Low Testosterone In Men

Written by BIH of Decatur on . Posted in Men


Many studies have demonstrated that low testosterone is a risk factor for earlier death.  When one is told, “You are more likely to live if you are wearing a seat belt if involved in an accident.” it would be prudent to wear your seat belt.

In the following article low testosterone is shown to be related to many of the signs we normally call “aging”.  But the downward spiral of aging may actually be secondary to the loss of testosterone most men see after age 30.  If low testosterone can be brought back to normal (not just normal for age) many of these conditions may be reversible.  So often men are told by their physician, “Your testosterone is normal for your age.  It is expected that a man your age to experience erectile dysfunction.”  Do not accept this judgment!

Call our office for a free consultation to see if you may be a candidate for Bio-Identical Hormone Replacement Therapy.

ScienceDaily (Aug. 17, 2006) — Men who have a low testosterone level after age 40 may have a higher risk of death over a four-year period than those with normal levels of the hormone, according to a report in the August 14/28 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Unlike women undergoing menopause, middle-aged men generally do not experience a dramatic decrease in the production of sex hormones, according to background information in the article. Testosterone levels gradually decline as a man ages, decreasing approximately 1.5 percent per year after age 30. The effects of low testosterone levels include decreased muscle mass and bone density, insulin resistance, decreased sex drive, less energy, irritability and feelings of depression.

Molly M. Shores, M.D., and colleagues at the VA Puget Sound Health Care System and University of Washington, Seattle, studied the relationship between hormone levels and death in a total of 858 male veterans older than age 40 years. All participants received care in the VA Puget Sound Health Care System and had their testosterone levels checked at least twice between 1994 and 1999, with at least one week and no more than two years elapsing between tests. The men were followed for an average of 4.3 years and a maximum of eight years, through 2002.

About 19 percent (166) of the men had a low testosterone level; 28 percent (240) had an equivocal testosterone level, meaning that their tests revealed an equal number of low and normal levels; and 53 percent (452) had normal testosterone levels. One-fifth (20.1 percent) of the men with normal testosterone levels died during the course of the study, compared with 24.6 percent of men with equivocal levels and 34.9 percent of those with low levels. Men with low testosterone levels had an 88 percent increase in risk of death compared with those who had normal levels. When the researchers considered other variables that may influence risk of death, such as age, other illnesses and body mass index, the association between low testosterone levels and death persisted.

Previous studies have found that testosterone levels may dramatically decrease one to two days after surgery, trauma or critical illness–all factors that can increase the risk of death. To eliminate these effects, the authors reanalyzed the data excluding men who had died within the first year of follow-up. Men with low testosterone levels were still 68 percent more likely to have died. “The persistence of elevated mortality risk after excluding early deaths suggests that the association between low testosterone and mortality is not simply due to acute illness,” they write.
(Arch Intern Med. 2006;166:1660-1665. Available pre-embargo to the media at www.jamamedia.org.)

Pellet Natural Bio-Identical Hormone Replacement

Written by BIH of Decatur on . Posted in functional medicine, Men, Menopausal Research, Women

pelletsPellet Bio-Identical Hormone Replacement is very much different than the traditional methods of replacing diminishing hormones. Hormones can be increased somewhat by creams that are applied to the chest, arms or medial thighs. Testosterone injections are administered usually every 7 to 10 days. Estrogen can be used orally or as patch.

Each of these has their inherent problems. None of the above delivery systems can get the hormone levels as high as pellet hormone replacement therapy and keep the hormones levels where they should be for more than a few hours. This is what gives the roller-coaster effect of most hormone replacement therapies. The creams do not get hormone levels high enough. Injections hurt and are a hassle. Blood clotting factors are changes when estrogen in any form is taken orally.

Pellet Bio-Identical Hormone Replacement Therapy is an ideal delivery system because you are seen only every 3 months. Your blood levels help the doctor to adjust the dosage administered because the blood levels are relative constant for months. Because pellet hormones are used the chances of blood clots are greatly decreased. Because bio-identical hormones are used the chance of breast cancer is much less.

