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