Dr. Jon Crisler
Q: What are the symptoms of hypogonadism ("low testosterone")?
Fatigue
Loss of muscle mass
Fat gain
Poor recovery
Irritability
Depression
Decreased memory
Lack of libido
Erectile Dysfunction
A problem with using these symptoms to diagnose hypogonadism is that you cannot directly relate either the number of symptoms present, or the severity of any of them, to the actual severity of the hypogonadism. That is why proper evaluation by a physician specifically trained in this type of medicine, as well as appropriate laboratory testing (much more on that in future articles), is absolutely necessary.
Q: What diseases and conditions are associated with hypogonadism?
Cardiovascular disease
Cancer
Diabetes
Metabolic Syndrome X
Osteoporosis
Depression
Dementia (including Alzheimer's)
Erectile Dysfunction
That is a scary list, to be sure! One of the scarier conditions is Metabolic Syndrome X which has only recently begun to receive much public attention. Metabolic Syndrome is an insulin-insensitivity condition that is believed to be the precursor to adult-onset diabetes. It is estimated that approximately 47 million Americans (22%) now have Metabolic Syndrome. For persons 60-69 years of age, the prevalence rises to 42%.
Metabolic Syndrome (also called Syndrome X) is defined as the simultaneous presence of 3 of the following 5 risk factors:
Abdominal obesity (beer belly): waist circumference greater than 40 inches in men; 35 inches in women.
Elevated blood pressure: greater than 130/85 mmHg.
Decreased HDL (the "good") cholesterol: less than 40 mg/dL in men; less than 50 mg/dL in women.
Elevated triglycerides: greater than 150 mg/dL.
Elevated fasting glucose: greater than 110 mg/dL.
Left untreated, people with Metabolic Syndrome are at increased risk of cancer, diabetes, heart disease, and erectile dysfunction. We learn more about this condition nearly every day, but many signs point to the possibility that Hormone Replacement Therapy (HRT) may help to prevent and/or delay the onset of Metabolic Syndrome. It may even help you to partially overcome the condition.
Q: Is testosterone replacement therapy (TRT) helpful in treating these diseases and conditions?
Yes, it is not enough to recognize that low hormone levels are associated with a given disease state or physical symp tom . It also must be shown that raising that hormone's level reduces the risk of developing, or dramatically improves-even eliminates--that disease or symp tom . Fortunately, scientific studies have shown that testosterone replacement therapy (TRT) does this for every single one of the above listed diseases AND symptoms.
Q: Is testosterone replacement therapy (TRT) dangerous?
Literally millions of men, from all over the world, have enjoyed the benefits of TRT. To date, we have not found a single case of appropriate testosterone replacement therapy (TRT) hurting anyone.
Q: Can testosterone replacement therapy (TRT) give me cancer?
Absolutely not. In fact, appropriate testosterone replacement therapy (TRT) has been shown to reduce your risk of cancer, probably due to its immune system boosting benefits.
Q: What are the possible negative side effects of TRT?
Some men report some water retention. This usually subsides, but if it doesn't, can be easily controlled by using a medication or OTC (Over-the-Counter) supplement to lower estrogen-the usual cause of chronic water weight gain while on TRT.
The risk of possible liver disease is listed on the package insert. But this is a throw back to the abuse of testosterone supplementation-in other words, taking steroids. I have never heard of appropriate testosterone replacement therapy (TRT) damaging the liver.
While the possibility of inducing, or increasing, the symptoms of BPH (Benign Prostatic Hypertrophy) is often mentioned, numerous studies have shown this is not the case. testosterone replacement therapy (TRT) has also been shown to not increase the risk of prostate cancer as well.
On the subject of prostate cancer, that is one of two medical conditions which are, at this time, an absolute contraindication (meaning a reason to withhold treatment) to TRT. That is why doctors who administer testosterone replacement therapy (TRT) monitor prostate health with regular PSA tests and Digital Rectal Exams. The other contraindication is male breast cancer.
Patients on blood thinners may need to have these medications dosed differently, as testosterone replacement therapy (TRT) also helps protect against unwanted clotting. On the other hand, the consistency of the blood is appropriately monitored while on testosterone replacement therapy (TRT), as a few men will develop polycythemia (blood that is too thick)-a completely reversible condition. In fact, TRT's ability to build up the blood is why it is one of the treatments for anemia.
Diabetics-whether on insulin or oral medications-usually need to have the dosages of these medications decreased, often dramatically. testosterone replacement therapy (TRT) is profoundly effective at controlling blood sugar levels.
Patients with hypertension (high blood pressure) on a class of medications called beta blockers may need to have their meds monitored as well.
Q: My doctor tested my testosterone level, and because it was just barely above the bot tom of normal range, he said I do not need TRT. Is he right?
The "normal" reference range for Total Testosterone is found through statistical means, meant to include 95% of all adult males. Yet, when tested properly-with what is called a Bioavailable Testosterone assay-about half of all men over the age of fifty have low testosterone . That means a significant percentage of those included in "normal" range are actually sick with hypogonadism (reread the list of serious diseases associated with hypogonadism). Therefore "normal range" has absolutely nothing to do with health and happiness!
Anti-Aging experts agree that if you are experiencing the symptom s of hypogonadism (low testosterone), even if your levels are as high as mid-range, a course of testosterone replacement therapy (TRT) is probably warranted. If your symptoms improve or disappear altogether, that proves you had the disease. This is known to doctors as "therapeutic testing."
Q: Can any adult male with low or low-normal testosterone levels get TRT?