Hormones control every system of the body. The list includes:

• Regulate heartbeat • Fights stress • Regulates breathing • Prevents fatigue • Helps sleep • Helps alleviate anxiety • Controls blood pressure • Reduces stress • Builds bones • Helps keep memories • Builds muscles • Resists allergic reactions • Lubricates joints • Helps prevent infection • Regulates growth • Helps relieve pain • Regulates heat and energy • Increases sex drive • Helps burn fat • Increases fertility • Regulates menstrual cycle • Increases virility • Helps to allow pregnancy • Stimulates the brain • Fights cancer • Stimulates the immune system

Hormone replacement aids in prevention of disease instead of curing a disease. Most diseases…..heart attacks, strokes, arthritis, loss of sex drive, obesity, breast and cervical cancers, fatigue, poor sleep…..occur after age 40. Most of us after age 40 begin to see signs of a decrease in hormones.

The blood work to determine hormone deficiency may include Estradiol, Testosterone, FSH (follicular stimulating hormone), TSH (thyroid stimulating hormone), Progesterone, CBC, and B12 and PSA in men. Lab results do not reflect what really is “normal”. A man’s testosterone may show 375 ng and he is told he is well within the normal range for his age. But when he was 22 his testosterone was 1000 to 1200. Men by age 70 have 10% of the testosterone they had in their youth.

Testosterone in a normally functioning female at age 20 is usually 60NG to 80NG. By the time she is 50 years old testosterone may be 10 or lower. Estrogen performs 400 vital functions in a woman’s body. How can she lose 90% of her natural estrogen and testosterone and 98% of her progesterone and be expected to happy and healthy?

You do not have to “just live with it”. You can do something about your hormone deficiency.

Women’s Hormones Pamela Wartian Smith, MD, MPH page 5

Low Testosterone – A Risk Factor for Heart Disease

Written by BIH of Decatur on . Posted in Men, Uncategorized

man with heart










The following article shows MEN who are low in testosterone are MORE  likely to die especially of heart disease.

Testosterone is a vasodilator and aids in blood flow to the heart. There are more receptor sites to testosterone in the heart muscle than any other muscle in the body. All this could explain the reason men live longer if their testosterone is normal.

What you see in the study is that in 930 men who already had coronary disease low testosterone was common. And of those men who had low testosterone, they were twice as likely to die. This, of course, suggest strongly that men with higher testosterone levels are more likely to live. Using bio-identical hormones to raise one’s testosterone to that of a younger person just makes sense.

ScienceDaily (Oct. 21, 2010) — Low testosterone levels seem to be linked to a heightened risk of premature death from heart disease and all causes, suggests research published online in Heart.

The finding refutes received wisdom that the hormone is a risk factor for cardiovascular disease. The researchers base their findings on 930 men, all of whom had coronary artery heart disease, and had been referred to a specialist heart centre between 2000 and 2002. Their heart health was then tracked for around 7 years.
On referral, low testosterone was relatively common. One in four of the men was classified as having low testosterone, using measurements of either bioavailable testosterone (bio-T) — available for tissues to use — of under 2.6 mmol/l or total testosterone (TT) of under 8.1 mmol/l.

These measures indicate clinically defined testosterone deficiency, referred to as hypogonadism, as opposed to a tailing off in levels of the hormone as a result of ageing.

During the monitoring period almost twice as many men with low testosterone died as did those with normal levels. One in five (41) of those with low testosterone died, compared with one in eight (12%) of those with normal levels.

The only factors that influenced this risk were heart failure (left ventricular dysfunction), treatment with aspirin or a high blood pressure drug (beta blocker) and low bio-T levels.

A low bio-T level was an independent risk factor for premature death from all causes and from heart disease, after taking account of other influential factors, such as age, other underlying health problems, smoking and weight.

Borderline levels of low total testosterone (15.1mmol/l) also increased the risk of an early death.

While high doses of testosterone found in anabolic steroids are harmful to health, the evidence suggests that low, rather than high, levels of the hormone, are associated with obesity, risky blood fats, and insulin resistance, all of which are risk factors for diabetes and heart disease, say the authors.

