Testosterone Replacement and Andropause-Part 1 of 3

I am often asked about testosterone replacement options for men. With respect to testosterone, men want to know three things; first, how do I know if I need testosterone replacement therapy ; second, what is the best option for replacement and; third, is testosterone replacement safe? In this three part series I will address these questions.
So, how do you know if you need testosterone replacement? The first, obvious answer is in the form of a question “how are you feeling?” Signs and symptoms of low testosterone include:
decreased libido
decreased muscle mass
decreased strength
decreased stamina
deceased enjoyment in life
lack of energy
deterioration in the ability to play sports
depression and moodiness
Many men dismiss these symptoms as part of the natural aging process. Still others are embarrassed to talk about symptoms of low testosterone because they feel that they are somehow “less of a man”. It is important to note, that these symptoms are likely a result of a hormonal imbalance and can be easily fixed.
A second way to determine if you have low testosterone levels are by taking simple blood or saliva tests. If you get a blood or saliva test, ensure your physician orders a complete hormone panel. These should include total and free testosterone, estradiol, DHEA and cortisol. All of these tests are important because they tell us different aspects of your hormonal status.
Total testosterone is obvious; it tells us the total amount in your body. “Normal” blood levels are between 250 and 850 ng/dL. Many physicians are happy if your levels fall within the “normal” range. The fact is, some men require more testosterone to feel good than the minimum “normal”. I’ve had men come in to talk with me with levels of 300 ng/dL who felt terrible, but whose physicians refused to treat because their levels were “normal”. If your total levels fall within the “normal” range but you are still symptomatic, it is likely that you require more testosterone than “normal” for other men.
Free testosterone is important because only the free, or unbound, testosterone is available to work at the receptors on the cells. You may have adequate total testosterone, but also have excessive sex hormone binding globulin which binds up the testosterone and keeps it from working in the body.
Some men convert large amounts of their testosterone to estradiol thereby obviating the need for estradiol testing. The conversion of testosterone to estradiol is catalyzed by an enzyme called aromatase and tends to be higher in men with increased body fat or who consume excess amounts of alcohol. The good news is that we can shut this enzyme down with aromatase inhibitors such as Arimidex® (anastrazole) but we must know if estradiol is a problem in order to treat it.

The last two tests are DHEA and cortisol. If someone is stressed, their hormones are forced down the cortisol pathway. This leaves the “sex hormone” part of the cascade undersupported. DHEA is the immediate precursor to androstenedione which is an immediate precursor to testosterone. If DHEA levels are low, sometimes we can fix low testosterone levels with simple DHEA supplementation.
This is part 1 of a 3 part discussion, stay tuned and give us your thoughts!
David Miller, RPh, PhD Owner and Chief Formulation Scientist

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