Aug
10
2013

Bioidentical Hormone Replacement

In many previous blogs I have mentioned that bioidentical hormone replacement prolongs life. Here is a more detailed look at what such hormone replacement looks like for both women and men. Before I get into details I want to stress that I am talking about replacing what is missing and replacing only with natural hormones, not some artificial hormone derivative produced by a drug company. The reason this is immensely important is that hormone receptors in the body are distributed all over our vital organs including bones, blood vessels and the nervous system. If there is no lock and key fit (bio-identical hormone fitting the hormone receptor), there is trouble as the Women’s Health Initiative in 2002 has shown. Unfortunately they had used synthetic hormones for HRT that were not fitting the hormone receptors, and this caused many problems (heart attacks, strokes, osteoporosis, cancer).

Physiology of aging

As we age, we gradually produce fewer hormones in our hormone glands, but the various hormone glands deteriorate in their functions at different rates. Beyond the age of 30 we produce less melatonin and less growth hormone. As a result our sleep pattern may change, as melatonin is necessary for a deep sleep. The decreasing growth hormone production means that we are losing some of our muscle mass and accumulate more fat in the subcutaneous tissues. Our adrenal glands produce less DHEA at the age of 35 to 40, a hormone that is a precursor to our sex hormones in males and females. The gonads (testicles and ovaries) also produce fewer hormones, a process which already starts 5 years before menopause and about 5 years before andropause (the male menopause equivalent).

Typically a woman will get into menopause at the age of 45 to 55 at which time the periods stop and postmenopausal symptoms are interfering with her well-being.  Men get into andropause (the male equivalent of menopause) at the age of 55 to 65 at which time erectile dysfunction occurs and often the individual will become the “grumpy old man”.

Other hormones such as thyroid hormones are also affected by the slow down. Hypothyroidism is common in people above the age of 50.

Bioidentical Hormone Replacement

Bioidentical Hormone Replacement

Baseline laboratory tests

In order to know what is going on, the physician or naturopath needs to order a number of tests to assess whether there is inflammation, how your key hormone levels are; the cardiovascular system markers should also be checked, the liver enzymes and vitamin D3 level. Inflammatory markers are fasting insulin levels and C-reactive protein (CRP). Fasting cholesterol and subfractions (HDL, LDL, VDLP, small LDL) and fasting triglycerides are also measured. Thyroid hormones (T3 and T4, TSH) are measured to rule out over or under function. Typically hypothyroidism is found, which would have to be rectified by taking Armour (a mix of T3 and T4 thyroid hormones).

At this point I need to explain that long time ago the research by Dr. Lee has shown that progesterone hormone levels are notoriously unreliable when blood tests are done. All of the other sex hormones, and cortisol are also not that reliable with blood tests. For this reason the saliva hormone tests have been invented that conveniently report a panel of 5 hormones from one saliva sample: DHEAS (which is the storage form of DHEA), estradiol (the major estrogen in a woman), progesterone, testosterone and cortisol. The saliva hormone tests correlate very well with the actual tissue hormone levels. You can order the saliva tests through Dr. Lee’s website. Another longstanding lab in the US is Dr. David Zava’s lab. In Canada the Rocky Mountain Analytical Lab can process your saliva tests.

Women’s hormone replacement

Let us assume that a woman is getting postmenopausal symptoms and bioidentical hormone replacement is being discussed. The physician will want to first rule out that insulin resistance is not present by ordering a fasting insulin level. If this is normal and the other baseline tests are normal as well except for missing estrogen and progesterone, the physician will usually start to replace progesterone first using a bioidentical hormone cream to be applied once or twice per day. If estrogen levels were also low, the next step in 4 weeks or so is to add Bi-Est, a bioidentical estrogen replacement cream. After 8 weeks of hormone replacement the saliva hormone test is repeated to see whether the estrogen and progesterone levels have come up and also, whether the ratio of progesterone to estrogen is at least 200 or more. Dr. Lee has extensively researched this and found that women with a ratio of less than 200 to 1 (progesterone/estrogen ratio) were more prone to breast cancer. He also stated in this link that there are 3 basic rules with regard to bioidentical hormone replacement:

1. only replace hormones, when they were measured to be low.