Men at high risk of these diseases may stand most to gain from testosterone replacement, they suggest.
An accompanying editorial points out that there is increasing interest in looking at the impact of testosterone replacement.

Beneficial effect of hormone replacement therapy on weight loss in obese menopausal women

Written by BIH of Decatur on . Posted in Menopausal Research, Women

At the onset of menopause, weight-gain and the aggravation of certain cardiovascular risk factors are frequently observed. The aim of this study was to examine the metabolic effects of combined hormone replacement therapy (17beta-oestradiol transdermic 50 microg for 21 days and oral medroxyprogesterone acetate 5 mg from day 10 to 21) using, in particular, indirect calorimetry.
Patients (21; 12 substituted and nine controls) were studied twice (3 months apart) during an oral glucose load (75 g).
Total body weight was unaltered after 3 months in the control group, whereas a fat-loss of 2.1+/-0.2 kg and a decrease of the waist:hip ratio were observed in the substituted group. In the latter group, a significant increase in lipid oxidation was observed (0.58+/-0.06 mg/kg/min before and 0.75+/-0.04 mg/kg/min after substitution P<0.05), whilst total energy expenditure and thermogenesis were also increased. Glucose, lipid and protein oxidation remained stable during three months in the control group. The insulin response to an oral glucose load diminished by 30% with hormone replacement therapy (102.3+/-32.8 mmicro/l versus 71.4+/-20.0 mmicro/l). Total and LDL-cholesterol improved after hormone replacement therapy whereas plasma triglycerides were not altered. CONCLUSIONS: Combined hormone replacement therapy not only prevented weight-gain, but favored weight-loss by significantly increasing lipid oxidation after 3 months of treatment. It also favourably influenced the insulin response, plasma lipids and energy expenditure. Source: http://www.ncbi.nlm.nih.gov/pubmed/10515671

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Bioidentical Hormones for Menopausal Hormone Therapy: Variation on a Theme

Written by BIH of Decatur on . Posted in Menopausal Research

Bioidentical or natural hormones are being promoted to consumers as benign health tonics. The term bioidentical is a pseudoscientific neologism that refers to endogenous hormones, including estriol, estrone, estradiol, progesterone, testosterone, DHEA, thyroxine, and cortisol. Natural alludes to the fact that these are native human hormones. In fact, these hormones are synthesized or semisynthesized. Stigmasterol from soybeans (Glycine max) and diosgenin from an inedible Mexican yam (Dioscorea villosa) can be converted to progesterone in the laboratory, but there is no evidence that plant sterols convert to progesterone endogenously.

Many bioidentical hormone products that require a prescription are prepared by compounding pharmacies. Compounding pharmacies use commercially available drugs to create formulations that are not commercially available. For example, compounding pharmacies routinely turn tablets into syrup for patients with swallowing problems, combine two or three pills into a single capsule, make a pet-sized dose of a drug meant for humans, or make a topical preparation from a drug available only in an oral form. Because compounding pharmacies are not manufacturing facilities, they are not subject to FDA standards for good manufacturing practices. Compounded preparations are not regulated by the FDA and may vary in potency. For example, one study found that only 1 of 10 compounding pharmacies provided progesterone vaginal suppositories that were all within the potency range required of similar FDA-approved products.

This article will focus on compounded bioidentical hormone preparations aimed at menopausal and perimenopausal women. Oral products include estriol, biestrogen (Bi-est, containing 20% estradiol and 80% estriol), or triestrogen (Tri-est, containing 10% estrone, 10% estradiol, and 80% estriol). Estriol is usually dosed at 2 mg twice daily; the usual dose of Bi-est or Tri-est is 1.25–2.5 mg twice daily. These doses are believed to be equivalent to 0.625–1.25 mg of conjugated equine estrogens. The term estrogens encompasses all forms, including human estrogens (estradiol, estriol, and estrone), synthetic forms (for example, ethinyl estradiol), and conjugated equine estrogens (mixed estrogens derived from mare’s urine). The term progestogen is an umbrella term that encompasses progesterone, which is the mammalian progestogen, and synthetic progestins (for example, medroxyprogesterone). Bioidentical progesterone is micronized progesterone, oral forms of which are used in conventional medicine. Transdermal progesterone cream, however, remains an alternative treatment in the United States.

