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Category : Testosterone Physicians

Testosterone Replacement | T Nation

Testosterone replacement is an issue that concerns most men over the age of 35 or 40. Although these men may feel great, they know, deep down, that they feel differently than when they were in their twenties. Granted, a lot of it has to do with general wear and tear and a host of age-related declines, but some of it has to do with the steady decline in testosterone production.

Few men take advantage of testosterone replacement, though. Either they accept all of the propaganda perpetuated by the media and the various health-care practitioners who haven’t bothered to bone up on the subject, or they just don’t know enough about it.

This article may give you the info that you need to pursue this avenue. True, most of the research on the subject concerns men who need total testosterone replacement. But the information still applies to those who are clinically deficient and need only a little boost to regain the sexual staying power and the muscle-building ability that they had in their twenties.

Hey, you with the bulge in your pants…yeah, you. Been feeling a little hornier than usual lately? Have you found yourself passing trees and musing about how like a young girl’s legs the limbs are, and how inviting that knothole in the crotch is, if only that woodpecker would fly the hell away? Does everything with a hole in it, whether it be a doughnut or a soap-on-a-rope, conjure up amorous fantasies?

C’mon, you can level with ol’ TC. You’ve even been eyeing that pumpkin on the stoop, haven’t you? That eye socket looks so moist, so inviting and, come Monday, the day after Halloween, that bitch is gonna’ be yours…

Ahh, but who can blame you? It’s October, and the testosterone levels of the North American male are up way up this time of year. Like other animals, homo sapiens have circannual variations in testosterone production as much as 25%, depending on the time of year. October, at least according to one group of researchers (Smals, et al., 1976), is the month, while other researchers (Dabbs, 1990) think that we get a little hornier in December.

Regardless of the exact month, most of us seem to be having a lot of trouble focusing on things lately. But some of us aren’t having any trouble focusing at all. Some men, because of advancing age or assorted medical problems, have low testosterone. It may not be an issue for you…yet. But sooner or later, your T levels will begin to drop, as surely as the value of my stock portfolio dropped when I invested in Ian King’s new signature line of industrial-strength panty shields.

Being able to focus on things a little better is probably a plus. But when you weigh that small advantage against all the other side effects of low testosterone, lack of concentration seems to be an appealing alternative. Consider the following symptoms of low T:

Decreased bone mass Skin atrophy, along with paleness and fine wrinkles Anemia Muscle atrophy Erectile dysfunction Decrease in sperm count Decrease in volume of ejaculate Decrease in libido Shrinkage and softening of the testes Disappearance of spontaneous erections Prostate shrinkage (below normal)

Now, I really think that Tribex-500 can boost T levels and help stave off that age-related decline, but it’s probably never going to take the place of various pharmaceutical testosterone preparations.

As far as the medical community is concerned, the goal of T replacement is to get levels as close to physiologic concentrations as possible. We at T pretty much agree with that, but we’d like to see docs push the envelope a bit and get all of us close to high normal, but no matter.

In the beginning of the whole science of T replacement, only the basic esters of testosterone were all based on the real thing. Then, scientists started to tinker with testosterone, trying to make it better. Basically, there were three roads that they could take: work on different routes of administration, chemical modification of the molecule itself, or esterification in the 17-beta position of the T molecule.

Ever wonder why you can’t just drink T down instead of shooting it into a butt cheek? Contrary to popular belief, you can actually drink most injectable steroids. Testosterone is absorbed pretty well from the gut, but the liver grabs a hold of the stuff, metabolizes it, and inactivates it before it gets to the target organs. This phenomenon is known as the “first pass effect.”

Only when the dosage exceeds 200 mg which is about 30 times the amount produced daily in normal, healthy man is the liver outgunned. Of course, if you were suffering from total testicular shutdown, you’d have to suck down 400-600 mg a day to see any positive effects. That, of course, aside from causing some potential health problems, would force you to hock your Beemer.

Unfortunately, you still see stuff in health food stores that contains dried up animal testis. Now, eating these things like popcorn kernels could theoretically work, but there’s another problem: unlike other endocrine glands, the testes don’t contain a lot of stored up hormone, so eating hundreds of them wouldn’t do any good anyhow. Makes you wonder how they can still sell these extracts, doesn’t it?

In an effort to thwart this first pass effect and produce “edible” steroids, scientists started making synthetic forms that were alkylated at the 17-alpha position of the molecule. In essence, that protected them from the metabolizing effects of the liver. The trouble is that these are the steroids that give steroids a bad rap. They cause toxic side effects such as elevated liver enzymes, cholestasis (a stoppage of bile flow), and peliosis (the presence of blood-filled cysts in the liver). These drugs have also been implicated in liver tumors.

Synthetic forms had other problems, too. Trouble was, these synthetic forms didn’t duplicate all the actions of T. For instance, some of them didn’t convert to 5-alpha DHT or estrogen and, despite the bad press that both of these compounds get, they’re vital to normal human function.

That’s why doctors don’t typically prescribe anything else other than “natural” forms of T. After all, the stuff’s been used for over six decades and has one of the highest safety records of any drug. There will probably be exceptions in the future, though. For instance, 7 alpha-methyl-19-nortestosterone (MENT) is experiencing a kind of renaissance, since it has high androgenecity and low growth-promoting effects on the prostate. Likewise, researchers continue to look at testosterone undeconoate. Unlike other “designer” steroids, this drug was esterified in the 17-beta position. It has virtually none of the side effects of the 17-alpha drugs, but it has such a short half-life that it ought to be prescribed in a Donald Duck Pez dispenser.

After pretty much settling on natural testosterone as the best hormonal thing since the invention of sliced hormonal bread, researchers started monkeying around with delivery systems. One relatively new delivery system involves incorporating T into cyclodextrins. When they’re administered orally, you get a T spike that lasts about the length of an average feature-length movie. In order for it to do any good, you’d have to remember to pop some in your mouth several times a day. Consequently, this type of delivery system’s pretty much been tossed out with yesterday’s chicken salad. Interestingly, a lot of supplement companies have adopted this delivery system for use with their androstenedione products. A nice idea but, again, the spike is very short-lived and very uneven.

