The World Of Hormone Replacement Therapy for Men

Reviewing the complex world of hormones and hormone replacement is often a daunting task.  In this review entry, my hope is to give some information regarding the many choices available to men as they contemplate hormone replacement therapy and to discover if it is right for them.

FOUNDATIONS FIRST

Before considering the aspects of hormone replacement therapy is it essential that the functional and foundational aspects of life should be addressed initially.  Sleep, movement patterns, food, stress and community are large influences on overall health.  Imbalances in these areas can cascade into imbalances in other areas, including hormones.  Start with a basic functional medicine analysis first and make the necessary changes in the foundations as the initial part of any plan.

START WITH THE GUT

Our gastrointestinal track has a great deal to do with our energy, vitality, immunity and inflammation.  An unhealthy gut can often lead to imbalances in other areas.  Avoidance of refined foods as well as food sensitivities and irritations, as presented in the basic IFM Elimination Plan, is a great start to restoring the natural balance in the gut.  Replacing nutrient deficiencies with complete and robust nutrition is also a critical part in healing the gut so that balance can return.

GET TESTED / GET TREATED

Signs and symptoms of hormone deficiencies in men can be both obvious and subtle.  Make sure you get a complete analysis from a functional medicine physician to help pinpoint the functional imbalances.  This type of analysis should include a complete history and physical to evaluate any and all symptoms associated with the imbalances.

After that, it is helpful to have your hormones levels checked.  Serum and blood test are often adequate, but sometimes this is not enough to have a complete picture of the problem.  Specialized testing using saliva or urine may be necessary to get the complete picture and develop the best treatment plan.

NATURAL OR HORMONAL

After the complete history, physical and analysis, you and your functional medicine physician should have a good idea of the problem and how to approach it.  One option is to approach symptoms and imbalances in a more natural way using plant extracts and botanicals.  Often symptoms relating to low hormone states can be alleviated and improved by using plants and botanicals.  This should be considered first in mild imbalances.  Some options to consider for hormonal imbalances are:

DHEA:
Dehydroepiandrosterone (DHEA) is produced in the adrenal gland and is a precursor to testosterone and estrogen.  Supplementing with this precursor is believed to help elevated testosterone and estrogen levels while at the same time lowering cortisol levels.

Tribulus:
Plant of the caltrop family believed to increase testosterone and improve sperm motility and viability.

Fenugreek:
Aromatic herb believed to improve sex drive in men and women as well as alleviate menopausal symptoms.

Saw Palmetto:
Dwarf palm tree believed to alleviate prostate symptoms as well as improve male pattern baldness as well as unwanted hair growth in females.  Also believed to be helpful in prostatitis and chronic pelvic pain.

Cowage Seed:
Legume believed to contain trace amounts of L-DOPA, serotonin, nicotine, and bufotenine.

I-3-C / DIM:
A compound, and its derivative, found in cruciferous vegetables.  These compounds assist with the metabolism of estrogens.  It is also being studied for its anti-cancer and anti-oxidant properties.

HORMONE REPLACEMENT THERAPY (Testosterone)

If, after the complete functional medicine analysis and interventions, there is a desire to use prescription hormone replacement therapy, then you need to be sure to work with a physician familiar with the approach.  Just measuring symptoms and testosterone is not enough.  Following aspects of testosterone breakdown products, estrogen levels, sex hormone binding globulin as well as cortisol is equally important.  This will create a truly balanced and healthy approach to hormone replacement therapy with testosterone.

Several aspects and choices should be considered when choosing the right approach to testosterone replacement therapy.

FERTILITY:

If fertility and having children is important, then direct replacement of testosterone is not the right choice.  Indirect stimulation of testosterone should be chosen so that sperm viability and fertility may be preserved.  This is often done with Injectable Human Chorionic Gonadotropin (HCG) or Oral Clomid or Oral Enclomiphemine.

TOPICAL or INJECTABLE:

If fertility is not a concern, then direct supplementation of testosterone can be chosen.  Two options are topical forms (Androgel, Testim, Androderm, Axiron, Fortesta, Vogelxo, etc.) or injectable forms.

Topical forms usually come as creams, gels or patches and must be applied daily.  It is also important to know that there can be transference of the testosterone from contact with others.  It is often recommended that the application be done on clean skin and that there be no contact with another person for at least one hour after the application of the gel or cream.  Patches supersedes this problem, but many men have an irritative response to the adhesive over time which is a problem in and of itself.

Injectable forms of testosterone are either synthetic or ester formations of testosterone.  They often come in single or combined forms based on the amount of time the testosterone is in the system.  The most common testosterones to know are Testosterone Enthanate, Testosterone Cypionate and Testosterone Propianate.

Testosterone Enthanate / Cypionate: These testosterone esters are relatively long acting and are injected once per week on average.  There is little difference between the two, although Enthanate is used and manufactured worldwide and Cypionate tends to remain in the United States.

Testosterone Propinate:  This testosterone ester is relatively short acting and is injected 2-3 times per week.

Once you have chosen your TRT mode of delivery and dosage with your physician, it is important that you and your physician follow your improvement in symptom as well as blood work and other specialized tests needed to optimize health and maximize safety.

 

HOW DO I CHOOSE?

The methods and pathways targeted to balance out your hormones is a very personal decision, but it is best to be guided by an experienced professional to gain maximum effect with minimal risk.  In the end, however, returning hormones into balance can be a truly life enhancing experience when done safely and correctly.  The major questions to consider are:

    • Are my personal lifestyle factors in balance (sleep, movement, food, stress and relationships)?
    • Should I use hormone enhancing botanicals or prescription hormones?
    • How will my hormones be monitored and regulated by my physician?
    • Does my physician have the knowledge and experience to manage my hormones?

Always make sure that you have a functional medicine physician who is educated and well versed in hormone replacement therapy because not all functional medicine physicians are.  Also, as stated previously, make sure that your physician takes a complete history, physical and hormone analysis before entering the world of hormone replacement therapy.  Lastly, make sure that you are teaming with your physician…that he or she is listening to your needs, teaching you about risks and benefits and giving you all the options available to you.


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