Our doctors explain the reasons for testosterone replacement therapy
There are two terms used to describe the most common causes of low testosterone in the adult population: hypogonadism and andropause. Simply put, hypogonadism is the medical terminology used to describe low levels of natural testosterone and andropause is the medical term for low normal levels of natural testosterone. The symptoms of these conditions are similar but diagnosis is not necessarily the same.
Natural testosterone is secreted in the testes and is commonly considered the “male sex hormone”. But it is important to realize that it is also made in small quantities in the female ovaries, the adrenal glands, and placenta, usually from cholesterol. Normal testosterone levels decline gradually in most cases and because of this, men and women become habituated or “used” to the symptoms and often do not realize how much the decrease has affected them until they reflect on it over time.
Typically natural testosterone begins to decline in the third decade of life. Since we rarely test levels in children, it’s hard to evaluate what a true low testosterone level is in adulthood. In other words, a man in is twenties who carries a level of 800 and then 400 in his forties may have dramatic symptoms of low testosterone and may still benefit from supplementation despite the usually accepted levels of low testosterone of less than 300. As research in this area continues, lab levels will become more useful but for now, as in all aspects of medicine, the patient’s history, symptoms, lab values, and determination by a physician are all necessary in determining whether testosterone replacement is right for you.
If you tire more easily or find it more difficult to stay in shape and be motivated to be in shape then you may have low testosterone levels. Others symptoms include:
- Sluggish results from an aggressive exercise routine
- A long recovery time post exercise
- Decreased love for life, a soft
- Flabby body
- A slow metabolism which you notice for reasons such as gaining weight despite watching your calorie intake and diet more carefully.
- A slow-down of your mental quickness, memory, and/or concentration
- A loss of interest in sex (your sex drive has burnt out or cooled down)
Men who receive testosterone replacement therapy report feeling more inspired to be sexually active; they feel stronger and grow in confidence, as their response to working out becomes more dramatic. The goal of testosterone replacement is to increase your low testosterone levels to normal levels to alleviate some of the symptoms we blame on growing older. Safely restoring normal testosterone levels under a doctor’s direction can increase men’s energy, restore strength, and libido. Natural testosterone can restore muscle tone and make you look forward to your workout again. Testosterone replacement can restore your confidence that you lost because of symptoms blamed on age. Natural testosterone can restore healthy sexual excitement and desire. Restoring testosterone to youthful levels in both men and women can diminish the loss of sexual dysfunction. One of the goals of testosterone replacement therapy is to restore sexual function so that we can live our extended life span with the same excitement and enthusiasm we enjoyed during our youth.
Menopause in women, andropause or hypogonadism in men are all possible reasons to explain what we have come to accept as normal aging processes when in actuality they are secondary to low testosterone levels. By correctly supplementing the aging body with natural testosterone, many of the symptoms of aging are easily correctable.
Who is not a candidate for testosterone replacement? First of all, anyone whose job negates the use of performance enhancing drugs is not a candidate for testosterone replacement therapy despite their age. Anyone who has a level already above the upper normal ranges or any person who may have a secondary cause of low testosterone levels is not a candidate. In other words, if another problem in their body is causing it to be unable to produce the natural testosterone it should have. In this case, the secondary cause must be found before treatment may be considered. Simple blood tests are usually enough to rule out this reason.
The biggest reason to avoid testosterone replacement is prostate cancer. Although testosterone within normal ranges does not cause prostate cancer, if one does already have it, testosterone replacement may cause accelerated growth of this tumor. Annual rectal exams by your doctor, careful medical history reviewing symptoms related to prostate cancer and family history are all taken into account on our patients before deciding if testosterone replacement is an option for you.
What is Hypogonadism?
Hypogonadism is a condition in which the testes produce a less than normal amount of natural testosterone. Symptoms of low testosterone levels are:
- A drop in sexual desire and performance
- depression, fatigue or loss of motivation
- Osteoporosis (a disease that causes a thinning of the bones that is usually connected with women but is also a risk for men as our natural testosterone declines and can be accelerated in disease states that makes our testosterone lower than usual starting at ages younger than usual).
- The loss of body hair and muscle size and strength.
Often the symptoms are gradual and become a problem slowly over time and are blamed on “the normal process of aging” when the problem can be easily treated by testosterone replacement.
Hypogonadism (a low total serum testosterone level) occurs with aging either because of primary failure of the gonads (testes), and/or failure in two areas of the brain: the hypothalamus and pituitary. Primary failure occurs because the cells that make natural testosterone, called Leydig’s cells, reduce their production of natural testosterone or are reduced in number. This results in decreased production of testosterone despite proper stimulation by the brain to do so by such factors as human chronic gonadotropin. Thus the symptoms of low testosterone levels begin and aging is to blame!