Another delivery system that never achieved widespread popularity (outside of San Francisco) is rectal administration, via suppository. Too bad, too, because it works pretty well. You avoid the first pass effect, and a dose of only 40 mg can cause a boost in serum T that lasts about four hours. Nasal application has also been investigated. You can avoid the first pass effect this way, too, but the effects are unreliable and short-lived. Besides, one sneeze, and you’ve got snot and steroids on your sleeve.

There was recently some work done with microspheres in which tiny, time-release chemical nuggets were injected directly into the bloodstream. A dosage of just 315 mg raised T levels gradually to a peak over the course of eight weeks, then gradually reaching sub-clinical levels after eleven weeks. Again, the method had its problems. The spheres lacked stability and were hard to make. No one’s really done any work with them since ’96 (Bhasin and Swerdloff).

Rod-shaped implants, similar to the Norplant birth-control implants used by some women, are experiencing renewed interest. These things exert their effects for several weeks or months. Along the same lines, actual testes-shaped implants are available, too. They consist of about 10 grams of vinyl and about 6.4 grams of T. Once implanted in the scrotal sac, they keep T levels normal for about a year. Obviously, the use of these is problematic, unless you’re missing a nut or don’ t mind having a third. Maybe an alternative would be to put them just under the skin over the biceps so that the patient can have instant Robbie Robinson-like biceps peaks.

One method that’s in widespread use is the patch. Even though putting one on in the morning and taking it off the next morning produces a great pharmokinetic profile (with fairly natural rises and falls in T), the patch has its problems. For one thing, it’s hard to control absorption rates. Scrotal skin is the thinnest and easiest to permeate and has an absorption rate that’s about 40 times higher than the forearm. Other areas work, but you have to use an alcoholic enhancer, which makes skin reactions more probable.

And, a slightly bizarre problem one that few people even considered a few years ago was person-to-person transfer. Just hugging a spouse or child is enough to androgenize them, leading to masculine traits in the female or premature sexual development in children.

Unfortunately for needle-phobics everywhere, it seems that needles are around to stay at least for the time being as intramuscular delivery elicits the fewest number of side effects or problems. Currently, there are three common testosterone esters used in T replacement therapy:

Testosterone propionate Testosterone cypionate Testosterone enanthate

For complete T replacement, testosterone propionate must be injected every two to three days, while enanthate requires a shot of 200-250 mg every two weeks. This dosage is, of course, for total T replacement, and partial T replacement would require much less. One other testosterone ester, testosterone cyclohexanecarboxyate, has similar properties but is less widely used that the other three.

Given the shortcomings of intramuscular T therapy (a big spike in the beginning, followed by a gradual decline) and all of the shortcomings of the various preparations and delivery systems, the World Health Organization initiated a steroid synthesis program in 1980 to develop different types of steroids. As far as I can tell, they didn’t make too much headway. But they did develop testosterone buciclate, a single shot (600 mg) of which produced normal T levels in hypogonadal men for 12 weeks. This stuff will probably be made available in a year or two.

And the Chinese found that testosterone undeconoate, when dissolved in teaseed oil and used intramuscularly (instead of swallowed as a capsule), produced pharmacological effects similar to testosterone enanthate. Later studies used castor oil instead of teaseed oil and found that a 1,000-mg shot had effects lasting as long as eight weeks. Whether or not this will catch on as the testosterone replacement drug of choice remains to be seen.

Generally, good things happen after T therapy begins. Abdominal fat generally goes down, muscle mass goes up, and all of the “bad” symptoms of low T go bye-bye. Other inconsequential things happen, too. For instance, beard growth and frequency of shaving goes up. Interestingly, giving total T replacement to a hypogonadal man will affect his hairline, too. Now, I’m not talking about baldness necessarily, but the actual front hairline which, in women or children or men with virtually no T, stretches straight across the forehead. Once T levels rise, though, recession around the temples occurs.

Baldness, of course, is a possibility in those genetically predisposed to the condition.

Sebum production goes up, too, so you can go through that whole adolescent acne thing all over again. Gynecomastia may also become a problem, but that can usually be handled just by adjusting dosages or switching preparations. Additionally, there are several prescription-type aromatase inhibitors that may be used to fight the problem (interestingly, these aromatase inhibitors themselves might be used to raise T production we’ll have an article on nonprescription forms of aromatase inhibitors in the next week or two).

This may surprise you, but virtually nothing bad happens after T replacement therapy begins, at least not in the vast majority of patients. No negative side effects occur to the liver (remember, all the bad things took place as a result of using the 17-alpha alkylated stuff you generally get from dealers or overseas markets). No definite negative cardiovascular effects have been noted. Even the prostate, long regarded as the first organ to take the plunge after using “evil” steroids, is relatively safe. The truth is that it’s pretty much accepted now that prostate growth occurs through the action of 5-alpha DHT and that these effects are related to things that happen exclusively within the prostate and are not influenced by serum concentrations of T or 5-alpha DHT. Furthermore, estrogens are believed to be the true culprit by some. T therapy increases the prostate size slightly, but only to the point of normalcy. If any doubt of this remains, a recent study (Hajjar, 1997) tracked men in their seventies who had been receiving T replacement therapy for two years. The treatment group experienced less prostate growth than the control group.

In fact, the only possible problem seen with T therapy is an occasional rise in red blood cell count (hematocrit) which, if unchecked, could contribute to stroke or cardiovascular episodes of some kind. In those cases, either the dosage was adjusted or the patient was asked to donate an occasional pint of blood.

In fact, it was the conclusion of one pair of authors (Nieschlag and Behre, 1999) that “…there is no proof that testosterone is a life-shortening agent. The risks inherent to testosterone, be it of endogenous or exogenous origin, would then appear to be the tribute men have to pay for being men.”

Couldn’t have said it better myself.

