Testosterone replacement for men

Because hormone replacement therapy (HRT) can reverse many signs of aging, men are flocking to doctors to sign up for testosterone.

by Dr. Paul Stallone — 

Hormone replacement therapy, specifically testosterone, may help a man feel like he is in his 20s again — a time when building muscle was almost easy, nothing could depress or bring him down, and getting an erection took little to no effort. However, many men over age 35 have a different outlook on life as they have started to notice what it feels like to get older.

Male aging happens, in part, because hormone production begins to decrease around age 30. Surprisingly, getting and maintaining an erection starts to become a struggle and unexplained fatigue soon sets in. Because hormone replacement therapy (HRT) can reverse many signs of aging, men are flocking to doctors to sign up for testosterone.

While HRT has been ruled safe and is approved by the FDA for certain individuals, it still has many risks, which are often downplayed or even skipped during a doctor’s visit. In the hurry to begin treatment, many patients are rushed through the process, which can be disastrous. Certain precautions can save time, energy, money and more.

An increasing number of physicians are beginning to offer this long-term program, but some are rushing into the field, lacking expertise. One of the patient obligations while on testosterone is to have repeat blood tests throughout the course of treatment. This testing often is not strictly complied with by the patient or doctor in an attempt to hasten the program and/or to save on costs.

Testing may rule out factors that can make testosterone potentially unhealthy to an unqualified participant. Specific blood draws are essential before starting any HRT, and patients should be on the lookout for and avoid a doctor who does not ask for a comprehensive blood work-up. Some patients try to get by with the bare minimum or less, and while some accommodating physicians are fine with this, testing is by far in the patient’s best interest.

Testing during treatment can alert a physician if testosterone is converting into estradiol. Conversion can occur from inaccurate or unmonitored prescribed dosages. Elevated levels of estradiol, something that is more common in overweight men, can produce unwanted symptoms, like breast pain and a low emotional threshold. More serious conditions like atherosclerosis or hardening of the arteries can develop from higher than normal levels of estradiol.

Testing throughout treatment can account for a decrease or increase in the strength of the hormone so that appropriate levels are maintained. Other symptoms, such as unwanted hair growth and testicle shrinkage, are associated with high levels of testosterone. Another side effect of improperly prescribed testosterone can be reddening of the face and thickening of the skin — something that can be very embarrassing, but avoidable with the right treatment.

The numerous ways to administer testosterone can be confusing to a doctor new to the field. Pellets that are inserted beneath the skin sound convenient, but pellets come in specific strengths, thus not allowing for a total customization of treatment. If an over-eager or untrained physician prescribes too much and negative side effects are experienced, the pellets may need to be surgically removed, which can be painful and inconvenient.

Oral replacement also sounds easy, but most of the testosterone is metabolized by the liver on its way out of the intestine, resulting in low blood levels and a higher risk of liver function abnormalities. An injectable form bypasses the liver and achieves very good blood levels, but this method requires frequent injections, typically every one to three weeks.

Compounded creams or gels are gaining in popularity with experienced physicians, as precise hormones are made in a pharmacy for one specific individual at a time. Creams, which are fairly inexpensive, are simple to use, travel well and produce great results. Few men report skin irritations related to using creams.

Another danger arises when a patient buys testosterone on his own, via the Internet. As with other drugs found online, getting them can be relatively easy, but it can also be extremely dangerous. Patients absolutely need to be monitored while on any HRT, and doing it by yourself is never recommended or approved. HRT can be an expensive, long-term treatment. Thus, patients need a physician who is willing to be up-front and explain all the benefits, alternatives and risks, including the financial obligations involved with starting a program.

Almost all male patients who are on a healthy testosterone replacement program will state, although anonymously if possible, that the expense is well worth it, since being able to “connect” with their partners again is priceless.

Testosterone replacement in men provides many benefits, including improved energy, strength and libido. Preservation of bone mass and muscle mass are also reported. The downside risks appear to be very modest and may include weight gain, sleep apnea and an increased red blood cell count (testing will monitor red blood cells).

There is also some concern about long-term effects on the prostate, including an acceleration of a benign enlargement or an increased risk of prostate cancer. Studies to date indicate that prostate-related risks do not appear to be of great concern, although long-term monitoring should continue.

The right physician for the right patient can make all the difference in getting the most out of life. The typical 40-year-old man does not have to feel the negative effects of aging, but it does take someone who completely understands the field to make a positive difference.


Paul Stallone, N.M.D., founded the Arizona Integrative Medical Center, located in Scottsdale, Ariz. He combines natural, alternative and conventional treatments to best fit each patient’s needs. or 480-214-3922.

Reprinted from AzNetNews, Volume 31, Number 2, April/May 2012.

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