone can increase DHT and in the presence of too much estrogen may increase the risk of prostate cancer.

Q. Will the use of testosterone increase the normal risk of prostate problems in men? What about estrogen for men?

PSA is used as a screening test for prostate cancer along with a rectal exam. Prostate specific antigen ( PSA) is also present in women with breast or uterine cancer and in breast milk. When women reach menopause their risk of heart disease and stroke is the same as men’s. When men reach Andropause, their risk of prostate cancer increases with each decade exponentially. The number one cause of death in men is heart disease and  the commonest cause of death in women is cigarette smoking (*women become more easily addicted than men).

Q. Why do these diseases increase AFTER hormone levels start to drop?

The causes of prostate cancer include genetic, dietary and hormonal abnormalities. The longest trial in thousands of men (24 years in Iceland) measuring their T, DHT, E, PSA and FT levels, revealed that there was no causal relationship between any one hormone and prostate cancer. Men with low T and a family history for prostate cancer were most likely to get the disease early. Older men with higher estrogen levels developed the highest number of cases of prostate cancer. The longest trial of estrogen use in women for over 25 years revealed that estrogen was not effective in prolonging life in women over men due to its effects on heart disease. Castration and estrogen are used to treat prostate cancer in men and progesterone and testosterone are used to treat breast cancer in women. Hormones are very complicated and cannot act alone in human beings, they are all interrelated and balance is essential to maintain health. Perhaps the reason women live longer is because men die sooner.

Q: There seems to be a lot of products on the market for testosterone use. Are these pills and creams effective?

T products all raise T levels if they contain testosterone. The question of  effectiveness depends on how much T is absorbed. To mimic the pattern and rhythm of hormones as much as possible, the higher levels of testosterone, Cortisol and DHT occur early in the morning and the lower levels occur at night .

The Free Testosterone levels are crucial and DHT is essential for regulating sexual drive.The best products deliver the most stable amount of T and cause the lowest conversion to estrogen (E). Testosterone, a Class 3 drug, found in all hormone creams/patches or gels requires a prescription. These hormone products need to be applied once daily to maintain levels that stay close to normal and do not rise too high or drop too low. Side effects of any hormone depend on the extent to which receptors (target cells) are stimulated on sebaceous glands, hair follicles, and both muscle tissue and brain tissue.  It does not take much hormone to exceed the recommended dosage, and when using too much cream or gel, side effects result. The benefits of smaller amounts of application are obvious when trying to avoid transference to a partner or child. Monitoring by a physician and regular blood or saliva tests are important to find the ideal level for each man.

We are all very similar but very different at the same time. (TRT=TC AND TESTING OF TT-SHBG=FT)