Original post:
Testosterone Replacement | T Nation

Recommendation and review posted by Alexandra Lee Anderson

Atlanta Low Testosterone Replacement and Men’s Health Clinic

Low T Nation specializes in Mens Health education and care in the Greater Atlanta area. Our treatment specialties include managing the symptoms of Low Testosterone, Erectile Dysfunction, and Human Growth Hormone Management. We pride ourselves in our education efforts to ensure that every practitioner at Low T Nation is aware of all of the latest treatment and service breakthroughs . We utilizeincredibly well developed protocols and close medical supervision. Add in great communication practices, constant patient education and top notch pharmaceuticalsandour patients are as happy and healthy as possible at all times.

Atlanta Low Testosterone Therapy. We educate, evaluate and treat men with Low Testosterone using a very individualized and customized system of care. We qualify patients based on a number of symptomatic and labwork related criteria. Once a patient has met the basic qualifications, we check for health related disqualifying factors. If the patient is still a good candidate for the Low-T Therapy, we then educate the patient on certain aspects of program administration and care. At that point, we take the patient on as one of our own and the patient is under our medical supervision. With our program, our patients have unlimitedaccess to our doctors and labsat anytime it is needed and this never costs more than the membership rate.

Erectile Dysfunction Specialists in Atlanta. Our ED program is a very versatile and cutting edge program that consists of a vast array of medications that we use to customize a perfect-fit formula for eachindividual male patient. Our treatments consist of several oral options and also many injection based solutions for our more severely affected men. We train patients on how to administer the protocols safely and effectively and what to do when the achieved result might not be the desired one. Our patients on our Atlanta Erectile Dysfunction protocols usually come back saying that weve dramatically improved their lives in many ways. From enhanced and reformed relationships, to restored self esteem and confidence, we love the outcomes our men communicate back to us after joining our family.

Human Growth Hormone Atlanta. We can successfully and safely increase human growth hormone levels in our patients by utilizing a proprietary system of precursory bio-identical hormones that stimulate the patients body to produce as much human growth hormone as possible. This approach is FAR superior to prescribing actual HGH because most men who arent producing HGH actually still have the ability to produce it. The body stops producing HGH for a variety of reasons, but our therapy will restart the biological function and optimize it moving forward. This approach also eliminates all of the catastrophic physiologic dangers of over use of HGH. Abuse or over prescribing HGH will cause extreme and dangerous side effects, therefore it is absolutely imperative to use a program that truly understands these risks and prescribes responsibly.

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Atlanta Low Testosterone Replacement and Men’s Health Clinic

Recommendation and review posted by Alexandra Lee Anderson

Testosterone Replacement Therapy – WebMD

Testosterone is a hormone produced by the testicles and is responsible for the proper development of male sexual characteristics. Testosterone is also important for maintaining muscle bulk, adequate levels of red blood cells, bone growth, a sense of well-being, and sexual function.

Inadequate production of testosterone is not a common cause of erectile dysfunction; however, when ED does occur due to decreased testosterone production, testosterone replacement therapy may improve the problem.

As a man ages, the amount of testosterone in his body naturally gradually declines. This decline starts after age 30 and continues throughout life. Some causes of low testosterone levels are due to:

Without adequate testosterone, a man may lose his sex drive, experience erectile dysfunction, feel depressed, have a decreased sense of well-being, and have difficulty concentrating.

Low testosterone can cause the following physical changes:

The only accurate way to detect the condition is to have your doctor measure the amount of testosterone in your blood. Because testosterone levels fluctuate throughout the day, several measurements will need to be taken to detect a deficiency. Doctors prefer, if possible, to test levels early in the morning, when testosterone levels are highest.

Note: Testosterone should only be used by men who have clinical signs and symptoms AND medically documented low testosterone levels.

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Testosterone Replacement Therapy – WebMD

Recommendation and review posted by Alexandra Lee Anderson

Testosterone Replacement Therapy: Listen Up, Gentlemen …

Sensational media stories over the past few months have warned men to think twice about testosterone replacement therapy. They call testosterone dangerous and suggest that replacement puts men at higher risk of heart attack.

Reality check: The two studies that prompted all this have several flaws and inconsistencies. For instance, follow-up blood tests to assess testosterone levels were not consistently done, and the average testosterone level of the men who were tested failed to reach the optimal therapeutic range.

Nor did they test levels of estrogen, which often rise during testosterone treatment and, if not corrected, can have adverse health effects. Furthermore, these two studies contradict everything we know about testosterone replacement.

Most research has found that a low testosterone level is a risk factor for heart disease and that testosterone replacement improves cardiovascular health. It bolsters the heart muscle and improves symptoms in men with angina.

As a therapy for cardiovascular disorders, it shines brightest in the treatment of congestive heart failure. This condition is associated with inflammation and loss of skeletal muscle, and supplemental testosterone addresses both of these concerns. In one study, men with heart failure who used testosterone replacement therapy for 12 months made significant strides in exercise capacity.

I am not suggesting testosterone replacement therapy is completely benign. Testosterone does fuel prostate cancer growth, so you should be screened before starting on this hormone. However, even though supplemental testosterone may raise PSA levels, it has been definitely proven that the treatment does not cause prostate cancer.

UCLA researchers reported in the Journal of the American Medical Association that older men on a placebo actually had more prostate cancer than those treated with supplemental testosterone. Still, I recommend that men with active prostate cancer avoid testosterone replacement and men who are using this therapy should take 360 mg of saw palmetto daily to support their prostates.

When you read about the other dangers of testosterone replacement therapy, including shrinkage of the testicles, shutdown of sperm production, liver damage, and roid rage (aggression), they are referring to very high, abusive doses. Truth is, when properly administered, testosterone therapy is exceptionally safe. The goal isnt to have sky-high levels of testosterone, its to restore depleted levels to that of a healthy adult male.

One in four American men over age 30 has a low testosterone level, which is defined as less than 300 ng/dL total testosterone and less than 5 ng/dL free testosterone. And these low levels have a decidedly negative effect on mens health.

Low levels of testosterone increase the risk of bone loss and muscle atrophy. They are clearly associated with diabetes (men with the lowest levels have more than double the risk of diabetes) and heart disease (levels are significantly lower in affected men).