Although all oral hormonal preparations require a prescription, topical hormone preparations are generally regulated as cosmetics, not drugs, and so are readily available without a prescription. Health food stores sell progesterone and DHEA creams, and estrogen creams may be purchased on the internet.

Estrogen is an effective treatment for hot flashes and vaginal dryness, but neither estrogen nor estrogen/progestin therapy should be used for disease prevention. Natural hormone proponents, however, claim that bioidentical hormones are different than conventional hormone regimens and will prevent disease. An educational packet distributed by one compounding pharmacy claims that “there are cardiovascular benefits to hormone therapy…protecting against premature heart disease, hypertension, and cholesterol.” Another pharmacy states that their hormone therapy protects against heart disease, breast cancer, and endometrial cancer. A company that sells various hormones over the internet describes estrogen as “literally a heart saver.” And another pharmacy states that Bi-est “…might allow for all of the protection of estriol, while potentially providing the cardiovascular and osteoporosis benefits and vasomotor symptom relief of estradiol.”

Although estrogen or estrogen–progestogen combinations are far more common, oral or injected progestogens are occasionally used in conventional medicine to treat hot flashes.

Transdermal progesterone cream has also been tested for hot flashes; one study found a positive effect and another found no effect. Progesterone cream is promoted to treat and prevent osteoporosis, and as a general health tonic. However, no clinical trials support the use of progesterone cream for either of these claims.

The perception that progesterone cream is a panacea can be traced to the late John M. Lee, MD, whose popular books claimed that breast cancer, fibroids, fibrocystic breasts, premenstrual syndrome, osteoporosis, and other conditions were all linked to “estrogen dominance secondary to relative insufficiency of progesterone.” One web site that sells progesterone cream states that “Natural progesterone cream contains NO synthetic hormones and thus can help you balance your hormones, eliminate estrogen dominance and relieve your symptoms without dangerous side effects.” Another web site claims, “Natural progesterone should not be confused with the progestins or progestogens in birth control pills and other drugs… Natural, USP progesterone, on the other hand, is identical to the body’s own progesterone molecule, and has no serious side effects when used as directed.”

Popular books have contributed to misconceptions about hormones. Actress Suzanne Somers has published three books promoting bioidentical hormone therapy in 3 years. In her latest book, Ageless: the Naked Truth About Bioidentical Hormones, Somers states, “Hormones are our life force; the decline of hormones is the hallmark of aging;” “Without hormone replacement, we will end up mere shells of our former selves;” and “Disease doesn’t develop when hormones are in perfect balance.” Despite developing breast cancer and undergoing a hysterectomy for endometrial hyperplasia while taking bioidentical hormones, Somers remains a hormone enthusiast.

Several physicians promote these hormones. Erica Schwartz, MD, author of The Hormone Solution: Naturally Alleviate Symptoms of Hormone Imbalance from Adolescence Through Menopause (NY: Warner Books; 2002) and The 30-Day Natural Hormone Plan: Look and Feel Young Again—Without Synthetic HRT (NY: Warner Books; 2004) evaluates patients through telephone interviews and prescribes hormone treatment. Schwartz states on her web site, “‘Natural’ Bio Identical Hormones are exactly the same as the hormones your body made when you were younger except they don’t have the same adverse side effects commonly associated with ‘Synthetic’ Hormone Replacement Therapy. ”

Steven F. Hotze, MD, author of Hormones, Health, and Happiness (Houston, Tex, USA: Forrest Publishers; 2005) and proprietor of the Hotze Health and Wellness Center in Houston, Tex, USA claims that, “When our hormones are in balance we are young, healthy, radiant, fertile, wrinkle free and excited about the posibilities life can offer.”

