Hormone Replacement Therapy for Men

People tend to fear what they don’t understand. Our propaganda machine, aka the media, often determines how people perceive things – from politics to drugs. Thirty years ago marijuana was the devil’s lettuce and now we are on the precipice of legalization. Hormones, mainly for men, fell victim to sensationalism and irrational fear.

*Before we go any further, this is not medical advice nor am I a medical doctor. Instead, I just want you to have the information needed to ADVOCATE for yourself if and when the time comes. 

I’ve been doing online coaching since 2012, where I’ve helped people of all ages, sex, and geographical location (California to Afghanistan), work towards their goals. What started as a nutrition and training business, has morphed into being more of a optimal health and well-being coach. And again, I am not doling out medical advice to these people. Rather, I do what I do with everyone…

• Ask questions – how do you feel? how is your energy? have you considered x? have you spoken with a Dr.? did you get a second opinion? how is your sleep? are you managing your stress?

• Provide research – send studies, articles, personal experiences relevant to the conversation. Even if I feel something can provide a benefit, I have to included potential risks associated as well.

• Leave the bias at home – I do my best taking myself out of the equation. I don’t want anyone to base their decision SOLELY off my opinion. I’m there to help them think through these situations and make an informed decision.

Men’s Health Stigma

Hormone replacement is nothing new. Anytime someone is lacking a specific hormone, whether it’s T3 (thyroid hormone) or estrogen for women during menopause, we typically supplement with that hormone. Diabetic? Here is some insulin (hormone) to raise your levels. It’s not rocket science.

Testosterone levels often drop 1% a year after age 30, as men creep into what we call andropause. Most people have never even heard of the word andropause, yet we are all familiar with menopause…

Andropause

“Andropause or late-onset hypogonadism is a common disorder which increases in prevalence with advancing age. Diagnosis of late-onset of hypogonadism is based on presence of symptoms suggestive of testosterone deficiency – prominent among them are sexual symptoms like loss of libido, morning penile erection and erectile dysfunction; and demonstration of low testosterone levels.” [1] Andropause – Current Concepts

“The finding of low circulating testosterone level in men is relatively frequent. The symptoms of hypogonadism are very frequent in the aging men. However, the diagnosis of hypogonadism is often neglected and the opportunity to replace low testosterone in older men is highly debated.” [2] Testosterone replacement therapy: For whom, when and how?

Is Your Testosterone Low?

What happens when you tell your Dr. that you think you might have low testosterone? I can’t know what yours will say, but I can tell you what those who serve my clients have said. First, unless you ask for your testosterone levels to be checked, or bring up potential symptoms, they likely won’t order it on your bloodwork. That’s step one.

If they do order it and they come back, “in range”, they will likely brush it off even though you could be on the low end of that range. If the range is 250-1,100 and you’re at 300, you’re “in range”, though you may not feel optimal. That is, unless you bring it up again.

Then they’ll give you the tried and true, “try exercise, losing weight, eating better, vitamin D.” Now I certainly wouldn’t criticize that advice, but most of my clients have already adopted these healthy lifestyle choices. Lifestyle modification should always be the first step.

If they’re especially clueless, they will prescribe something like Cialis. This literally just happened with an online client of mine over the last 3 months. His energy was down, libido was down, he felt off. So I told him to bring it up with his Physician and ask for a hormone panel.

His blood work showed him right at the bottom of “normal”. But because testosterone is so misunderstood and scary, he gave him cialis??? Obviously this didn’t work and he emailed me with headaches from the cialis and still no libido/energy.

That’s when I sent him a bunch of literature on hormone replacement. Both risks and rewards. I have no dog in this fight. I just want him to have some skin in the game and make informed decisions. I also recommended trying a different physician to get additional opinions.

What Does The Evidence Say?

Here’s where it gets interesting. When most people hear, “testosterone”, they think, “Oh my! A steroid, that’s bad!” That mindset comes from the media’s portrayal of steroids, often by using anecdotes of people who misuse and abuse them.

Let’s get this straight. All drugs have side effects. All drugs possess risk. If you abuse drugs, you run the risk of having serious implications. This is all common sense. It doesn’t matter what you’re taking – cholesterol medications, diabetes medications, anti-anxiety medications, etc.

The problem with vilifying testosterone is that it is negatively affecting men’s health and quality of life. Twenty or thirty years ago we didn’t have the research we have today, and we still need a ton more. But, aside from your health-span, low testosterone can also impact your life-span.