Moodiness, memory problems, difficulty concentrating, fatigue, loss of confidence, and diminished libido are all symptoms of testosterone deficiency. Testosterone is even linked to longevity. According to a landmark study of male veterans, men with low testosterone levels had a 68 percent increased risk of death compared to those with normal levels.

Once men start using supplemental testosterone, either in the form of topical creams and gels or regular injections, magical things often begin to happen. Sexual interest and performance perk up. Muscle mass, most noticeably in the shoulders and chest, makes a comeback. Men feel less grumpy and depressed, and more energetic and motivated.

Testosterone replacement therapy requires a prescription, and may be administered in several forms. At the Whitaker Wellness Institute, we primarily use daily applications of testosterone creams or gels. (Note: I do not recommend using oral testosterone as it may harm the liver.) To find a doctor in your area well versed in testosterone therapy, visit the American Academy of Anti-Agings website. To make an appointment at Whitaker Wellness call (800) 488-1500.

Now its your turn: Are you a good candidate for testosterone replacement therapy?

Read more from the original source:
Testosterone Replacement Therapy: Listen Up, Gentlemen …

Recommendation and review posted by Alexandra Lee Anderson

Testosterone Replacement Therapy: Myths and Facts

If you’ve been diagnosed with an abnormally low T, testosterone replacement therapy (TRT) offers a lot of benefits. But there are risks, too.

Here’s what you need to know before you start TRT.

If you have an abnormally low T, boosting your testosterone levels with TRT can help bring your energy levels back to normal. It can also restore your sex drive.

You may notice a drop in body fat and a buildup of muscle mass after TRT.

Yes. TRT has side effects, which may include:

Guidelines from the Endocrine Society say you should not have TRT if you have prostate cancer or breast cancer.

But some studies suggest that men who have been successfully treated for prostate cancer may be candidates for TRT as long as they are closely watched for signs of disease. Before starting TRT, your doctor should assess your risk for prostate cancer.

You might be told by a doctor not to get TRT if you have these conditions, which may be made worse by TRT:

TRT is also not advised to be used for treating those with low testosterone caused by aging.

If you have low testosterone, TRT may help restore your ability to have healthy erections and can boost your sex drive.

But ED has many other possible causes. Low testosterone may not be the whole story behind your ED. Talk to your doctor to determine what’s at the root of your erection problems.

TRT comes in several different forms. Each has pros and cons.

Patches. These are easy to apply. But patches can cause skin rashes and may have to be applied more than once a day.

Gels. You rub gels into the skin daily. They are convenient to use. But you have to be careful that no one comes into contact with the treated area for several hours after you’ve applied it. Otherwise they could get testosterone in their system. A nasal gel is now available that eliminates the risk of exposure to others.

Buccal patch. You put this on your upper gum twice a day. These patches are convenient but can cause irritation or gum disease.

Injections. Injections are given anywhere from 2 to 10 weeks apart. They are inexpensive compared to other treatments. But injections may not provide steady benefits. Your testosterone levels will go back down between doses.

Subcutaneous pellets. Your doctor inserts these under your skin every 3 to 6 months. They are very convenient once they’re put in, but they require minor surgery for each dose.

Your doctor will measure your testosterone levels at the 3- and 6-month marks after treatment begins. After that you’ll be tested once a year. If your levels are OK you’ll stay on your current dose.

If your testosterone levels are too low, your dose may be adjusted. At the same time, your doctor will check your red blood cell levels.

Within 1 to 2 years of TRT, your doctor will measure your bone density if you had osteoporosis when treatment began. Your doctor will evaluate your prostate cancer risk at the start of treatment and may do more tests at the 3- and 6-month marks, and then annually.

Patients taking TRT should call 911 immediately if they have symptoms which include:

Indefinitely. TRT does not cure low testosterone, so your symptoms may return if you stop taking it.

WebMD Medical Reference Reviewed by Jennifer Robinson, MD on August 27, 2015

SOURCES:

Urology Care Foundation: “Low Testosterone (Hypogonadism).”

Bassil, N. Therapeutics and Clinical Risk Management, June 22, 2009.

McGill, J. Cleveland Clinic Journal of Medicine, November 2012.

Endocrine Society: “Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes.”

News release, FDA.

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Testosterone Replacement Therapy: Myths and Facts

Recommendation and review posted by Alexandra Lee Anderson

Testosterone Therapy Lawsuits

Health Officials Worried About Potential Health Dangers

Pulaski Law Firm is taking claims from men, aged 50 and older who have suffered heart attack, stroke or other cardiovascular problems while taking testosterone replacement drugs

A new study has emerged detailing the link between testosterone therapy in men and an increase risk of heart attack, strokes and other cardiovascular diseases and problems. More than 55,000 men were followed in the study, and results show more than a doubling of risk of heart attack in those older than 65 who took testosterone compared with those men who did not take the hormone.

A similar increase in heart attack risk was shown for younger users of testosterone who had previously suffered heart attacks, compared to non-users who had previously suffered heart attacks. A lead author of the study indicated that more than a twofold increase in risk of nonfatal heart attacks also existed in younger men with heart disease who had otherwise never before suffered a heart attack.

As men get older they naturally experience a loss of testosterone. Sometimes the levels drop so low that it becomes a medical issue. However, many middle-aged men use testosterone as a means of enhancing their lifestyle, choosing to use testosterone in an attempt to reverse a natural lessening in muscle mass, energy and sex drive. The market has felt the surge of interest in testosterone replacement therapy, as the leading testosterone replacement product, Androgel, have overtaken sales of Viagra since 2012.

Testosterone replacement therapies may include the following products:

Many doctors find the growing widespread use of testosterone replacement concerning, and some medical professionals are now calling on the FDA to insist on large randomized trials to find out whether the therapy is safe, or whether the benefits outweigh the risks. The FDA has issued a statement announcing their investigation into the risk of cardiovascular events in users of testosterone replacement therapies.

If you or a loved one has suffered a heart attack, stroke or other cardiovascular event while taking testosterone, contact the attorneys of Pulaski Law Firm, P.L.L.C. for a free initial consultation.