At this time, men who have either prostate or breast cancer are deferred from undergoing TRT. We are also careful to regularly monitor PSA levels, as well as manually checking the prostate with a Digital Rectal Exam.
Along the way, we monitor blood levels, as a small portion of testosterone replacement therapy (TRT) patients will have their blood become too "thick", a condition known as polycythemia. This can happen because testosterone supplementation stimulates the production of red blood cells, which is why it is sometimes prescribed to treat anemia.
Beyond that, it is just a matter of finding a physician well-trained in how to best administer this profoundly effective treatment therapy.
Q: If I go on testosterone replacement therapy (TRT), how will it change my life?
Most men report dramatic increases in sexual performance, up to and including a reversal of Erectile Dysfunction (ED) symptoms. They also have much more energy, better stamina, increased muscle and decreased fat, and an improvement in their ability to concentrate and remember things. All of a sudden they are being active well into the evening again, enjoy great sex, can catch up to the grandkids, and hit that golf ball 40 yards further. They tell me they have regained their "edge". Plus they feel they just plain look younger. And this is in addition to the dramatic decreases in the risks for the serious diseases I listed previously in this article.
Q: If I go on testosterone replacement therapy (TRT), is it forever?
No, you can always go back to feeling the way you used to!
Q: Is Testosterone Replacement Therapy the same thing as doing steroids?
Good question, especially with all the press lately regarding steroids in professional sports. Doing steroids means taking testosterone waaaaay above the top of normal range. This is VERY bad for your health. Testosterone Replacement Therapy (TRT), on the other hand, is merely restoring, or optimizing, testosterone levels to healthy range. S tudies have shown that men get healthier (and happier) as they approach the top of normal range. And they tend to stay that way much longer.
A good analogy is the recent recommendation that a glass of wine at dinner each night may be good for our health. But drinking a whole bottle is a different matter entirely!
Q: What exactly do you do with testosterone replacement therapy (TRT) treatment? Shots? Pills?
There are several different methods for administering TRT: testosterone gels and creams, patches, pills, implantable pellets and injections. Each has their respective benefits, and shortcomings. Which testosterone delivery system to use has as much to do with each individual's lifestyle as it does the medical condition. That is why this decision must be made TOGETHER by the physician and the patient.
In my professional opinion, the best two methods are the gels/creams, and injectable testosterone.
Q: What is Anti-Aging Medicine?
It typically includes the tenets of Preventative Medicine, such as diet, nutrition and exercise. These efforts are meant to reduce the risks of serious diseases such as cancer, diabetes and heart disease. But it goes far beyond that, to the optimization of hormone levels, in order to maximize health, fitness and happiness. This includes not only testosterone, but also growth hormone, thyroid and even adrenal hormones. In coming articles we will explore all of these treatment modalities in depth.
This is why patients who want to maintain-or regain--their "edge" need to seek out the care of an Anti-Aging Specialist.
Q: After recognizing that I have the symp tom s of hypogonadism you describe, I asked my doctor about possibly getting on TRT. He told me I should not get testosterone replacement therapy (TRT), because it is natural for men to have their testosterone levels drop as they age. Is that true?
You might want to respectfully ask your doctor is he/she prescribes Hormone Replacement Therapy (HRT) for aging women. After all, it is "natural" for their estrogen levels to drop during menopause, and this is what causes their profoundly uncomfortable symptoms--which dramatically affects Quality of Life (QOL). Yet doctors routinely prescribe estrogen replacement for them, even though this is treating a completely "natural" condition. It has been said that female "menopause" is like falling off from a cliff, while male "andropause" (loss of male sex hormones) is more like rolling down a hill-it happens more slowly and insidiously. But the dangers of hypogonadism with respect to tremendous loss of QOL is undeniable. More so, it is associated with increased risk of cardiovascular disease, cancer, diabetes, osteoporosis, depression, dementia (including Alzheimer's) and Erectile Dysfunction. The fact most doctors feel it is perfectly a cc eptable for them to treat a drop in sex hormones in women, but not men, may be thought of as a form of bias against men's health.
When thyroid hormones get low (hypothyroidism) we give thyroid medication. When insulin gets too low (diabetes) we give insulin. Why should it be any different for the sex hormones?
On the second point, there is not one shred of evidence to suggest that testosterone replacement therapy (TRT) causes cancer. Not one. In fact, multiple studies have shown that LOW testosterone levels are strongly associated with a higher risk, and worse form of, cancer.
Both points demonstrate why you need a doctor who really understands this stuff. The risk of being subjected to unnecessary disease is too great. And why not live life to its fullest, for as long as possible?
Q: Why should I enlist the help of a genuine Anti-Aging Medicine physician to test for hypogonadism, and administer my TRT?
In the first place, God bless any doctor who is willing to provide TRT. But there are so many new developments in this exciting new kind of medicine that you want someone who is specially trained in this type of therapy. That is the only way to truly optimize one's health and fitness.
Q: Where can I research more information on this subject?
The American Academy of Anti-Aging Medicine , of which I am proudly a member (and also lecturer and Moderator of their national and international conferences), maintain a website resplendent with information at:
Worldhealth.net: Global Resource for Anti-Aging, Functional and Regenerative Medicine . You can even subscribe to their free email newsletter, which is a fascinating read, and some pretty exciting stuff!
Welcome to the cutting edge of medicine.
Q: What other services do you provide at the ALLTHINGSMALE Center for Men's Health?
We currently provide anti-aging consultation, Hormone Replacement Therapy (HRT) therapy, Botox treatments (for women and men), nutrition and supplement advice and sales. More services are added frequently, so please explore the rest of this web site.
