Testosterone Replacement For Men: Probably A Good Idea

It’s an interesting phenomenon that more women ask about testosterone therapy for the men in their lives than men ask for themselves. And when a man does ask, the question is usually couched with hesitations, “Uh, my…wife wanted me to…uh…ask about…you know…testosterone.”

There are good reasons for hesitation. For men, the symptoms of age-related testosterone decline are nothing as dramatic as menopause symptoms are for women: hot flashes on and off all day, night sweats that drench bed sheets and interrupt sleep, brain fog, sex a distant reminiscence, aging skin, vaginal dryness. And then, magic! Once the proper dose of bioidentical hormone replacement therapy (BHRT) is reached, everything vanishes. If you’re unfamiliar with BHRT, these are sex hormones made from substances (soybeans and the inedible Mexican wild yam) that are molecularly identical to the hormones made in the ovary of a woman. BHRT is totally different from the conventionally prescribed Premarin or Prempro, produced from the concentrated urine of caged pregnant mares. If you have concerns about your karma, realize that Premarin is right up there with sealskin boots and ivory chess sets.

If asked directly by their physicians (men rarely volunteer this stuff), men low on testosterone—or T, as it’s called in sales vernacular–report a drop in interest in sex, sad-looking erections, mood issues (“grumpy old men”), an increase in potbelly and love handle fat, and, despite regular exercise, muscles that grow flabbier by the day. Yet many of these symptoms can be dramatically improved when testosterone levels are returned from pathetic back to macho.

Testosterone myths
It’s useful to clear the air about testosterone myths and half-truths, especially if you’re a man with symptoms or you’re living with a guy who’s beginning to get on your nerves.

Myth #1: heart disease  There was a large kerfuffle with much publicity after a 2013 study published in JAMA reported increased heart disease risks among testosterone users. Days after the study was published, readers and researchers wrote letters pointing out that the study’s arithmetic was faulty.JAMA published a new version, this time with the correct math, which showed that heart disease risk was reduced by 50% among men using testosterone.

The latest research is now showing that:

  • Low testosterone is linked to increased coronary artery disease and that when testosterone levels are restored to normal, cardiovascular disease deaths are reduced by 50%.
  • Exercise capacity among men with known heart disease who are taking testosterone is much better than among men receiving a placebo.
  • There is uniform improvement in heart disease risk factors (fat mass, waist circumference, pre-diabetes indicators) among men taking testosterone vs. placebo.

Myth #2: prostate cancer  Just as the Women’s Health Initiative years ago incorrectly concluded that hormone replacement therapy caused breast cancer (it does not), the myth that testosterone replacement causes prostate cancer (it does not) has hung on. Based on an opinion about a single patient, it has never been confirmed in long-term studies using large numbers of patients. What is true is that sex hormones–whether estrogen for women or testosterone for men–can hasten the growth of existing breast and prostate cancers.

This is why women are screened with a mammogram and men with a PSA (prostate-specific antigen) test before being prescribed hormones. The PSA test can be useful as a baseline when tracking testosterone use. If it starts out normal and suddenly shoots skyward with testosterone, the testosterone is stopped.

Myth #3: T is overprescribed because of pharmaceutical advertising  Actually, the opposite is true. Levels aren’t measured during routine exams and testing is virtually never suggested by primary care physicians. Too many doctors, their brains hard-wired into the faulty testosterone/heart risk association, discourage both testing and prescribing. In addition, because testosterone is seriously overpriced, insurance companies make every effort to deny coverage. Many insurance companies actually request your testosterone test results to verify that your level is low enough to merit a prescription.

If anything, in my view, testosterone is under-utilized. A lot of men are missing out on a valuable therapy that has the potential to benefit their overall quality of life and reduce some significant health risks.

Bioidentical testosterone
All available supplemental testosterone is bioidentical. The products come as skin creams or injections, and both are effective though clearly a skin cream is easier to use. If you’re interested, ask your doctor to measure your testosterone level (get a PSA to test your prostate status at the same time). WholeHealth Chicago patients can call, scheduling a lab-only and asking for “testosterone levels and PSA.”

If your testosterone level is low, you can start with a T-raising herbal blend called Testosterone Formula or (if your PSA is normal) schedule a brief physician visit and get a testosterone prescription. If your insurance company won’t pick up the tab, don’t despair. Virtually identical products are available from compounding pharmacies at about 25% of the Big Pharma price.

We try to bring your testosterone level to about what it was when you were 25 or so. Think you can live with that?

Be well,
David Edelberg, MD

Posted in Blog, Knowledge Base, T Tagged with: , , , , ,
15 comments on “Testosterone Replacement For Men: Probably A Good Idea
  1. Lee says:

    If a man has A-Fib, can he still use Biodentical Testosterone Cream?

  2. Rebecca Tackitt says:

    I would be interested in the answer to the November 1 question re: A-Fib.