2. use only bioidentical hormones (never synthetic hormones) and

3. only replace with low doses of bioidentical hormones to bring hormone levels to physiological levels (body levels that were experienced to be normal before).

Many women who are not replaced in menopause have estrogen dominance meaning that the progesterone/estrogen ratio is less than 200:1, which puts these women at risk of developing breast cancer. Women who are overweight or obese also are estrogen dominant (from estrogen produced in excess through aromatase in the fatty tissue, explained further below), which makes them more prone to breast cancer, uterine cancer and colon cancer. Without bioidentical hormone replacement inflammatory processes take place in the joints (causing arthritis), in the nervous system (causing Alzheimer’s and dementia) and in the blood vessels (causing heart attacks and strokes). Rebalancing your hormones to a youthful state by paying attention to the hormone levels and the hormone ratios mentioned will remove the inflammatory reactions and reduce the risk for cancer.

Men’s hormone replacement

Males enter andropause 10 to 15 years later than women are entering menopause. Typically testosterone production slows down leading to hair loss, erectile dysfunction, loss of muscle mass, osteoporosis and Alzheimer’s/dementia. Blood tests (bioavailable testosterone) or saliva tests are both reliable in determining a deficiency. Replacement with bioidentical hormone creams once per day is the preferred method of treatment. Overweight and obese men produce significant amounts of estrogen through an enzyme localized in fatty tissue, called aromatase.

Aromatase converts testosterone and other male type hormones, called androgens, into estrogen. Estrogen causes breast growth, weakens muscles, and leads to abdominal fat accumulation, heart disease and strokes.

Similar to women, where the progesterone/estrogen ratio is important, there is another ratio for men, called testosterone/estrogen ratio. This should be in the 20 to 40 range for a man to feel good and energetic. Unfortunately many men above the age of 55 have testosterone/estrogen ratios much smaller than 20. This makes them more prone to heart disease and prostate cancer (Ref.1).

However, a male also does need a small amount of estrogen and normal thyroid hormones as well as all of the other hormones for his “hormonal symphony” (mentioned in Ref. 2) to function at his best.

Safety of hormone replacement

There are still otherwise reputable websites that state that bioidentical hormones are not safer than standard synthetic hormones. This confuses the consumer and does not serve the public well. I much prefer the text of the Wikipedia, which is a more thorough review regarding safety of hormone replacement and explains what the issues are.

In the US there is a collective experience of about 25 years on thousands of patients, but there have not been any randomized studies, as Big Pharma that would have the money to finance such studies is not interested in proving that bioidentical drugs would be safer than their distorted synthetic hormone copies that will not fit the body’s hormone receptors. There are some noble exceptions as Big Pharma is producing bioidentical insulin and human growth hormone that had toxicity studies done and showed safety. In Europe bioidentical hormones have been used since the 1960’s, on a larger scale since the 1970’s. So the European experience of safety of bioidentical hormones is presently about 40 to 50 years.

The FDA is contributing to the confusion of the public as can be seen from this publication. One example where the FDA is confusing the consumer, is the progesterone product Prometrium, a bioidentical micronized progesterone capsule that can be taken by mouth. By law the manufacturer had to put a warning label on the package identical to progestin, which is the synthetic, non-bioidentical hormone having been shown to have severe side effects. As is explained in this last publication Prometrium should not have been required to have a warning label in it ; the paper explains what I have already stated above, namely that bioidentical hormones are the safest form of hormone replacement and administered in the right ratios will actually prevent cancer and prevent premature cardiovascular and joint deterioration. In other words, bioidentical hormone replacement can add many years of useful life when started early enough before permanent organ damage sets in from the aging process (which would be due to missing hormones).

Why bother about hormone replacement?

Nature has a plan of “knocking us off” to make room for the next generation. The only way that you can change nature’s plan of killing us prematurely through cardiovascular disease, arthritis, dementia and loss of your sexual life is by bioidentical hormone replacement. Of course you also need the other ingredients of known life prolongers such as healthy (preferably organic) foods, exercise and detoxification. Many women are scared to treat the hormone deficiencies that cause their menopausal symptoms because of the Women’s health Initiative results with synthetic hormones. Men who would benefit from testosterone are often anxious that they may get prostate cancer, when in reality it is the exact opposite: testosterone prevents prostate cancer (Ref.3).