To take advantage of your free consultation, call 1-800-BAD-DRUG (1-800-223-3784) or fill out the short form found on the right.

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Testosterone Therapy Lawsuits

Recommendation and review posted by Alexandra Lee Anderson

Male Hormone Replacement – Testosterone – The Turek Clinic

The average age of men in the US is projected to rise significantly over the next 25 years, with the greatest increase occurring in men > 65 years old.

As this happens, there will be a dramatic increase in age-related health problems too, including cancer, strokes, heart disease and hormone deficiency. Although the health risks associated with age-related hormonal decline in women, termed menopause, have been thoroughly addressed, it has now been shown that hormonal changes in the aging male are associated with significant health problems.

Specialty board certified Dr. Paul Turek at The Turek Clinic, a Best Doctors in America choice for 7 years running, has expertise and interest in helping patients understand all of the issues, good and bad, that surround testosterone replacement therapy in men of all ages.

To learn more about male hormone replacement, please select one of the following topics. If you are ready to schedule a consultation with Dr. Turek, please request a consultation here.

There is a progressive decline in testosterone production in men with age. These changes can be dramatic, such that 50% of men >60 years old have low levels of testosterone. Although the rate of decline varies widely, a general rule of thumb is that testosterone levels decrease about 1% yearly after age 50. Despite the fact that it is not as rapid a drop in hormones as women get with menopause, it certainly is just as real. This has been termed male menopause, male climacteric, andropause, or more appropriately, partial androgen deficiency in the aging male (PADAM). Serum testosterone levels in men fall progressively from the third decade to the end of life, mainly due to a decline in the cells in the testis that make the hormone (Leydig cells). This decline may also be due to changes in hormones (GnRH, LH) and proteins (SHBG, albumin) that regulate testosterone production.

One issue with testosterone that complicates matters is the fact that it exists in several different forms in the blood, and each form has different hormonal activity (Figure 1). Free or unbound testosterone is a fully active hormone, but protein-bound testosterone are only partly active, or sometimes completely inactive. What is usually measured in a blood draw is the total testosterone, which is a combination of the free and protein-bound forms. An analogy to explain this is to think of the total testosterone as all of the cars in a parking lot.

Importantly, though, only the cars that can start or drive are useful or active. Free testosterone comprises all of the cars that can start and be driven away, but the protein-bound testosterone are those cars that may or may not start, and those that may or may not be able to be driven away. So, aging is associated with 1) lower total testosterone production (fewer cars in the lot) and 2) higher levels of certain proteins that bind testosterone (sex hormone-binding globulin, SHBG), such that even fewer cars can start and run, and it is this combination of events that leads to declining testosterone activity with age. Thus, the complex physiology of testosterone balance often clouds the interpretation of age-related declining levels of the hormone.

Testosterone affects the function of many organs in the body (Table 1). In the brain, it influences libido or sex drive, male aggression, mood and thinking. Testosterone can improve verbal memory and visual-spatial skills. It as also been shown to decrease fatigue and depression in men with low levels. It is responsible for muscle strength and growth, and stimulates stem cells and blood cells in bones and kidneys. Penile growth, erections, sperm production, and prostatic growth and function all depend on testosterone. It also causes body hair growth, balding, and drives beard growth. Thus, testosterone makes us who we are, and influences how we look.

In men with low testosterone levels, testosterone can improve bone mineral density and reduce bone fractures, an effect similar to that found in postmenopausal women on estrogen replacement. Importantly, hip fractures are 2-3 times as likely to kill an older man as a woman of the same age, and 40% of older male patients with hip fractures die within 1 year of the injury.

Testosterone results in increases in lean body mass, possibly strength and can decrease fat mass. By stimulating erythropoietin, testosterone increases blood counts. It appears to improve lipid profiles and dilates blood vessels in the heart but no data has yet shown that it reduces heart attacks or strokes. It appears not to alter LDL or total cholesterol levels. In recent work, it has been shown that men with chronically low testosterone levels have 2-3 fold higher risk of developing metabolic syndrome and have up to a 40% greater risk of death than men with normal testosterone levels.

Sexual function also improves with testosterone. Most studies agree that sexual drive is improved by testosterone. Penile erections may be improved with testosterone, but only in men with low testosterone levels. Important, isolated low testosterone is an unusual (6%) cause of erectile problems in older men as lower sex drive and age-related changes to the penis are far more common.

To make an accurate diagnosis of low testosterone, symptoms or findings must accompany a blood draw showing a low testosterone level. This combination makes treatment worthwhile to pursue. Symptoms include decreased sexual desire and erectile dysfunction, changes in mood associated with fatigue, depression and anger, and decreases in memory and spatial orientation ability. On examination, there may be decreased lean body mass with reduced muscle volume and strength, and increases in abdominal girth. Decreased or thinning of facial and chest hair and skin alterations such as increases in facial wrinkling and pale-appearing skin suggestive of anemia may also be noted. Testicles that have become smaller or softer may also be present. Finally, low bone mineral density with osteopenia or osteoporosis may also suggest a problem.

Not all of these findings need to be present at the same time to diagnose the problem. In fact, many of these symptoms can be attributed simply to the natural and unavoidable consequence of aging. For example, frailty may be due to many causes, some of which include loss of muscle strength, bone fractures, decreased mood, and impaired cognition, symptoms typical of testosterone deficiency. However, the association of such symptoms along with a low testosterone certainly implicates this as a problem. By these criteria, it is estimated that only 10% of men with low testosterone levels are currently being diagnosed.

Because testosterone is found in several forms in the blood, there is debate as to what test is best to diagnose testosterone deficiency. In general, a total testosterone is ordered first. Dr. Turek then follows the algorithm in Figure 2.

