Why testosterone therapy is safe and effective for men.
It is easy to prescribe testosterone in any form to men, in fact much easier than prescribing it to women. The reasons for this situation range from the many choices in testosterone prescriptions that doctors have which are approved by the FDA for male andropause to the comparative simplicity of the male sex hormone symptoms. The apparent simplicity of just writing a prescription, like any other drug, gives the treating doctor the illusion that no other surveillance is required.
In fact, the prescribing of testosterone for men is extremely complicated due to the estrogens made by aging men, the increase in iron absorption that can increase red blood cell count (polycythemia), and hemochromatosis, as well as the possibility of prostate enlargement due to elevated DHT and Estrone. These are the most prevalent problems encountered in treating men with testosterone. These issues take experience and cause many doctors to shy away from treating with this vital hormone. I would like to make this treatment less onerous both for the men who need it and the doctors who prescribe testosterone.
The most common side effect of testosterone gel (e.g. Androgel) is the production of a large amount of estrogen, which can blunt the effect of the testosterone, cause escalating dosage to get the same effect, belly fat, and prostate enlargement. I manage this issue initially by not choosing transdermal gel, and by only prescribing testosterone pellets. They make a very small amount of estrogen in most men and are much more effective. In addition I recommend DIM, a supplement that blocks the conversion of testosterone to estrone and estradiol. This is a mild and natural type of aromatase inhibitor. When the level of estrone and estradiol are quite high I use a prescription of Arimidex every other day to effectively block the production of estrogens. This drug can also be prescribed to men who have a normal total testosterone but convert large amounts into estrone and therefore have a very low free Testosterone. It is the only aromatase inhibitor I use because it is the only reversible AI, and it is the only one that causes fat loss and not weight gain.
Polycythemia, which is the second complication found due to testosterone replacement. It is a progressive increase in the number of red blood cells, which causes the blood to sludge and clot due to high viscosity. When the percentage of red blood cells in the blood rises above 52% donation of blood is necessary to decrease the thickness to below 50%. Testosterone therapy of any kind causes the stomach to absorb more iron than usual so more blood cells are produced. Only men with specific genetics have this issue, so I send these men to the Red Cross for therapeutic blood draws three to four times a year.
The tendency to absorb iron causes different men to increase storage of iron in the tissues of the liver, brain, eyes, and other vital organs. This genetic disease is hemochromatosis and is common in postmenopausal women and men of all ages. It is handed down from the northern European blood lines and worsens with over abundance of iron. The treatment is the same as polycythemia—blood donation. The last issue that can complicate testosterone replacement is that of elevated DHT which can cause prostate enlargement. No one wants to create problems with therapy which is supposed to improve the life of a man, so prostate enlargement that can impair the ability of a man to pass urine is a side effect that is not desired.
I first treat elevated DHT and prostate enlargement with saw palmetto, an herb that blocks the production of DHT from Testosterone. This herb is in most prostate formulas. If this doesn’t work, then the drug finasteride is used to suppress the growth of the prostate. The prostate growth is usually limited when using testosterone pellets, and the prostate shrinks after two months so this therapy is not always necessary to be continued. These are trouble shooting methods that are successfully used to allow men to take testosterone pellets safe and tip the scales to increasing the benefit of testosterone pellets well above the risks of therapy.
This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author, with Brett Newcomb, MA., LPC., Family Counselor, Presenter and Author. www.BioBalanceHealth.com.