Conclusion

I wrote this blog about bioidentical hormone replacement in order to clarify this often-misunderstood topic. Don’t get confused by the FDA, by highbrow medical websites (such as the likes I mentioned). Big Pharma has a powerful lobby that attempts to keep the medical profession in the belief that their products are better than those that nature has provided (I call it “defend your patent rights”). We are still in a flux state where anybody who tells the truth about hormones gets much criticism. In another few decades it will be an accepted fact and people will wonder why the Women’s Health Initiative was done without a control with bioidentical hormones. With bioidentical hormone replacement you can add about 20 years of youthful life without disabilities to the normal life expectancy. Exercise, detoxification and organic food with avoidance of wheat, starch and sugar can add another 5 to 10 years to your life. The baby boomers are lucky that they have this new tool to prolong life. I wonder whether they will put it to good use.

More information about bioidentical hormone replacement: http://nethealthbook.com/hormones/anti-aging-medicine-women-men/

References:

1. John R. Lee: “Hormone Balance for Men – What your Doctor May Not Tell You About Prostate Health and Natural Hormone Supplementation”, © 2003 by Hormones Etc.

2. Suzanne Somers: “Breakthrough” Eight Steps to Wellness– Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 2008

3. Abraham Morgentaler, MD “Testosterone for Life – Recharge your vitality, sex drive, muscle mass and overall health”, McGraw-Hill, 2008

Last edited Nov. 7, 2014

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Jun
08
2013

Breast Cancer Due To Stress

The medical profession is of the opinion that breast cancer is multi-factorial, where genetics, body weight, hormonal and other factors play a role in causing it (details see Ref. 1). The Wisconsin Longitudinal Study (United States) showed in May 2012 that girls from families of lower socioeconomic status have a higher risk of breast cancer later in life. The study also showed that girls from families with a higher socioeconomic status had a low risk of breast cancer later in life.

The same cohort of women was the subject of another study, which was just published in April of 2013. In this study the question was asked whether stress in career women could cause a higher rate of breast cancer. Using 1957–2011 data showed that 297 of the 3682 White non-Hispanic women of the Wisconsin Longitudinal Study developed breast cancer. Details of the study showed that the peak of the age for breast cancer to develop was around 55 to 65. Women working with the lowest job authority had the lowest rate of breast cancer. High job authority, being the “boss”, was associated with a 1.57-fold (range 1.12 – 2.18-fold) increase in breast cancer. There was also a striking difference between the lengths of job stress exposure, 5 years versus 15 years with both groups, high and low job authority. The lowest risk of breast cancer was for the low stress group of women who worked under these conditions only for 5 years, followed by the same group who had worked there for 15 years. Slightly above that latter group was the breast cancer risk for the 5-year employed high job authority. The highest group of breast cancer risk, rising above all other groups, was the group with high job authority, exposed to this for type of stressful situation for 15 years (see Fig. 1 of the above link). The researchers interpreted their data to say that the majority of the breast cancer risk in these groups of women was due to the stress hormone (cortisol). Minor contributions were thought to be due to the carcinogenic effect of estrogens.

Breast Cancer Due To Stress

Breast Cancer Due To Stress

 