The diagnosis is not as clear-cut as it may seem. There are many factors involved to determine the diagnosis of Hypogonadism, clinical as well as laboratory and subjective input from the patient. The patient may provide such information as past medical history forms, questioning during the physical exam, and a good questionnaire.
Most labs give a range of 260 to 1000 ng/dl for total normal testosterone levels and a second test (to be explained somewhat better below), a free testosterone of anywhere from 50 to 210 ng/l. The problem is, with time, these values become misleading, as our organs become less sensitive to stimuli in other parts of the body to produce natural testosterone. Ranges vary with age and thus this total is not age related, nor is there any reliable data on what is a normal testosterone level in certain age levels, especially teenagers and men in their twenties when levels theoretically are at their highest. Again, since very little data has been done on normal, healthy teenagers and men in their twenties concerning natural testosterone it is hard to say what is normal. Not only that, what is normal for one teenager now in his forties is not necessarily normal for another.
Typically, we consider free or bioavailable testosterone as that testosterone that has the positive effects that we want. Active, natural testosterone is not bound to other particles in the body such as albumin and SHBG (Sex Binding Hormone Globulin). Studies of random samples from healthy men showed ranges of natural testosterone between 100 and 1300. Studies have also shown no reliable correlation between aggressive healthy teens or adults with elevated levels of natural testosterone.
So how is it that Hypogonadism is diagnosed again? All insurance criteria vary, as well as research. The truth is that levels must be individualized for each patient. Most experts will agree that total testosterone levels below 300 almost invariably can be at the very least a part of the blame for symptoms related to low testosterone levels.
What is Andropause?
Unfortunately, not only women have menopause. Andropause is “male menopause” linked to the inability of the male body to continue producing natural testosterone at a rate sufficient to make a man feel young, the way he did in his twenties, thus the side effects of aging occur and are felt. The idea of maintaining this vitality, especially in this day and age when life spans are prolonged and our need to be efficient sexually, socially, professionally and in parenting is thrust further into our middle age, the idea of trying to maintain the physical and mental peak of youth is quite appealing. Why not couple the maturity of learning experience and have it at the same time we feel physically and mentally superior? Obviously such maturity is based on learning experience. Learning experience takes time… years, even decades. These decades show that our levels of hormones especially the ones in question here, natural testosterone and human growth hormone begin to fall.
Some of the symptoms described throughout this website start to occur because of this decline in both natural testosterone and human growth hormone. This deficiency can lead to a number of symptoms that many people consider natural to the aging process. But is it really natural to “feel” old? If replenishing your body after ruling out secondary causes of low testosterone levels, with testosterone can make us overcome, eliminate or reduce the symptoms of age, wouldn’t that be an advantage? Wouldn’t it make us more productive and less fearful of aging? Why not couple our maturity that has occurred with decades of learning with the continued supply of vital human growth hormones that begin to strip away our youth and begin the symptoms of aging? Let’s put them both together and maintain the vitality, energy, and drive necessary to maintain all the social and professional aspects of life that now occur into our middle years (40s and 50s) to even our “golden years” (80s and 90s)! The physicians at Vitality Quest want to invite you to embark on such a quest!
Andropause is similar to female menopause except men do not have a clear-cut sign such as ceasing of menstruation as females do. Symptoms that both the male and female patient experience as a result of human growth hormone decreases are similar. The transition that takes place in men occurs gradually over many decades. Many other things other than natural causes can contribute to its onset such as the patient’s levels of natural testosterone when he was young, his attitude, psychological stress, alcohol misuse, injuries, surgery, medications, obesity, infections, and even genetics can all be contributing factors.
A boom in the diagnosis of human growth hormone and testosterone replacement occurred in the mid-1990s when the FDA approved human growth hormone in the response to the AIDS epidemic to help treat wasting that occurred with the infection. A doctor of osteopathy named Dr. Klatz took research created and wrote a book called, “Grow Young with HGH”. Anti-aging practices sprang up and at first treated only the very rich in Europe.
Since that time, interest in the causes of aging have heightened and spread to the medical community. Increased diagnostic capability has been created and at a lower price. Some of that testing has been described above.
Starting at about 30, natural testosterone levels drop. Also, at about age 30, SHBG begins to increase which traps much of the testosterone that is still circulating and makes it unavailable to exert its effects in the cells of our body. What’s left performs the necessary functions. So, if you take less production of natural testosterone and add in a culprit that likes to tie it up and that culprit called SHBG is increasing, it is obvious that time has a negative effect on normal testosterone levels and its ability to do its necessary functioning in the body.
Andropause is associated with low free testosterone, the testosterone necessary to perform and function. Symptoms of andropause as well as hypogonadism follow.
