Hormones for men
Healthy aging men will have a predictable decline in the male sex hormone, testosterone, leading to decreased energy and fatigue, weight gain, loss of muscle mass, and loss of sex drive or erectile function. They will also have increasing risk for heart disease, diabetes, osteoporosis and dementia. Yikes…
Have heart, men, for there is something you can do about it! Men can supplement their hormones, just like women. The decline in male hormones is called andropause, with a decline in hormones similar to menopause in women, but it occurs over 10-15 years instead of the few years it takes for menopause.
Men don’t usually have hot flashes or night sweats and unlike the mood swings noted with the wildly fluctuating hormone levels during menopause, men tend to just get more and more apathetic, with decreasing motivation, security, and confidence. Feeling so blah causes many men to feel anxious or depressed. Insomnia is also common with low testosterone.
Testosterone Replacement Therapy (TRT) is a well established science and there are hundreds of studies documenting the safety and effectiveness of TRT. Some of the largest studies simply observe that men who are low in testosterone have about a 50% increased death rate over the subsequent decade when compared to men with normal testosterone levels.
Heart disease is the number one killer in men. Testosterone helps prevent heart disease by improving the cholesterol profile, discouraging blood clots, and by keeping blood vessels open and elastic. Testosterone can be given to men with advanced heart disease and is shown to improve their functional ability to stress the heart.
Sarcopenia is the age-related loss of muscle mass, strength and function. Muscle is replaced by fat and fibrous tissue. Hormone decline - particularly androgens like testosterone - is one of the biggest reasons for sarcopenia in men and women. Maintaining muscle mass means less frailty, more energy and more stamina.
Testosterone indirectly prevents diabetes by preventing sarcopenia. But, TRT also has a direct effect on helping insulin work better. Several studies show men who replace testosterone need about 50% as much insulin. Adding TRT to an exercise program results in much better blood sugar control than exercise alone. I consider TRT in all my patients with type 2 diabetes or metabolic syndrome X.
Osteoporosis or “brittle bones” is not as common in men as women, since men build stronger bones in the first place because of testosterone. However, the mortality and disability caused by osteoporosis in men in worse than in women. Again, TRT has a direct stimulating effect on bone – testosterone will build bone!
Dementia and depression are much higher in men with low testosterone levels. Testosterone has both protective and growth stimulating effects on nerve tissue in the brain, and is shown to have a regulating effect on the plaque that accumulates in the brain with Alzheimer’s dementia. TRT improves cognition and mood, especially abstract and spatial skills such as reading a map, coordination and balance, and motor control.
The myth of testosterone causing prostate cancer has been thoroughly debunked. In fact, at the time of diagnosis, men with prostate cancer tend to have a lower testosterone level than average. Men with low testosterone also tend to have more aggressive forms of prostate cancer. TRT does not increase the risk of cancer and recent studies show it is even safe to use TRT after treatment of prostate cancer.
This all sounds great – but what are the risks of TRT? The main risk is if a man already has an existing prostate cancer then TRT will stimulate the cancer. We monitor this through routine blood testing and it is very rarely an issue. TRT will also cause an increase in the production of red blood cells, which alone does not cause blood clotting like other syndromes of increased bone marrow cells, so this is not a big issue.
Still sounds great – how does one go about starting TRT? First of all, check blood levels of testosterone, and if they are low then you can start TRT. I recommend getting the “free” T level in addition to the “total” T as the free portion is the active portion. With aging the free portion tends to get smaller and smaller in proportion to the total and more accurately determines if T levels are low.
You can raise T levels with a few natural supplements. DIM is derived from cruciferous vegetables such as broccoli and can effectively raise free T levels by improving the metabolism of estrogens. Other natural supplements are known to raise T levels 10-30%, such as Tribulus terrestris, chrysin, nettle root or muira puama.
When replacing T directly only use bioidentical hormones, which simply means they are 100% identical to our biology – that is, the molecular structure is exactly the same as that found in our body. Simply taking a pill that one swallows does not work and we recommend either a tablet that melts under the tongue or a cream that is absorbed through the skin. Some men prefer a weekly injection.
Improved mood, energy, sleep, sex drive and general outlook will usually start within a few weeks of TRT. It may take a few months to fully appreciate the improved stamina, muscle building, fat burning and erectile function effects of TRT.
There are a few caveats to testing and monitoring TRT. Once on TRT one should get a “free” testosterone blood level, and monitor the normal by-products, estradiol and DHT. I suggest only considering TRT with a physician who is familiar with the process.
TRT prevents disease and helps maintain quality of life, and like other age management strategies, it is changing the paradigm of normal aging!