Review of the literature regarding this study

Dr. Lee had been publishing about estrogen dominance for many years (Ref. 2 and 3). When women age, their ovaries do not produce as much progesterone during the luteal phase as in younger years and above the age of 30 to 35 anovulatory cycles are common. During anovulatory cycles ovulation (=release of an egg) does not occur and there is no formation of a corpus luteum that would produce progesterone for 2 weeks. The end result is that there is a lack of progesterone as a woman ages. This has been discussed in detail in Ref. 3. Dr. Lee called this disbalance of estrogen and progesterone “estrogen dominance”. This is one of the important causes of breast cancer as explained in Ref.2. This can be caused by aging, xenoestrogens from exposure to artificial fertilizers, insecticides and cosmetics, but also taking the birth control pill for prolonged periods of time. However, stress by itself can also produce a state of estrogen dominance. Dr. Lee explained (page 180 of Ref. 2) that the cortisol-binding globulin (CBG), which binds both cortisol and progesterone, is a storage form for both of these hormones. As a person is under chronic stress the CBG is increased binding both cortisol and progesterone. This means that less of these hormones are preliminarily available in their free form for body consumption as CBG binding is a storage form for these hormones. The free progesterone, which is the only biologically active progesterone portion, is lowered as a result of stress causing estrogen dominance. If estrogen is not opposed by progesterone, it is cancer causing for breast tissue and the uterine lining, which translates into being at risk for breast and uterine cancer. Only supplementation with bioidentical progesterone cream as described in Ref. 3 will rebalance the hormones (progesterone/estrogen balance) and reduce the cancer risk. The symptoms of estrogen dominance according to Ref. 4 (p. 29) are fatigue, weight gain, less ability to handle stress, headaches, mood swings, loss of sex drive, irregular periods, uterine fibroids, fibrocystic breasts, fluid retention (particularly around the ankles), irritability and depression.

Practical recommendations for women in stressful jobs

Above the age of 35 it is wise to have a saliva hormone test done, checking the levels of 5 hormones (cortisol, DHEAS, estrogen, progesterone and testosterone). This establishes the baseline values for these hormones. The relationship between the levels of these hormones determines whether they are balanced or not. For instance, if the ratio between progesterone and estrogen (divide the level of progesterone by the level of estrogen) is less than 1 in 200 the patient has estrogen dominance (see Ref. 5). You may need to get a naturopathic physician or an A4M physician who is knowledgeable in interpreting these results and treating the patient with bioidentical hormones. Some women may need to start bioidentical hormone replacement at this point if a hormone deficiency is noticed.

In order to counterbalance stress you need to schedule some time for yourself regularly where you can relax, do yoga exercises, meditation, and/or self-hypnosis. Make sure you get enough sleep. Avoid alcohol, if you can as it interferes with a restful sleep, or reduce alcohol to the absolute minimum. Alcohol causes decreased hormone production of both ovaries. It also weakens the adrenal glands contributing to hormone disbalance. Usually the first hormone to show a decline with stress and aging is progesterone. It has to be measured by the saliva test. Ref. 2 and 3 explain why: progesterone is fat-soluble and is transported through the blood in its free form through red blood cells. However, a progesterone blood test measures the serum progesterone level after the red blood cells have been spun down in the centrifuge, which leads to misleading results; only the saliva test gives reliable results in terms of bio-available progesterone levels. Many conservative physicians blindly insist on blood progesterone levels, which will lead to false results. This is why you need a naturopathic physician or A4M physician to help you with the proper interpretation of the test results.

If saliva progesterone levels are low, progesterone cream (bio-identical, as explained below) is applied daily in a concentration that will normalize the levels. Physicians who have been influenced by drug company representatives may suggest to use Provera (or another progestin, which are synthetic hormone substances) as a “supplement”, but this is known from the Women’s’ Health Initiative to cause breast cancer, heart attacks and strokes.

Do the proper monitoring tests with saliva testing and only substitute what is missing with bioidentical hormone creams. Otherwise a low fat, low refined carbohydrate diet, exercise and other good health habits as I have summarized in this link will be very beneficial to prevent stress as a cause of breast cancer. Ref. 6 is also a useful text written for the layperson explaining what to do when stress leads to adrenal fatigue.

References

  1. A review of the causes of breast cancer: http://www.nethealthbook.com/articles/causesofbreastcancer.php
  2. Dr. John R. Lee, David Zava, Ph.D. and Virginia Hopkins: “What your doctor may not tell you about breast cancer”. 2002 Hachette Book Group, New York,NY, USA.
  3. Dr. John R. Lee: “Natural Progesterone”.  2nd edition. Jon Carpenter Publishing, 1999 Charlbury, England.
  4. George Gillson, M.D., Ph.D.: “You’ve hit menopause. Now what? 3 simple steps to restoring hormone balance” 2nd edition, 2004, Rocky Mountain Analytical Corp., Calgary, AB, Canada.
  5.  John R. Lee, M.D. and Virginia Hopkins: “Dr. John Lee’s Hormone Balance Made Simple- The Essential How-to Guide to Symptoms, Dosage, Timing, and More”. Wellness Central Hachette Group USA, New York, NY 10017. Published 2006. Page 57 discusses saliva testing and states: “The healthy ratio of progesterone to estradiol is at least 200 to 1 and can go up to 1,000 to 1 in women using transdermal (delivered through the skin with cream, gels, oils) progesterone.”
  6. James L. Wilson, ND, DC, PhD: “Adrenal Fatigue, the 21sty Century Stress Syndrome – what is it and how you can recover”; Second printing 2002 by Smart Publications, Petaluma, Ca, USA