The terms bioidentical and natural may imply safety to consumers. A survey of 82 women interviewed at a compounding pharmacy found that 74 had heard about natural hormones and 37 used them. Half of those who had heard about natural hormones believed that natural meant “not synthetic/not man-made/no chemicals” and 45% thought the term meant plant-derived. Only 11% agreed that natural meant “identical to human hormones.” More than two thirds (71.4%) of respondents believed that natural hormones had fewer risks than pharmaceutical hormones.

Bioidentical hormones are identical to hormones used in some commercial pharmaceutical preparations. Estradiol, for example, is available in pills (including Estrace®, Gynodiol®, and generics), transdermal delivery systems (Climara®, Alora®, Estraderm®, Vivelle®, and generics), vaginal creams (Estrace® and generics), and vaginal rings (Estring®) and Femring®). Progesterone is available in capsules (Prometrium®, Solvay Pharmaceuticals, Marietta, Ga, USA [marketed], manufacturer: Schering Plough) and vaginal gels (Crinone®, Serono Laboratories, Inc., Rockland, Mass, USA and Prochieve, Columbia Laboratories, Livingston, NJ, USA). Ironically, the estrogen in the best-selling hormone preparations Premarin®, PremPro®, and Premphase® (Wyeth, Philadelphia, Pa, USA) is derived from pregnant mare’s urine, an inarguably natural source.

Interest in bioidentical hormones appears to have increased since 2002, when the estrogen–progestin arm of the NIH-funded Women’s Health Initiative (WHI) was stopped because of harm. (the estrogen-only arm was stopped in 2004). In this definitive randomized controlled trial (RCT) that included more than 26,000 women, neither estrogen nor estrogen–progestin combinations reduced cardiovascular risk. Both estrogen and estrogen–progestin therapy increased stroke risk; estrogen–progestin therapy increased rates of breast cancer and dementia. Hormone therapy increased the risk of incontinence and improved quality of life only in women with hot flashes.

The WHI tested conjugated equine estrogens (with and without medroxyprogesterone acetate), but no RCT to date has shown a benefit for any estrogen on cardiovascular events. Two RCTs have shown that estradiol, a natural hormone, prevents neither heart attack22,23 nor stroke.

Estriol, specifically, is believed by bioidentical hormone proponents to decrease breast cancer risk. This belief is based on several articles written in the 1970s by a researcher who remained enthusiastic about estriol even after his only published clinical study failed. Six of the 24 subjects with breast cancer who took estriol developed metastases; two developed endometrial hyperplasia. The researcher, however, never made specific disease prevention claims about estriol.

Other evidence refutes the purported benignity of bioidentical estrogens on the breast. High levels of endogenous estradiol and estrone are associated with increased breast cancer risk; estriol has also been implicated in increased risk. In breast cancer cell lines, estriol stimulates breast cancer cell growth more than other estrogens. Breast tissue from women with breast cancer, compared to women without breast cancer, contains higher levels of estriol, estrone, and estradiol.

Little information is available about long-term effects of micronized progesterone. There is preliminary evidence from E3N-EPIC, a large French cohort study of 98,997 women followed up for a mean of 5.8 years, that hormone regimens incorporating micronized progesterone rather than other progestogens may be safer in terms of breast cancer risk.41 However, this is an observational study, not an RCT, that included hormone regimens rarely used in other countries. This study by no means constitutes proof of a differential effect.