These symptoms are:
- Erectile dysfunction and especially decreased libido (sex drive)
- Irritability and grumpiness
- Less zest for life, enthusiasm, and depression
- Weaker orgasms and less sensitive to stimulation
- Becoming fatter and losing muscle tone
- Obvious loses of energy and strength
- Disadvantages changes in mental sharpness, memory and concentration
- Increased risk of coronary artery disease and some types of cancers
Testosterone replacement is accomplished in many ways approved by the FDA including creams, gels, patches and pills. But the best way, far and away, is injectable. For qualified patients, we use a long acting injectable testosterone called depo-testosterone and it is injected into the muscles at intervals prescribed by our doctors dependent on your diagnosis, symptoms and lab results.
The effects of testosterone replacement therapy are dramatic and they include the following but many more:
- Increased motivation for sex, better orgasms, higher sexual drive and increased frequency
- Improved mental function, a feeling of being sharper with better retention and concentration
- Higher sense of well being and confidence
- Obvious improvements in energy, stamina and endurance
- Heart disease protection
- Increased muscle strength and mass, greater endurance and less noticeable fat
- Heightened motivation to live life, work out, and participate in daily events
Why do men wait?
We learn early never to give in and overcome all problems with perseverance and dedication. This is the same reason I have a hard time getting middle aged men to the physician in the first place for any reason and this type of attitude cannot only be inconvenient but dangerous.
Because of the gradual onset in most cases, we accommodate the symptoms. Decreased hormone levels are not normal for your age. Many doctors not knowledgeable with treatment options might remind their patients of this. Of course this is their opinion. You should always go to a doctor that fits your needs and your personality. Is this any different than telling a construction worker to stop lifting concrete because it hurts or a businessman who relieves stress and stays fit by jogging to stop because he has injured himself? In other words, if it hurts, stop it. Obviously there are cases when this is true, but not always and not usually.
The male pride is a prominent cause of treatment delay. It is our strength and our weakness. Often men approach their doctor with problems because their wife demands it or a crisis or injury has happened to someone that they are related to or know.
Catch on to the wave. Talk to a friend who is trying it. I guarantee we all have one that is or is contemplating it! What is different about our treatment with human growth hormone replacement and what you hear on the news, magazines or ESPN?
We do not treat anyone for sports enhancing reasons or for conditions in which such treatment might be dangerous to themselves or their health. We do not treat anyone who is not intellectual enough to understand the concept of what we are doing or the importance of doing it under a physician’s care is. We will not continue to care for non-compliant patients (those who refuse to follow the directions and orders of our physicians), and we never maintain blood levels for any prolonged periods of time or ever deliberately above the high normal acceptable blood thresholds.
Why should someone interested in using any hormone, especially anabolic hormones, do it under the direction of a physician?
There are many factors of hormone replacement to consider when a program is set up for our patients. Lab work, questionnaires, verbal discussions, past medical history forms and physical exam results that are put together when deciding if one should begin therapy and how much of what kind of hormone they should be given. It is a personal choice, one that involves a relationship between the patient and the physician, one that encourages, allows, and gives the patient access to questions and answers about what they are considering or already begun. Maybe most importantly is the monitoring process after initiating therapy, which once again involves blood work and discussion, considering input from the patient to the medical person and visa versa. Then there is the ever continuing research that is occurring and as it occurs and results are obtained, the patient will hear about what is truth and what is not from the expert they have chosen to customize their therapy program with. This field has been around for decades but relatively speaking is in its youth and billions of dollars are being spent on perfecting care, treatment regimens and the medications used. There is more to it then just sticking a needle in your body and giving the hormone. There are additional regimens to follow to get the most out of the hormone you have spent your hard-earned money on.
Many of our patients are ex-athletes who experimented illegally in the past with “steroids”. They liked what they offered them then and want to continue the results now, as they have aged and accrued more responsibilities with their jobs and families. They want to safely replenish what their bodies needs. They have matured in their decision-making process and understand the potential harm despite the overwhelming good that such therapy can render. They want to know what they are getting, that the product is coming from a reputable pharmacy, that the dose is being prescribed by a licensed physician and that the advantages of replacement are taken to the utmost while keeping the dangers and side effects of such treatment to a minimum. Our new patients, those who have never tried them in their younger lives, like myself, want the same kind of treatment.
Obviously there are cheaper ways of purchasing what we offer; the claims of what is being sold may or may not be true. But what if the hormone purchased comes from another source, has been tainted, diluted, distorted in some other way or potentially is not even what it has been claimed to be? There really is no way to know for sure. Does coming from another country necessarily mean it is not legitimate? No, but it means it has not passed the scrutiny of our own FDA in the USA.
Over the next few years, more and more types of FDA-approved products will be available including compounding pharmacy products of injectable human growth hormone and natural testosterone. People will be using hormone replacement in the future, the knowledge of their benefits will increase and the treatment will become more and more socially acceptable, most probably the norm instead of the minority. We offer products that are FDA approved, and purchased from accredited pharmacies, put together in customized programs by our licensed physicians of whom each patient will speak with personally.