Last edited Nov. 6, 2014

Jan
22
2013

Long-Term Multistep Weight Management

In February of 2001 my wife and I attended an anti-aging conference in San Diego. The keynote speaker was Dr. Barry Sears who is the inventor of the zone diet. We had read a book from him before the conference and were excited to hear him speak in person. We liked the book; we liked the talk, so we cut out sugar, starchy foods and stuck to a diet where the calories derived 50% from low-glycemic, complex carbohydrates, 25-30% from lean meat, poultry and fish. Calories derived from fat were reduced to about 15-20% (there is hidden fat even in lean meat). No butter, but instead some lean cheeses and olive oil for cooking and in salad dressings. We shed both 50 pounds within 3 months without any hunger pangs. Our energy increased and this has stayed  this way ever since. There was no problem getting down with our BMI’s (body mass index) to 23.5 or 24.0, which is usually viewed as normal by the medical profession. We noticed, however, that when we did not exercise, there was a problem maintaining our normal weight.  We are under the care of an anti-aging physician who did special tests like fasting insulin, C- reactive protein, and hormone tests. They were all normal. We took up ballroom dancing really seriously having been inspired by “Dancing With the Stars”. This was 6 years ago. What started innocently with only a few basic ballroom lessons three times per week has now blossomed into dancing more than 10 different dance styles 5 times per week.

Long-term Multistep Weight Management

Long-term Multistep Weight Management

3 ½ years ago both of our energy levels were slowly going down, particularly after a long night of dancing. Hormone tests revealed the initial stages of age-related hormone deficiencies which did not come as a surprise , as  decreasing hormone levels was a topic discussed  in detail at the conference in San Diego in 2001 (we also attended several other anti-aging conferences on a yearly basis from 2009 onwards). With bioidentical hormone replacements these levels normalized within one year, our energy was back and our weight stayed normal. We enjoy travelling, but there can be problems with our multistep weight management program. We need to watch our diet (no toxins, preferably only organic food), and physical exercise may be less regimented. In 2008 we read Suzanne Somers’ book “Breakthrough”. We ordered urine tests for toxic metals and we were shocked that we had noticeable levels of mercury and lead. Since then we started to cut our salmon consumption from 3 to 4 times per week down to once or twice per week. To get rid of the heavy metals we started intravenous chelation treatments with vitamin C (10 Gm) and Glutathione (1250 mg) every two weeks. In July 2012 there were reports of radioactive salmon from the Japan nuclear disaster earlier that year in the Canadian media. After this news we stopped eating all fish and other seafood, not only because of radioactivity, but also because of other toxins like mercury, cadmium, PBC’s etc.  We do take high doses of molecularly distilled omega-3 fatty acids along with our other supplements. We also started eating mostly organic foods as we do not want to ingest insecticides, herbicides and other toxins.

We acquired body composition scales, which give information about fat percentage including visceral fat percentage, muscle mass percentage, BMI, weight and the basic metabolic rate. We wanted to define the end point of what our ideal body weight would be. We noticed that our dance program was not good enough to lower the BMI below about 23.5; using the body composition scales we noted that our body fat content was still too high and the visceral fat percentage was still in the 6% range. It took a prolonged trip to the US where we could not find enough dance events to decide that we would introduce a one hour gym program consisting of 30 minutes of treadmill, 15 minutes of upper body circuits, and 15 minutes of lower body circuits every day as a basis to our exercise program. Any dance activity would be just an additional exercise on top of the base exercise from the gym. It took only about 2 months before our fat composition decreased, our muscle mass increased, the visceral fat went to a normal at 5% and the BMI was now stabilized at the 21.5 to 22.0 range. We feel a lot more confident in managing our weight long-term without really thinking much about the weight. It is now a routine we follow, like an athlete would do to stay in shape. While nobody has a permanent guarantee to everlasting health, we do it to prevent the diseases we do not need in our retirement like diabetes, arthritis, heart attacks, strokes, cancer or Alzheimer’s.