  3. Dr E says:

    Hi Lee
    At fib is no problem. By the way, if your at fib is intermittent, you might try; (1) the herb Hawthorn, (Eclectic Labs) two caps twice a day and (2) magnesium powder, one tsp at bedtime

  4. Lee says:

    Thanks so much! That is good news!

  5. Leah Jozwiak says:

    Is there an archived article concerning testosterone therapy for women? Would love your take… Also on pelleting. Is pelleting available for men also or just women?

    Thanks!

  6. Tom Rusin says:

    My doctor says that serum and free testosterone must be below lower limit before he can prescribe testosterone. Is this true for all doctors?

  7. Rita says:

    Just for your information.

    My husband had a very low PSA and very aggressive prostate cancer. PSA is unreliable when there is obesity, etc. He is in remission for 10 years because of excellent care. When he tried testosterone briefly it made him horribly aggressive and almost violent.

  8. Pawan Kumar says:

    If a man has hypertension(High blood pressure) and have low T. Does Testosterone Formula increases blood pressure? What dosage is safe for man with hypertension.

    Thanks
    PK

  9. Dr E says:

    Hi Tom
    This is an issue with insurance rather than something medical. Because the Big Pharma testosterone is so expensive, insurance companies frequently request a patient’s testosterone results and deny coverage if remotely in normal range. This is all avoided using bioidentical from a compounding pharmacy because you’d be paying out of pocket (at a fraction of the price)

  10. Dr E says:

    Hi Leah
    I may have written about testosterone for women, but after over 1000 articles, I doubt if I can find it. I do use testosterone for women but either as a cream or as a small dose orally, usually as part of estradiol and progesterone. From the patients themselves, it gets mixed reviews. Generally the cream seems superior

  11. Lee says:

    Rita, sounds like your husband was given too high of a dosage.

  12. Dr E says:

    Hi Pawan
    Testosterone Formula is safe, one capsule twice a day. Obviously, you could have an unexpected reaction, so monitor your blood pressure during the first week or so

  13. Tom Rusin says:

    “Bioidentical from a compounding pharmacy” means what? Is this over the counter?

  14. Dr. R says:

    Tom. A compounding pharmacy is basically an old fashion pharmacy. Pharmacy compounding is the art and science of preparing personalized medications for patients. Compounded medications are made based on a physicians prescription in which individual ingredients are mixed together in the exact strength and dosage form required by the patient. This method allows the compounding pharmacist to work with the patient and the prescriber to customize a medication to meet the patient’s specific needs.

  15. Vic says:

    For those looking for articles regarding women and testosterone replacement. Ani Pharmaceuticals appears to be sitting on very important information from the larger Libigel Safety trial involving 3656 postmenopausal women at higher risk of experiencing a cardio vascular events.

    The findings have never been published or articulated by any company, other than in the patent applications (see attached link)

    http://appft.uspto.gov/netacgi/nph-Parser?Sect1=PTO2&Sect2=HITOFF&p=1&u=%2Fnetahtml%2FPTO%2Fsearch-bool.html&r=3&f=G&l=50&co1=AND&d=PG01&s1=%22simes,+stephen%22.IN.&OS=IN/%22simes,+stephen%22&RS=IN/%22simes,+stephen%22

    During the study they accidentally found that by restoring testosterone to pre-menopausal levels it reduced the risk of experiencing a cardio vascular event by at least 71% over what had been anticipated. Cardiovascular events included: cardiovascular death, non-fatal stroke, non-fatal myocardial infarction, hospitalized unstable angina (including acute coronary syndrome), angioplasty, coronary bypass surgery, pulmonary embolism and deep vein thrombosis.

    Unfortunately it appears the info has never been published as they try to secure a patent for this accidental discovery. Looking at the patent prosecution information. It appears that they also recently found that restoring t-level also reduced the risk of breast cancer.

    The study has over 7300 patient years of data collected. My research leads me to believe that Abbvie may be quietly advancing the project. Abbvie hired Dr Michael Snabes Study Director and one of the identified inventors in the patent application as a Sr Medical Director of Men and Women’s Health in 2013. I have additional information supporting this belief, but will spare you the details.

    Abbvie also acquired a $350 million Priority Review Voucher on August 19, 2015. The day after the FDA approved Addyia the first drug to treat HSDD for pre-menopausal women. Seeing that the voucher was issued in March 2015, I can’t help but think that the voucher acquisition was related to their work with Libigel.

    If you have access to the American Heart Journal article entitled “A cardiovascular safety study of LibiGel (testosterone gel) in postmenopausal women with elevated cardiovascular risk and hypoactive sexual desire disorder”, you will note that William B White, MD, chaired the executive committed for the safety trial and Dr Henry R. Black, MD, was a member of the Data Monitoring Committee. Both are past presidents of the American Society of Hypertension.

    If I am correct in my assumptions. ANI pharmaceuticals and/or Abbvie may publicly announce their findings in the near future. If so, you may see them filing an NDA in 2017.

    Hope it helps.

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