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 Important Note: Bio-Identical hormone replacement therapy is
for recognized medical conditions. Therapy is not
prescribed for those seeking increase athletic performance,
competitive or not. Therapy will only be prescribed to
those after the appropriate lab testing, coupled with a history and
physical that ascertains a medical condition exists. Acceptable
conditions include androgen deficiency, and menopausal / peri- menopausal
conditions. Those patients under current therapy with a
different provider will be required to have records faxed directly
to us for review prior to being considered as a new patient
.
Testosterone, if deficient, can be replaced in many
methods. Cream, gel, injections, pills, and pellets. Symptoms
of Testosterone Deficiency Fatigue Lack of stamina and energy Mental
Brain Fog Loss of lean muscle mass Increase body fat Loss of
sex drive Loss of a.m. erections Loss of erectile strength Loss
of interest in activities In fact, some physicians conclude that
the questionnaire for adult ADD looks a lot like that for
testosterone deficiency. Testing? After initial
blood testing, repeat testing occurs at 6 weeks, 6 months, and 12
months. Then twice a year from then on. We monitor standard blood
tests, Lipids, PSA, and hormone levels. If PSA is above
4ng/mL, or a follow up test shows a 2ng/mL change, then a urological
evaluation is dictated. Contraindications to Testosterone
Therapy This therapy is contraindicated with men that have
prostate carcinoma or carcinoma of the breast. Hormone
therapy is also not recommended in men with severe BPH-Benign
Prostatic Hypertrophy. Testosterone therapy is not
appropriate to enhance athletic performance. Testosterone
therapy is not recommended in those men that want to conceive in the
near future. Testosterone therapy can temporarily decrease
sperm counts, as well as cause a 20% decrease in the size of a
testicle.
Testosterone Replacement Methods
Creams and Gels This method comes in
pharmaceutical preparations or compounded preparations. While
easy and cost effective, some problems with maintaining proper
levels can occur utilizing testosterone creams. The skin and
subcutaneous fat has enzymes that break down testosterone as
it is absorbed. 5 alpha reductase converts testosterone into dihydrotestosterone
(5 DHT). Aromatase converts testosterone into estrogen. In
men, elevated levels of estradiol, and/or 5 DHT can cause
problems. Additionally, creams and gels need to be applied
daily. In women the sites need to be rotated as testosterone cream
in the same place can lead to hair growth in that area.
Intramuscular Injections Intramuscular injections
of testosterone bypasses the enzyme conversion in the skin, and can
decrease the aromatization into estrogen. Usually given in 1-3
week intervals, injections initially give a peak level that
gradually dissipates and sometimes returns the patients testosterone
level to below normal levels. Because hormone levels are
regulated by the brain through feedback loops, the injected
testosterone signals the testicles to quit producing what ever
amount they are naturally. In an a testosterone deficient
male, this is usually a low level of production from the testicles,
but supplementing through injection can lower that even more. So
once the injected testosterone is metabolized, the normal body
levels drop even lower. Additionally, the serum testosterone
bioavailability curve looks more like a line of peaks and
valleys. While this method is better for maintaining testosterone
levels than creams, it is not problem free.
Testosterone Pellets Testosterone pellets
insertion using the SottoPelle technique, provides the best option
of maintaining physiologically similar testosterone levels.
The heat fused pellets are placed in the subcutaneous tissue,
several inches below the belt line in the buttocks. Using a small
surgical instrument and local anesthetic, the pellets are places
every 4-6 months. The pellets provide a good supply of
testosterone, and if demand increase because of increase activity,
the resulting increase in blood flow increases testosterone
absorption.
Additional Issue with Testosterone Replacement /
Supplementation Testosterone supplementation requires
monitoring with lab work. In the first year you usually have
blood labs drawn 3-4 times. Initially, prior to first visit to
determine if there is a deficiency, then at 6 weeks post therapy,
again at 3 months, 6 months, and 12 months. After the first year, if
your history, physical, and labs remain normal, then lab work is
done every 6 months. It is important to make sure your
physician doesn't just monitor your testosterone levels.
Intermittent lab test should look at estradiol levels, as well as
PSA, and Hemoglobin/Hematocrit levels.
Important Note: Testosterone replacement therapy is
for recognized medical conditions. Testosterone therapy is not
prescribed for those seeking increase athletic performance,
competitive or not. Testosterone therapy will only be prescribed to
those after the appropriate lab testing, coupled with a history and
physical that ascertains a medical condition exists. Acceptable
conditions include androgen deficiency.
Articles
The August 2006 issue of Circulation
magazine— “Anabolic Deficiency in Men with Chronic Heart
Failure/Prevalence and Detrimental Impact on Survival.”
The studied looked at four variables in men with
CHF (congestive heart failure) : (1) circulating total
testosterone ; (2) free testosterone; (3) DHEA; and (4) insulin-like
growth factor-1 (IGF-1).
They concluded men:
- Men with CHF had
hormone deficiencies in all four categories, most averaged out
in the lower 10th percentile of their peers.
- Survival rates of men with CHF and
a hormone deficiency in one of these categories showed a 74%
three-year survival rate. Those having deficiencies in two had a
55% three-year survival rate; and those with
deficiencies in all three had a 27% three-year survival rate.
- Men with CHF but no
deficiencies in any of the four hormone classes had the best
three-year survival rate at 83%.
LOW
TESTOSTERONE LEVELS ASSOCIATED WITH INCREASED RISK OF DEATH IN MEN
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 the Archives of Internal Medicine.
- Low testosterone correlated with higher
mortality rates
........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
...................... 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. "Large
prospective studies are needed to clarify the association between
low testosterone levels and mortality."
(Arch
Intern Med. 2006;166:1660-1665
Study Finds No Direct Links Between
Testosterone Therapy, Diseases
A retrospective analysis by researchers at
Beth Israel Deaconess Medical Center published in The New England
Journal of Medicine found no causal relationship between
testosterone replacement and prostate cancer or heart disease risk
1/28/2004
Low testosterone level is an independent
determinant of endothelial dysfunction in men.
Hypertens
Res. 2007 Nov;30(11):1029-34
PMID: 18250551
Dr. Fox serves patients needing testosterone supplementation or
bio-identical hormones therapy from Seattle, Bellevue, Redmond,
Kirkland, Bellingham, Tacoma, Olympia, Puyallup, Medina, Auburn,
Kent, Des Moines, Alaska, Spokane, and Idaho.
SottoPelle ® Hormone Pellet Insertion
Serving the Greater Puget Sound Area
Weight loss, Stop Smoking, Hormone Program
Seattle, Tacoma, Federal Way, Olympia, Bellevue, Kirkland, Redmond,
Puyallup, Testosterone, Estrogen, Deficiency, Menstrual Migraines,
Fibromyalgia, Lipodissolve, Mesotherapy, Fat Injection, MIC
Injection, Endometriosis Non Surgical Therapy
SottoPelle ®Therapy in
the Seattle Tacoma area please sign up for our email newsletter
Phone 253-517-8846
Copyright © 2007 Dr. Scott Fox
Information on this site is meant for patients of Fox West Medical
& Aesthetics Only
* These statements have not been evaluated by the FDA. These
products are not intended to diagnose, treat, cure, or prevent any disease.
Contact your primary care provider prior to adding, changing, or
stopping any medications you may be taking, or adding any
supplements to the medications you take. A thorough discussion with
your primary care physician is imperative prior to any changes in
medications or supplements.
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