What we did not know until after the 20th A4M Anti-Aging Conference in Las Vegas (mid December 2012) was that inadvertently we were protected from exposure to chemically modified wheat from 2001 onwards as we had cut out all refined carbohydrates and starchy foods (including wheat) since then. Unfortunately many Americans still expose themselves unknowingly to larger or smaller quantities of wheat, suffer from leaky gut syndrome with the associated changes in the immune system and the development of autoimmune diseases.

Personally, I believe that long term weight management is possible: you can turn older and hopefully wiser…not wider. The good news: it can be done. The bad news: this is not an instant fix, but a program that needs to be part of your lifestyle package.

More information on weight loss: http://nethealthbook.com/health-nutrition-and-fitness/weight-loss-and-diet/

Last updated Nov. 6, 2014

Apr
01
2005

Hormone Replacement Worsens Incontinence

Once hailed as the miracle pill for the aging woman, hormone replacement therapy (HRT) is now being approached with caution. The infamous Women’s Health Initiative study, which first disproved benefits of hormone therapy, first pointed out an increase of breast cancer risk and risk of cardiovascular disease. On re-analysis of the data the Journal of the American Medical Association has published a study in its issue of February 23, 2005, which shows some more reason for caution with HRT. The previous notion that hormone replacement would improve the symptoms of urinary incontinence has turned out to be a fallacy. Dr. Susan Hendrix and her colleagues from Wayne State Untiversity School of Michigan in Detroit analyzed the data from 23,296 women with urinary incontinence. In randomized trials they received either estrogen alone, estrogen with progestin (Prempro) or the placebo effect (“fake pills”). Among those who were continent at the baseline, both, estrogens alone as well as the combination therapy were associated with an increased risk of incontinence at one year. Estrogen (Premarine) alone produced the most marked effect: stress incontinence increased by a factor of 2.15, the combination therapy increase stress incontinence by a factor of 1.87. In addition, women who were already suffering of incontinence, tended to report a worsening of their symptoms after beginning hormone therapy. The Women’s Health Initiative trials were stopped because the treatment risks appeared to outweigh its benefits. These new findings tilt the scales even further against hormone therapy, the authors say in their study.

Hormone Replacement Worsens Incontinence

Hormone Replacement Worsens Incontinence

Reference: National Review of Medicine, Canada, March 15, 2005, page 28

Comments on Nov. 8, 2012: We have to keep these observations in perspective. The authors of that study were using the “regular” Big Pharma manufactured hormone substitutes that the body cannot read. There are no Premarin or Provera receptors in the tissue, only testosterone receptors, estrogen receptors and progesterone receptors. These artificial hormones cannot be metabolized in the woman’s body into testosterone as bio-identical estrogen and progesterone would, because they are structurally different from the bio-identical hormones. The sad truth is that an anti-aging physician could have treated these poor women with incontinence safely by prescribing small amounts of testosterone cream that would have had to be applied to the urethral opening. From there the body would have sent it to the bladder, the bladder sphincter and the testosterone receptors that control these tissues and would have taken care of the incontinence problem.  You do not need a clinical trial. This type of treatment has been used in Europe for decades and has been used in the US for maybe 10 to 15 years as well by some open minded urologists and anti-aging physicians. The heading for this post is only applicable for HRT in the conventional sense (using Big Pharma drugs), but none of this applies to bio-identical hormone replacement for menopause.

