STEP INTO THE SPOT LIGHT with Teresa Sievers, MD, MSMS, FAARM and Karen Callan BA, CHHC, AADP
Dear Dr. Sievers,
I am a 55 year old executive. Over the past year, I have felt I am aging more than is appropriate from my age. For exercise I play golf a couple of times a week, but I can’t hit the ball as far any more. I am always tired and irritable. I’ve gained weight without changes in my diet. I do have a couple of cocktails most evenings. What’s really concerning me is my mental focus and sharpness; the decline is affecting my work. Recently my wife began bio-identical hormone replacement therapy and her energy and libido are back. For the first time, she wants to have sex, but I have no interest. Could I benefit from hormone therapy too?
Low testosterone symptoms do include your complaints, as well as depression and loss of muscle mass, a reason your golf game is affected. Men often lose their competitive edge during this time and can become somewhat of a couch potato. When men begin to experience having erection problems and loss of libido, it’s usually an indication that testosterone has been low for a while. But even without erection or libido issues, it’s possible to have low testosterone..
There are health concerns with low testosterone. Elevated cholesterol and blood pressure are among them, increasing heart disease risk. Decreased muscle mass is generally replaced with body fat setting the stage for diabetes and osteoporosis. And low testosterone also increases the risk of prostate cancer.
Although controversial, it is generally recommended to have an annual PSA and a rectal exam to assess the prostate and it definitely should be done prior to beginning testosterone therapy (bio-identical hormone replacement therapy BHRT). Contrary to popular belief, bio-identical testosterone therapy does not cause cancer. However, if you have undetected prostate cancer, testosterone therapy may unmask it. This is because when testosterone is low, the PSA may also be low.
Once replacement begins, the PSA may rise naturally because of the testosterone or it can be because of cancer. Therefore it is important to have regular follow up labs while on therapy. Even men who have had prostate cancer and are cancer free for at least two years can receive therapy with careful monitoring.
Complications of testosterone therapy typically occur when levels are too high. Acting as a stimulant to red blood cell production, testosterone can cause the blood to thicken, which can increase the risk of stroke and heart attack. It can also cause irritability.
Keep in mind that if you are considering having children, testosterone therapy can cause cause infertility. For men wishing to maintain fertility, HCG hormone or clomiphene are options.
Estradiol and Estrone, both estrogens, also needs to be monitored during testosterone therapy to be sure the levels are not increasing, as this can set the stage for prostate and male breast cancer. It is often why men develop breasts whether on testosterone therapy or not. Taking zinc limits this conversion as does lowering alcohol intake and losing weight.
Testosterone levels can be measured through blood or saliva. But it is imperative that your doctor checks your bioavailable testosterone–testosterone available for your body to use. But conventional doctors tend to overlook this point, often only checking total testosterone and free levels. They also believe low levels “are normal for a particular age.” But anti-aging medicine recognizes we age because our hormones decline.
What causes low testosterone? It’s partly because the testicles stop working, but a lot is related to the brain. The testes send a signal to the brain for the testes to make testosterone, but even an old brain injury can disrupt this communication. Other factors include excess alcohol, diabetes, medications, exposure to heavy metals/toxins and excessive physical or mental stress. And while exercise can improve testosterone, excessive workouts can lower it.
Along with bio-identical testosterone therapy, there are lifestyle changes you can make to help raise your testosterone. Decreasing alcohol and sugar while increasing vegetables, eating lean protein and exercise, as well as adding a high grade, doctor prescribed multi-vitamin with zinc is a great place to start. Avoid skin products, as well as environmental toxins that contain xenoestrogens, which mimic estrogens in your body and cause imbalances in all hormones throughout your body. Sex will also raise your testosterone.
Testosterone therapy can be taken via injection, ideally twice per week to avoid extreme highs and lows. You can also use topical treatments. I do not use conventional forms of topical testosterone as the doses are too high. Using a compounding pharmacy allows me to customize treatments to meet individual requirements. It also allows me to add chrysin to the dosages, an herb that limits testosterone conversion to estrogen.
Remember, follow up labs are important, not only for testosterone, but you should also have complete blood counts, PSA and estrogen levels checked regularly.
Teresa A. Sievers,
MD, MSMS, FAARM
Restorative Health & Healing Center
10201 Arcos Av., Suite 201, Estero
Learn more about Dr. Sievers at:
Karen R. Callan, CHC, AADP
Certified Health Coach
10201 Arcos Ave., Suite 201 Estero
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