Why Testosterone Therapy? And What Is It?

Both men and women in their late 30 and early 40 will start lowering testosterone levels approximately 1% to 2% per year as part as the natural aging process. This drop in testosterone is aggravated by diet and lifestyle behaviors such as lack of sleep, but also diet high in processed foods and sedentary lifestyle.

Chronic use medications can also disrupt testosterone production in men and women. These are the most common medications that may cause this effect:

• Ketoconazole (Extina, Nizoral, Ketoderm) is used to treat infections caused by fungi or yeast (e.g., athlete’s foot, yeast infection of the skin, seborrheic dermatitis, or dandruff.) Ketoconazole can be taken as a pill or used as a cream, foam, gel, or shampoo.
• Cimetidine (Tagamet) is often prescribed to people with ulcers or gastroesophageal reflux disease (GERD). It’s also available in an over-the-counter form to treat heartburn. It comes in tablet and liquid forms.
• Spironolactone (Aldactone) may be used with other medicines to treat high blood pressure and heart failure. It may also help people who have too much aldosterone (a hormone), or people who have edema (fluid retention) from heart, liver, or kidney disease.
• Certain antidepressants Selective serotonin reuptake inhibitors (SSRIs) used as first line of treatment in major depressive disorder (MDD) are known to exert negative effects on the endocrine system and fertility. A doctor can advise a patient on which antidepressant is most suitable.
• Chemotherapy drugs have been shown to lower testosterone levels, possibly because they can damage the testes, the organs that produce testosterone in men.
• Ibuprofen: The journal Proceedings of the National Academy of Sciences of the United States of America published a study in January 2018 showing that ibuprofen causes compensated hypogonadism by suppressing testicular endocrine function. Patients in said study were on a high dose ibuprofen for 6 weeks. Most patients may continue using ibuprofen as needed without concern. Yet, chronic high-dose users, such as athletes or people with chronic pain are at higher risk for adverse endocrine effects. Patients complaining of symptoms consistent with hypogonadism (eg, decreased sex drive, depression, fatigue, and reduced lean muscle mass) may find relief from avoiding ibuprofen. Ibuprofen’s impact on the male reproductive system is a class effect shared with other NSAIDs (Non-steroidal anti-inflammatory drugs such as naproxen, diclofenac, indomethacin). Interested patients, such as men attempting to father children, may use acetaminophen as an alternative for mild pain.

Testosterone Resistance

Symptoms not blood tests are the answer!

The latest research has shown that there is no relationship between blood levels of testosterone and the typical symptoms of testosterone deficiency. This is because, like insulin resistance in diabetes, there are varying degrees of testosterone resistance in each man causing a relative rather than absolute insufficiency of the hormone. This is why less than 5% of the men who could benefit from it are being given treatment. The symptoms give the diagnosis, and when testosterone replacement therapy (TRT) is given on this basis, they usually go away and stay away, whether you start with low or “normal” testosterone levels.  We optimize your hormonal levels. Doctors should be treating the patient and not the lab numbers.

Forms of testosterone therapy and what we offer

Injectables: the most common form for use in men. Levels tend to be more predictable, and most patients are compliant with this form. IM injection are commonly done on the outer thigh, shoulder area or buttock area while subcutaneous injections are most commonly done around the navel or love handle area.

Pros: can be weekly shot, twice weekly or “micro-dosing” on a daily basis; these can be intramuscular or subcutaneous (under the skin) injections. You decide.

Cons: your blood testosterone level rises quickly and then lowers back to baseline, giving you a roller-coaster effect that can affect your mood, but this effect can be avoided by dividing the dose in at least 2 or more injections per week. Intramuscular injections can be painful or cause discomfort for up to 48 hrs. after and long-term use may cause scar tissue. Subcutaneous injections are virtually painless but may cause some local redness and itching and a nodule or welt formation that may last 1 to 2 days. Injections can also increase the risk of skin infection though rare if using an alcohol wipe prior to the injection.

Creams or topicals: more common in women; most doctors assume women prefer creams over injections but as stated before, you the patient will decide.

Pros: no needles, syringes or alcohol supplies are needed. Unlikely risk of skin infections and applying a topical cream is painless. The concentrations of Bio-identical hormonal creams can be adjusted to the patient’s need but typically start at 10% concentration. Commercially available products such as Androgel, Axiron, Testim, or Fortesta concentration is usually set in stone from 1% to 2% with a mild increase in total testosterone levels. To be clear higher concentrated creams tend to have predictable levels and benefits as equal to intramuscular or subcutaneous injections.

Cons: Compliance for those who do not like applying creams on a daily basis can be an issue. Cross-contamination with other household members such as your spouse, children or even pets if they come in contact with residual amounts of testosterone cream on a daily basis may cause serious adverse effects. Typically, you should avoid skin to skin contact for at least 4 hrs. after applying cream. Some patients maybe sensitive to the ingredients found in creams and may cause localized skin irritation.

Where do I apply the cream? The best absorption and effect for topical hormonal therapy is usually the scrotal area in men and the vulvar area in women. Other areas such as the antecubital (inside part of the elbow) area, forearm, or inside of the upper arm the skin can be thicker, and results may vary.