• “Low T levels in men may increase their risk of developing coronary artery disease (CAD), metabolic syndrome, and type 2 diabetes. Reduced T levels in men with congestive heart failure (CHF) portends a poor prognosis and is associated with increased mortality. Studies have reported a reduced CV risk with higher endogenous T concentration, improvement of known CV risk factors with T therapy, and reduced mortality in T-deficient men who underwent T replacement therapy versus untreated men. Testosterone replacement therapy (TRT) has been shown to improve myocardial ischemia in men with CAD, improve exercise capacity in patients with CHF, and improve serum glucose levels, HbA1c, and insulin resistance in men with diabetes and prediabetes. There are no large long-term, placebo-controlled, randomized clinical trials to provide definitive conclusions about TRT and CV risk. However, there currently is no credible evidence that T therapy increases CV risk and substantial evidence that it does not. In fact, existing data suggests that T therapy may offer CV benefits to men.” [3] Testosterone and The Heart

• “A total of 39 RCTs and 10 observational studies were included. We did not find any significant association between exogenous testosterone treatment and myocardial infarction, stroke, or mortality in randomized controlled trials.” [4]  Cardiovascular Risks of Exogenous Testosterone Use Among Men: A Systematic Review and Meta-Analysis

• “When use in androgen-deficient men with documented low morning testosterone levels, TRT was not associated with an increased risk of cardiovascular outcomes. During long-term follow-up the risk of cardiovascular outcomes was lower in testosterone-treated men.” [5] Association of Testosterone Replacement With Cardiovascular Outcomes Among Men With Androgen Deficiency

• “.The experience in Low T Centers shows that, in a testosterone patient registry, testosterone is generally safe for younger men who do not have significant risk factors. Of patients that developed MI with testosterone, there was no association with testosterone or hematocrit levels.” [6] Myocardial Infarction and Stroke Risk in Young Healthy Men Treated with Injectable Testosterone

• “Some of the effects of testosterone treatment are well recognized and it seems clear that testosterone treatment for aging hypogonadal men can be expected to increase lean body mass, decrease visceral fat mass, increase bone mineral density and decrease total cholesterol. Beneficial effects have been seen in many trials on other parameters such as glycemic control in diabetes, erectile dysfunction, cardiovascular risk factors, angina, mood and cognition.” [7] Testosterone for the aging male; current evidence and recommended practice

• “Based on these findings we suggest that long-term TTh in overweight and obese hypogonadal men produces progressive and sustained clinically meaningful weight loss and that TTh may contribute to reductions in mortality and incident major adverse cardiovascular events.” [8] Differential effects of 11 years of long-term injectable testosterone undecanoate therapy on anthropometric and metabolic parameters in hypogonadal men with normal weight, overweight and obesity in comparison with untreated controls: real-world data from a controlled registry study

• “Testosterone replacement therapy has been shown to improve components of metabolic syndrome and decrease prostate inflammation, which is related to the worsening of lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia. Testosterone replacement therapy could be considered for most men with late-onset hypogonadism regardless of their history of prostate disease. However, a discussion about the risks and benefits of testosterone replacement therapy is always advised, especially in men with prostate cancer.” [9] Late-onset hypogonadism: Prostate safety

• “The results showed that the men treated with testosterone had “significant progressive and sustained reductions in their body weight, fasting glucose, HbA_1c and fasting insulin over the treatment period,”. In the control group, fasting glucose, HbA_1c and fasting insulin increased.One-third (34.3%) of men treated with testosterone saw remission of their diabetes; almost half (46.6%) achieved normal glucose regulation with antidiabetic treatment and a vast majority (83.1%) reached their target level of HbA_1c.Patients in the control group saw no remission of diabetes or reduction in glucose or HbA_1c levels.

  In addition, there were fewer deaths, myocardial infarctions, strokes and diabetic complications in the group treated with testosterone.

  The research indicates that long-term treatment with testosterone is potentially a novel additional therapy for men with Type 2 diabetes and hypogonadism, the authors wrote.” [10] Study finds testosterone therapy can lead to remission in men with Type 2 diabetes

Wrapping Up

HRT might be a viable solution for some, and it might not be for others. While public perception is changing slowly, more and more doctors are willing to try this medication. I imagine research will continue to evolve, so you should attempt to keep up with its evolution.

In my opinion, you should treat this situation as it specifically relates to you and only you. You should thoroughly examine the benefits and risks before making a decision. It’s your life and you need to play an active role in your health.