(Part 2 of a 5 part series)

Last week I wrote the first of a five-part series on bioidentical hormone replacement therapy, or BHRT. I introduced the work, Functional Endocrinology, which is a term that I have come to love. It means that there is no hormone-producing organ or gland in the body that operates in isolation. It means they all work together in the context of the environment that the body and mind are functioning in. Anyone who doesn’t address the thyroid, the adrenals, stress reduction, weight management, nutrition, medications AND the reproductive system in a talk about bioidentical hormone therapy isn’t giving you the whole picture.

I also mentioned that hormone imbalance is ALWAYS related to stress. Stress makes us crave carbs, snap at our kids, drink cups and cups of coffee, and then have to use alcohol to calm down at the end of the day, making us “tired but wired”. If you go on a vacation, your life is still waiting for you when you get back. This is the cause of hormone imbalance. I covered estrogen and progesterone in the last segment of this blog, so now let’s move on to testosterone…

Some facts about testosterone

• Testosterone is primarily secreted in the testes of males and the ovaries of females, although small amounts are also secreted by the adrenal glands. It is the principal male sex hormone and an anabolic steroid.
• In men, testosterone plays a key role in the development of male reproductive tissues such as the testis and prostate as well as promoting secondary sexual characteristics, such as increased muscle, bone mass, and hair growth.
• Testosterone is essential for health and well-being as well as the prevention of osteoporosis.
• Women make only 10% less testosterone than men.
• There is 50% less in women with no ovaries.
• Testosterone replacement limits the estrogen stimulation of breasts (a good thing).

Causes for a lowered testosterone level in women

• Adrenal insufficiency
• Oral estrogen therapy (including oral birth control)
• Advancing age, which causes low DHEA
• Thyroid medications
• Chronic illness
• Depression

Causes for lowered testosterone levels in men

• Chemotherapy
• Damage occurring during surgery involving the pituitary gland, hypothalamus, or testes
• Glandular malformation
• Head trauma that affects the hypothalamus
• Infection (e.g., meningitis, syphilis, mumps)
• Isolated LH deficiency (e.g., fertile eunuch syndrome)
• Radiation therapy
• Testicular trauma
• Tumors of the pituitary gland, hypothalamus, or testicles

Studies have shown that men with obesity, diabetes, or hypertension may be twice as likely to have low testosterone levels.

Andropause (or Low “T”) and Male Hormone Replacement

There have been studies reporting increases in all-cause mortality with lower testosterone levels and high testosterone levels. It is important NOT to overdose on testosterone.

Symptoms of low testosterone

• Fatigue
• Loss of muscle mass
• Increased body fat
• Depression
• Loss of assertiveness
• Moodiness
• Loss of mental agility
• Lower libido

Diagnosing low testosterone

Properly run salivary testing will show:

• Adrenal fatigue
• Decreased testosterone
• Elevated estrogens
• Low or normal progesterone

Tips on treating low testosterone

• Oral synthetic testosterone in the 1980s caused liver tumors with chronic use and was abused by professional athletes.  Natural testosterone does not cause these issues.
• High estrogen and high testosterone  can increase your risk for prostate cancer. Your medical provider must follow the PSA as well as the hormone levels. The PSA can go up 10-15% with therapy, which will increase the risk for prostate hypertrophy and cancer.
• Normal levels of testosterone are beneficial to the prostate by decreasing PSA and prostate volume.
• Testosterone does not affect erectile dysfunction. Correction of testosterone will cause improvement in desire and peak penile rigidity. Only 8-10% of men with ED have testosterone levels low enough to benefit from replacement.
• Libido improvement is found when cortisol, thyroid, estrogens and progesterone are balanced along with testosterone. Also look at nutrition, relationships, and stress.
• Remember that when you are in a constant state of sympathetic nervous system overdrive (fight or flight), it’s not safe to reproduce because your body believes you are in danger (picture being chased by a saber-toothed tiger).
• Treating andropause must start with fixing the adrenals and any issue with cortisol FIRST.
• Then you can begin BHRT with testosterone cream in a pump that has been compounded by a pharmacy trained in BHRT and is being followed by a medical provider trained in BHRT.
• Your salivary levels should be tested at least 2-3 months after the start of your treatment.
• For men: re-check a PSA no later than 6 months into therapy and only accept a 10% or less increase from baseline.

Many men’s magazines and body builder magazines advocate the use of over-the-counter DHEA. I would like to address this issue.

DHEA is the highest produced steroid hormone other than cholesterol. It declines 10% per decade from the age of 20. DHEA is a potent precursor to androgens and estrogens and marker for cumulative adrenal stress over time. If a person keeps their DHEA reserves up they do better with stress than those who don’t have enough. However, DHEA is also the precursor for androgen and estrogen issues for men and women if it isn’t properly administered and levels tested periodically.

DHEA potential benefits, but only if properly dosed with testing. Will not do these things by itself:

• Improved sex drive
• Increased energy
• Improved immune function
• Improved sleep
• Better memory and moods
• Improved bone density
• Reduced CV disease
• Weight loss by reducing insulin resistance

You must be off of DHEA and other steroid hormones for 2 weeks to get an accurate test. If you are on creams, the time is longer. Women should only take 5-10 mg DHEA a day, not the usual 25 mg seen in over-the-counter supplements.

The take home about DHEA is this: You should take the hormone (testosterone) rather than the precursor (DHEA), which has no known end point. We don’t know how it will be taken up by the body. DHEA can throw every steroid hormone off balance by taking it without proper testing. It is like putting a pin ball into action in a pin ball machine and thinking you can predict which route it will take to the bottom…impossible. It is best to take the actual hormone and guide it along the pathway the body needs with proper testing.

Next week will be part 3 of this 5-part hormone series: Salivary Testing and BHRT with Creams.

Here’s to your health…