National guidelines suggest that a testosterone level below 300 ng/dL is suspicious for being low, but obviously this will vary among men. Evidence of a prior testosterone level that is much higher than a current level might warrant treatment even if the current level is > 300ng/dL. Presently, measuring testosterone byproducts such as dihydrotestosterone (DHT), estradiol and dihydroandrosteindione (DHEA) is not that useful in making the diagnosis.

lthough not used in all cases, a blood count showing anemia may help make the diagnosis. In addition, a DEXA scan is an accurate, quick and painless procedure for measuring bone density or bone loss. The amount of radiation used for this X-ray technique is extremely small less than 1/10 the dose of a standard chest x-ray. Bone density assessments can also be performed periodically during testosterone replacement to assess the bone response to treatment. Certainly an evaluation for prostate cancer with a PSA and rectal examination is indicated in men who are at risk prior to testosterone treatment.

View also our video Truth about Testosterone.

The ideal testosterone therapy maintains normal concentrations of the hormone without having significant side effects. Several kinds of hormone replacement are currently available at The Turek Clinic, including oral, injectable, transdermal and buccal mucosal systems as outlined in Table 2.

Testosterone replacement is generally considered a long term therapy and patients need to be monitored regularly as outlined in Table 3. Prior to starting treatment, a digital rectal examination and serum PSA are important. Within a month or two after treatment is started, symptoms and testosterone levels should be assessed. During the first year of therapy, patients should be followed regularly to assess clinical response. After the first year, patients who are stable may be followed annually. Annual evaluations should include testosterone, hemoglobin, liver function tests, lipid profile and PSA tests. Bone density and psychological evaluations can be done depending on the original reasons for treatment.

The natural androgen DHT is a metabolite of testosterone. It is a selective androgen because, unlike testosterone, it cannot be converted to estrogens. It is also a potent androgen, binding to receptors more avidly than testosterone. DHT has an effect on several target tissues, including external genitalia, prostate and skin. DHT deficient men have normal muscle mass and are not osteoporotic. In normal men, DHT supplements suppress pituitary FSH and LH secretion, likely causing infertility. As an androgen, DHT is relatively prostate sparing. Because of its potency and potential, significant research is being conducted with DHT supplements for androgen replacement.

DHEA is available in over-the-counter formulations in the US. It is a steroid hormone made by the adrenal gland and its level progressively declines beginning the third decade of life and beyond. As a consequence of this, studies have attempted to correlate levels of DHEA and DHEA-sulfate with many health conditions. Clinical trials looking at DHEA for multiple conditions have been inconsistent. Placebo-controlled studies suggest that doses of 30-50mg of oral DHEA may produce physiologic androgen levels. In men with poor adrenal function, 50mg of oral DHEA can increase serum androgen levels to within the physiologic range for young adults, improve sexual function, mood and self-esteem, and decrease fatigue/exhaustion. However, its value in older men is not well established.

There are decreases in growth hormone and insulin-like growth factor-I with age in both men and women. In addition, treatment of young GH-deficient adults with growth hormone improves body composition, muscle strength, physical function, and bone density, and reduces blood cholesterol and cardiovascular disease risk. Some of these improvements are in health domains similar to those affected by testosterone. However, growth hormone treatment is often accompanied by carpal tunnel syndrome, peripheral swelling, joint pain and swelling, breast tenderness, glucose intolerance, and possibly increased cancer risk. In older individuals, growth hormone treatment improves lean body mass and reduces body fat. However, clinically significant functional benefits, prolongation of youth, and life extension have not been demonstrated. Until more research better defines these risk/benefit relationships, treatment of elderly individuals with growth hormone is not recommended.

The general risks of testosterone replacement are:

This may lead to hypertension, leg swelling, or worsening heart failure. Weight and blood pressure monitoring are important for at-risk patients on therapy.

Testosterone therapy of any type generally leads reduced sperm production. In fact, zero sperm counts occur in 90% of patients within 10 weeks of starting therapy. Sperm counts usually rebound within 6-12 months after therapy is stopped. Patients on testosterone should be informed that fertility will be impaired during treatment.

Excessive red blood cell count (polycythemia) was a commonly observed side effect in a meta-analysis of clinical trials of testosterone therapy. Blood counts (hematocrit) levels above 50 have been associated with an increased risk of stroke. Polycythemia is most commonly seen with injectable testosterone. Monitoring blood counts is important for patients on testosterone replacement. In addition, testosterone may suppress clotting factors II, V, and VII, and worsen bleeding in patients on anticoagulation.

Liver damage has been reported with oral treatments. However, it is very rarely observed with injectable, transdermal and transbuccal formulations.

Although it does not cause sleep apnea, testosterone therapy can worsen existing sleep apnea. Men at risk of sleep apnea include elderly and obese men, and those with chronic obstructive pulmonary disease.

Painful breast enlargement (gynecomastia) due to high levels of estrogen (which comes from testosterone) can develop during therapy. Medications call estrogen receptor blockers can treat this side effect.

Testosterone therapy is not thought to affect total cholesterol or LDL cholesterol, but the affect on high-density lipoprotein (HDL) levels remains unclear. It is reasonable to follow lipid levels during treatment.

One of the most concerning risks of androgen replacement is the potential to worsen detected or undetected prostate cancer. However, no link has been made to testosterone replacement and the development of prostate cancer. Careful follow-up of patients at risk for prostate cancer while on testosterone therapy is important. The FDA recommends that testosterone therapy not be given to men with prostate or breast cancer. A second concern is whether testosterone treatment worsens urinary symptoms in men with enlarged prostates. For this reason, voiding symptoms should be monitored in treated patients.

Contact Dr. Turek about Male Hormone Replacement

References:

Last update: March 24, 2014

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Male Hormone Replacement – Testosterone – The Turek Clinic

Recommendation and review posted by Alexandra Lee Anderson

Testim VS Androgel – Testosterone Replacement Therapy

The two major testosterone gel brands are Testim and Androgel. They are very similar and generally prescribed interchangeably, but sometimes insurance wont cover one or the other. Often, I hear that they wont cover Testim and people want to know if Androgel is just as good. So here is a general guide to choosing if you are lucky enough to have the choice which one is right for you.

Testim Vs Androgel I would try whichever your insurance covers first. If your insurance covers both medications, try whichever one has coupons or kickbacks. Ive heard people say they didnt pay any/much for Testim for the first year because the company (Auxilium) that markets the drug has a financial assistance program available for the first year.