More info on bio-identical hormone replacement in menopause: http://nethealthbook.com/hormones/hypogonadism/secondary-hypogonadism/menopause/

Last edited October 28, 2014

Mar
01
2003

Men Need Testosterone For the Male Menopause

Introduction

Men need testosterone for the male menopause as their testicles no longer produce enough of the male hormone. At a recent continuing education meeting at the University of Calgary in Alberta/Canada, which was reported in the Jan. 14, 2003 edition of the Medical Post, Dr. Norman Wong (professor of medicine, biochemistry and molecular biology) reviewed the symptoms, investigations and treatment modalities available for men who experience andropause (the male equivalent of menopause). They are as follows (my summary in table form).

Here is a link to the ADAM questionnaire regarding andropause by Dr. Morley, a geriatrician at the St. Louis University in Missouri. If you answer “yes” to question #1 and #7 (sexual dysfunction or lack of sex drive) or if you answer “yes” to any three of the other total of 10 questions, you should see your physician and ask for a testosterone blood test.

The testosterone blood test

What should you know about testosterone blood tests? What counts is the free testosterone or bioavailable testosterone. Dr. Ronald Swerdloff, professor of internal medicine and endocrinology at the UCLA School of Medicine in Torrance, California, stated at this conference that testosterone production decreases with aging, but is actually also one of the causes of aging. Testosterone levels decrease 1% to 2% every year from the age of 30 onwards. However, the sex hormone binding protein (SHBP) can buffer these changes for a certain period of time, if the SHBP is binding less testosterone thus keeping the free or biologically available testosterone relatively stable for a number of decades or years.

Replacement of missing testosterone

Often, however, the andropausal men who need testosterone replacement have high SHBP levels. Nobody knows why some men have problems earlier than others. So, if the free testosterone serum level is low (and the LH and FSH hormones are low or normal) this means that this man should have testosterone replacement therapy, if there are also clinical signs and symptoms of hormone deficiency.

Testosterone For Male Menopause (Andropause)

Testosterone For Male Menopause (Andropause)

Gonadotropins

As can be seen from this link to menopause in women , the pituitary hormones LH and FSH, which are also known as gonadotropins, should be high to indicate that the feedback mechanism between the estrogen (or in the male the testosterone) no longer suppresses the production of these gonadotropins. The fact that this mechanism is lost in most older men shows that the hormone deficiency is likely much more profound than a simple deficiency, it may actually be indicative of the aging process of the hormone glands themselves. The good news though is that with a simple testosterone patch this can be fixed. Your doctor can discuss this further with you.

Injections of testosterone

Other possibilities are injections every 3 to 4 weeks with a Depo-testosterone hormone preparation or tablets. However, with the tablets the problem is that this will get metabolized in the liver and higher amounts of hormone are required to overcome the liver barrier. Liver cancer has been reported in a small percentage of men taking tablets for a long period of time.  I think that testosterone tablets are not safe for this reason. Prostate cancer is the other worry and regular PSA tests and prostate exams should be done by your doctor. No clinical trials are available regarding the safety of long term testosterone replacement in andropausal men. Dr. Swerdloff recommended to replace only in the lower dose range to the point where the free testosterone serum values are just barely in the normal range and the clinical signs and symptoms disappear. Avoid overtreatment with testosterone.

Andropause symptoms (male menopause)
Symptoms: Comments:
loss of sex drive (libido) testosterone from the testicles, is responsible for a normal sex drive
erectile dysfunction
(impotence)
inability to have sustained erections
loss of male characteristics loss of male type hair distribution, deep voice, muscle mass etc.
fatigue and depression brain hormones dysbalanced from low testosterone levels
decrease in muscle mass, increase in fat mass lack of testosterone responsible for muscle loss and change in bone metabolism
oligospermia or azoospermia too little sperm count or no sperm present

Additional information about effects of testosterone

Addendum Nov. 2, 2012: At the 19th Annual World Congress Anti-Aging and Aesthetic Medicine in Las Vegas (December 8-10, 2011) Dr. Abraham Morgentaler, a Harvard trained urologist explained that with bio-identical testosterone replacement there is no longer any concern about prostate or liver cancer with long-term use. It has been one of the “medical myths” that has been around. Dr. Morgentaler also noted that testosterone replacement is safe and actually prevents prostate cancer. He suggested replacement of testosterone with blood values being in the higher range of normal.

See also link to andropause/male menopause from the Net Health Book.