Testosterone Hormone Therapy
Testosterone is an essential hormone in men. Testosterone levels peak in puberty and early adulthood. After the age of thirty, research has shown that men’s testosterone levels roughly decline 0.5-2 % every year. Most men, by the age of 40 typically have a 5-20% decline in their natural (endogenous) testosterone production. For some men, this decline is does not affect quality of life and is considered a normal result of aging. However, sometimes the decrease in testosterone is accompanied by health changes that can be distressing. This is known as andropause, which is the male equivalent of menopause in females. Some common symptoms of testosterone deficiency are:
- Decline in sexual function
- Decrease in muscle mass and strength
- Increase in fat mass, particularly around the belly
- Decrease in energy and exercise endurance
- Changes in mood and cognition
- Decrease in bone mineral density and increased risk of fractures
If you have symptoms of andropause, the treatment team will check the levels of testosterone in your blood. If your testosterone levels are below the optimal level, you may be prescribed supplemental testosterone. This is typically administered as an intramuscular injection, 1-2 times per week. The treatment team may also recommend supplemental Human Chorionic Gonadotropin to boost your body’s own production of testosterone.
Testosterone For Women
Testosterone is one of several hormones known as “androgens,” the hormones primarily responsible for developing stereotypically masculine traits. As such, it is typically thought of as a male hormone, but women need small amounts of testosterone to regulate mood, energy, sex drive, and a healthy body composition too. There are no clear guidelines for defining androgen deficiency in women, so most physicians do not even consider testosterone supplementation in women. However, testosterone supplementation has been shown to improve sexual function in post-menopausal women and may also help improve body composition.
Testosterone supplementation can be administered via transdermal creams/gels, sublingual lozenges, pellet implants, and long-acting injections. Women treated with testosterone typically report that transdermal creams (either daily or every other day) work best.
Does Testosterone Supplementation Have Any Side-effects?
Possible side effects with testosterone treatment include acne, hirsutism (abnormal hair growth on face or body), deepened voice, and clitoral enlargement. This side-effects are very uncommon, especially with careful dosing and monitoring to avoid inappropriately high levels of testosterone. With proper treatment, these side effects can be avoided.
Should I Be On Supplemental Hcg While On Testosterone Therapy?
Testosterone replacement therapy can cause the body to stop its own production of testosterone by inhibiting the hormonal pathway that stimulates production of testosterone by the testes. As a result, men receiving supplemental testosterone may notice a decrease in testicle size. Additionally, abrupt cessation of testosterone therapy may lead to a rebound in symptoms of low testosterone, because the body has stopped producing testosterone on its own. Supplemental HCG is useful in maintaining natural testosterone production and testicle size in patients on testosterone and restoring function in those who have recently discontinued testosterone supplementation.
Should I Be Taking An Estrogen Inhibitor While On Testosterone Therapy?
Circulating testosterone is naturally converted to estrogen by an enzyme called aromatase. In men, this process occurs primarily in fatty tissue, and so the conversion from testosterone to estrogen is particularly pronounced in obese men. Additionally, the administration of supplemental testosterone, particularly at levels above the range of normal (as in the case of bodybuilders who use inappropriately high doses of anabolic steroids), leads to increased conversion to testosterone and side-effects associated with high levels of estrogen – primarily enlarged breast tissue (gynecomastia) and loss of libido. Our physician will determine if an estrogen inhibitor would be beneficial based on your clinical picture and laboratory results. If so, you may be prescribed either a medication to block the function of aromatase (aromatase inhibitor, e.g. anastrazole) or a medication that blocks the action of estrogen at estrogen receptors (selective estrogen receptor modulator or “SERM,” e.g. clomiphene).