Now that price and availability are out of the way, lets deal with smell: Testim smells. Some people think it smells good, and some cant stand it. Personally, I like it and my wife likes it. Ive found that women ask me what cologne Im wearing, and mention that they like it too. Still, if you or your wife dont like the smell of something you have to put on every day, that would be a deal-breaker. So try out a tube and see what you and, if applicable, your partner thinks about the Testim scent. Androgel doesnt have much of a smell at all.

Testim is sticky. Androgel goes on much like that hand-sanitizer stuff, while Testim seems to remain stickier longer. Some say this is why Testim seems to work better for them: Because it stays on the skin and soaks in better. These personal statements of efficacy cant be relied on as empirical data, however. But the fact that you can feel it on your skin longer, does bring up a question about Testim gel Vs Androgel: Does it take longer to soak in and, if so, does that increase the exposure time I have to worry about when it comes to my wife and children? The short answer is: NO. In-fact, according to US National Library of Medicines website, the wait-time for AndrogGel is much longer:

You should not shower, bathe, swim, or wash the place where you applied the medication for at least 2 hours after you apply Testim gel or at least 5-6 hours after you apply AndroGel .

Waste Testim comes in little single-use tubes so you go through more of them and it generates more waste. If you are eco-minded this may factor into your decision. Androgel comes in a dispenser with a little pump on it (like soap) so there is less waste.

But the real question when considering AndroGel Vs Testim is: Which works better? Which is the best? Which testosterone topical gel is going to get my testosterone levels on track fast, keep my levels steady, and keep me there for the long term since Ill be taking this stuff for many years to come? As you might guess, both brands have their fans. Personally, I like Testim. And here is a study to back up my personal preference:

Efficacy of changing testosterone gel preparations (Androgel or Testim) among suboptimally responsive hypogonadal men. Grober ED, Khera M, Soni SD, Espinoza MG, Lipshultz LI. Division of Urology, Mount Sinai Hospital and Womens College Hospital, University of Toronto, Toronto, ON, Canada. Summary of the study:

A change in testosterone gel preparation among initially unresponsive hypogonadal men is justified prior to abandoning or considering more invasive TRT. Changing from Androgel to Testim offers hypogonadal men the potential for improved clinical and biochemical responsiveness. Changing from Testim to Androgel is indicated to eliminate or minimize unwanted side effects.

Note: This study was done to find out if switching brands would help men who were unresponsive to one brand or the other.

More important to me than such a study is to find out from others who have been on TRT for more than a year, preferably several years or more, and hear about their experiences with both or either drug. Please comment below with your own experiences.

I am inclined toward a weekly injection over a daily application, but what does ones rear-end feel like after being used as a pin-cushion for decades? I dunno any bodybuilders out there want to elaborate on that?

See the article here:
Testim VS Androgel – Testosterone Replacement Therapy

Recommendation and review posted by Alexandra Lee Anderson

Testosterone Replacement Portland – Testosterone Therapy …

Similar to women, men also experience a hormonal decline as they age. Testosterone levels usually peak between the ages of 18-25 and then it gradually declines at a rate of about one percent per year thereafter.

Known as andropause, the decline of testosterone levels can make daily life a struggle. However, unlike menopause, the symptoms of andropause are subtle. An increase in daytime fatigue and decreased sexual interest are usually the first signs that hormones are shifting. Other symptoms may include weight gain, fatigue, muscle loss, depression, memory loss, decreased drive, erectile dysfunction, decreased sex drive, and irritability.

Your customized treatment plan may consist of the integration of testosterone replacement, thyroid support, DHEA replacement, nutrition, exercise, and nutritional supplements. With optimal levels of testosterone, the body becomes strong again by building lean muscle and supporting healthy heart and brain function. By optimizing testosterone, you may experience:

Bio-identical testosterone pellet therapy is a natural alternative to synthetic testosterone that offers sustained daily testosterone levels for up to 3-6 months. Unlike testosterone injections, creams, gels, and patches, which usually cause a roller coaster effect of testosterone blood levels, testosterone pellets offer a steady dose.

If you live in the area of Portland, including Beaverton, Lake Oswego, Tigard, Milwaukie, Clackamas, Oregon City, Tualatin, Wilsonville, Hillsboro, Sherwood and Vancouver, and want to feel your best as you age, Dr. Maddox has the knowledge and experience in testosterone replacement therapy to help you. Contact us today to schedule your consultation and take back control of your health.

September 2015

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Testosterone Replacement Portland – Testosterone Therapy …

Recommendation and review posted by Alexandra Lee Anderson

Hamilton NJ Urologist Doctors – Testosterone Replacement …

2

Mukaram Gazi Hamilton Surgery Center 1445 Whitehorse Mercerville Rd Ste 101 Hamilton, NJ 08619 (609) 689-4820

3

Alexander Gotesman University Urology 1374 Whitehorse Hamilton Square Rd Ste 101 Trenton, NJ 08690 (609) 581-5900

4

Manuel A. Rivas Manuel A Rivas MD 2081 Klockner Rd Hamilton, NJ 08690 (609) 588-5656

5

John A. Watson Hamilton Urology 2105 Klockner Rd Hamilton, NJ 08690 (609) 588-0770

6

Phillip S. Brackin Jr Hamilton Urology 2105 Klockner Rd Hamilton, NJ 08690 (609) 588-0770

7

Earle S. Linder Hamilton Urology 2105 Klockner Rd Hamilton, NJ 08690 (609) 588-0770

8

Michael S. Cohen Urology Care Alliance 2 Princess Rd Ste J Lawrence Township, NJ 08648 (609) 895-1991

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Jarad S. Fingerman Urology Care Alliance 2 Princess Rd Ste J Lawrence Township, NJ 08648 (609) 895-1991

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Russell M. Freid Urology Care Alliance 2 Princess Rd Ste J Lawrence Township, NJ 08648 (609) 895-1991

11

Gary S. Karlin Urology Care Alliance 2 Princess Rd Ste J Lawrence Township, NJ 08648 (609) 895-1991

12

Deven R. Gabale Urology Care Alliance 2 Capital Way Ste 407 Pennington, NJ 08534 (609) 730-1966