Women with intact uteri are prescribed estrogen with a progestogen to oppose estrogen-induced endometrial hyperplasia and cancer. Bioidentical hormone proponents sometimes recommend topical progesterone cream instead of oral progestin for this purpose. However, it is unclear whether topical progesterone can effectively mitigate estrogen-induced endometrial stimulation. Three studies have examined the ability of progesterone to oppose estrogenic stimulation. The longest study, which lasted for 48 weeks, found that transdermal cream containing 40 mg of progesterone could not effectively oppose estradiol-induced endometrial stimulation. A 12-week study of a cream containing up to 64 mg of progesterone found similar effects. The only study that found that progesterone cream (1.5% or 4%, dosed by body weight) effectively opposed estrogen lasted only 28 days, too short a time to assess estrogenic effects. Five studies that measured serum or plasma levels after topical progesterone treatment have found progesterone levels <5 ng/mL (the minimum level believed to induce a secretory endometrium). Only one study found a progesterone cream equivalent to oral progesterone after measuring progesterone concentration in whole blood (Table 1). Bioavailability Studies on Topical Progesterone Cream Although oral estriol preparations are an alternative treatment for menopausal symptoms in the United States, estriol is a commonly prescribed conventional drug in other countries and was often prescribed without a progestin. Although estriol is far less potent than estradiol and rapidly metabolized, estriol appears to stimulate proliferative changes identical to those induced by more potent estrogens. Two Swedish studies found that unopposed oral estriol (1–2 mg/day) was associated with endometrial hyperplasia. Compared to nonusers, the use of oral estriol doubled the risk of endometrial cancer; 5 years of oral estriol tripled the risk. Vaginal estriol did not significantly increase risk. Although one recent study concluded that estriol has a benign effect on the endometrium, the data presented show that estriol treatment was associated with significant endometrial thickening and polyps, both considered to be estrogenic effects. The FDA’s Guidance for Industry states, “other combinations and dosage forms of estrogens and progestins were not studied in the WHI clinical trials and, in the absence of comparable data, these risks should be assumed to be similar.” SALIVARY HORMONE TESTS Saliva testing for hormones has been promoted to individualize the dosing of bioidentical hormone treatment. It is not clear how best to correlate progesterone levels with endometrial effects, but it is clear that salivary progesterone levels are unreliable. Correlations between serum and salivary levels of reproductive hormones vary by hormone tested, time of day, diet, and type of assay. Also, serum levels may not reflect tissue levels. Hormone tests are not indicated for menopausal symptoms because there is no correlation between hormone levels and symptoms. Salivary tests may be used to persuade asymptomatic women to use hormones, and may encourage symptomatic women to use higher doses than are necessary to treat symptoms. This would be expected to result in an unfavorable risk–benefit ratio. As Boothby stated in an excellent review, “Although attractive on the surface, individualized NHT [natural hormone therapy] is an ill-conceived attempt to apply pharmacokinetic principles to drugs that do not meet the criteria for individualized dosing.” DISCUSSION Bioidentical hormones are an unusual form of alternative medicine. Unlike dietary supplements, most orally administered hormones require a physician’s prescription. Despite the fact that these hormones are no more natural than (and in many cases are identical to) commercially available drugs, when formulated by a compounding pharmacy these preparations fall outside of the current realm of FDA regulation. No reliable data support the claim that bioidentical hormones are safer than other hormones, and natural, bioidentical, and compounded preparations must be assumed to have the same risks as commercial hormone preparations. Commercial or compounded estrogen preparations should be effective for treating hot flashes or vaginal dryness, and oral micronized progesterone is acceptable as the progestogen portion of menopausal hormone therapy. Any estrogen, including estriol, should be opposed with an oral progestogen in nonhysterectomized women. Whereas some progesterone creams may provide some endometrial protection in some women, studies to date are not reassuring. Progesterone creams should not be relied upon to protect uterine endometrium from estrogen-induced stimulation. Oral progestogens with known effects are preferred. Any menopausal hormone therapy should be reserved for women with bothersome symptoms, and used in the lowest effective dose for as brief a period as possible. Whereas compounded preparations may be useful for creating lower-dose preparations of hormones, these preparations lack the consistency and regulatory oversight required of commercial hormonal drugs. Adverse effects of hormones must be assumed to be drug class effects until reliable clinical evidence proves otherwise. Claims that the hormones present in compounded prescriptions are safer than commercial pharmaceuticals can only be made by those unfamiliar with or unwilling to accept scientific data. Women who wish to use compounded hormones to treat menopausal symptoms should be counseled that bioidentical hormones have the same risks as conventional hormones. Because hormones are readily absorbed through the skin, the FDA should regulate transdermal hormone preparations as drugs. In addition, the FDA should require compounding pharmacies to provide patients with the same written information required of commercial drugs with any compounded prescriptions made with those drugs. To do otherwise risks the health of consumers. Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2219716/

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