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Brad S. Rogers Urology Care Alliance 2 Capital Way Ste 407 Pennington, NJ 08534 (609) 730-1966

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Steven M. Orland Urology Care Alliance 2 Capital Way Ste 407 Pennington, NJ 08534 (609) 730-1966

15

Jeffrey M. Becker Delaware Valley Urology LLC 103 Old Marlton Pike Ste 225 Medford, NJ 08055 (609) 267-6800

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Adam D. Perzin Delaware Valley Urology LLC 45 Homestead Dr Columbus, NJ 08022 (609) 914-0021

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Scott W. Asroff Delaware Valley Urology LLC 103 Old Marlton Pike Ste 225 Medford, NJ 08055 (609) 267-6800

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Robert W. Goldlust Delaware Valley Urology LLC 45 Homestead Dr Columbus, NJ 08022 (609) 914-0021

19

David S. Hulbert Lourdes Medical Center Same Day Surgery 218A Sunset Rd Willingboro, NJ 08046 (609) 835-2900

20

Anthony J. Vasselli Anthony J Vasselli MD 299 Witherspoon St Princeton, NJ 08542 (609) 252-0575

21

Marc I. Schwarzman Marc I Schwarzman MD 60 Mount Lucas Rd Ste 500 Princeton, NJ 08540 (609) 497-3400

22

Marc A. Lavine Urological Associates PC 240 Middletown Blvd Ste 107 Langhorne, PA 19047 (267) 560-1001

23

Healther Gottlieb Urological Associates PC 240 Middletown Blvd Ste 107 Langhorne, PA 19047 (267) 560-1001

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Ravi R. Rajan Urology Care Alliance 825 Town Center Dr Ste 150 Langhorne, PA 19047 (215) 750-6510

25

Ashish Behari Urology Care Alliance 825 Town Center Dr Ste 150 Langhorne, PA 19047 (215) 750-6510

26

Christopher Schaefer Urology Care Alliance 825 Town Center Dr Ste 150 Langhorne, PA 19047 (215) 750-6510

27

Drew H. Hecht Urology Care Alliance 825 Town Center Dr Ste 150 Langhorne, PA 19047 (215) 750-6510

28

Sidney J. Goldfarb Sidney J Goldfarb MD 419 N Harrison St Ste 206 Princeton, NJ 08540 (609) 921-3008

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Peter A. Sinaiko Urology Care Alliance 940 Town Center Dr Ste F100 Langhorne, PA 19047 (215) 757-6300

30

Heather M. Van Raalte Princeton Urogynecology 10 Forrestal Rd S Ste 205 Princeton, NJ 08540 (609) 924-2230

31

Alexander P. Vukasin Urology Group Princeton PA 134 Stanhope St Princeton, NJ 08540 (609) 924-6487

32

Stanley E. Rosenberg Urology Group Princeton PA 134 Stanhope St Princeton, NJ 08540 (609) 924-6487

33

Stanley E. Rosenberg Urology Group Princeton PA 134 Stanhope St Princeton, NJ 08540 (609) 924-6487

34

Barry R. Rossman Urology Group Princeton PA 134 Stanhope St Princeton, NJ 08540 (609) 924-6487

35

Karen M. Latzko Urology Group Princeton PA 134 Stanhope St Princeton, NJ 08540 (609) 924-6487

36

Jamison S. Jaffe Comprehensive Urologic Specialists 1203 Langhorne Newtown Rd St Clare Bldg Ste 334 Langhorne, PA 19047 (215) 710-4490

37

Laura Gurten Comprehensive Urologic Specialists 1203 Langhorne Newtown Rd St Clare Bldg Ste 334 Langhorne, PA 19047 (215) 710-4490

38

Justin D. Harmon Comprehensive Urologic Specialists 1203 Langhorne Newtown Rd St Clare Bldg Ste 334 Langhorne, PA 19047 (215) 710-4490

39

Stephanie M. Molden Female Pelvic Health Center 760 Newtown Yardley Rd Ste 115 Newtown, PA 18940 (215) 504-8900

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Manish Gopal Shore Area Obstetrics & Gynecology PA 111 Union Valley Rd Ste 202 Monroe, NJ 08831 (877) 987-6496

41

Devdatta R. Gabale Urology Care Alliance 1205 Langhorne Newtown Rd Ste 104 Langhorne, PA 19047 (215) 757-6931

42

Joel W. Goldsmith Robert Wood Johnson Medical Group Urology 1 Worlds Fair Dr FL 1 Somerset, NJ 08873 (732) 235-5642

43

Emily Baliant Urology Care Alliance 333 Forsgate Dr Ste 202 Jamesburg, NJ 08831 (732) 561-2058

44

Steven L. Richards Urology Care Alliance 333 Forsgate Dr Ste 202 Jamesburg, NJ 08831 (732) 561-2058

45

Heather Gottlieb Urological Associates PC 3998 Red Lion Rd Ste 305 Philadelphia, PA 19114 (215) 632-8882

46

Milton E. Coll Urological Associates PC 3998 Red Lion Rd Ste 305 Philadelphia, PA 19114 (215) 632-8882

47

Jamie A. Gray Urological Associates PC 3998 Red Lion Rd Ste 305 Philadelphia, PA 19114 (215) 632-8882

48

Joan E. Zaccardi Urogynecology Arts New Jersey 620 Cranbury Rd Ste 219 East Brunswick, NJ 08816 (732) 651-0005

49

Mark L. Mokrzycki Urogynecology Arts New Jersey 620 Cranbury Rd Ste 219 East Brunswick, NJ 08816 (732) 651-0005

50

Jeffrey I. Silverstein Atlantic Urology 495 Iron Bridge Rd Ste 11 Freehold, NJ 07728 (732) 683-1617

51

Alexader Kirshebaum William I Kohlberg MD 501 Iron Bridge Rd Ste 5 Freehold, NJ 07728 (732) 780-7603

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Hamilton NJ Urologist Doctors – Testosterone Replacement …

Recommendation and review posted by Alexandra Lee Anderson