| Prescribe
Testocreme |
 |
What hormones should
be monitored in male patients receiving
replacement therapy?
We
recommend measuring the following:
Serum: Free and Total
Testosterone (FT andTT),
5-Dihydrotestosterone (DHT), Sex Hormone
Binding Globulin (SHBG), Estrone and
Estradiol (E1 and E2), DHEA, and Prostate
Specific Antigen (PSA).
Saliva: FT, DHT, E2,
Cortisol, Progesterone.
Why monitor free
testosterone as well as total
testosterone? Why
use Saliva?
Free testosterone (FT) is a
measurement of the biologically active
unbound testosterone which decreases with
age and is a market
for erectile dysfunction. FT is measured
easily in saliva and tends to be much
more accurate than serum levels. Total
testosterone does not decrease much with
age. Measuring total testosterone does
not measure the amount of biologically
active testosterone or Bioactive T (
BioT) that is available or achieved
therapeutically as free testosterone
measurement in saliva does.
If free testosterone is
within the therapeutically desired range,
all is
well. However, if free testosterone is
low, measurement of Sex Hormone Binding
Globulin(SHBG) is important to get a
better assessment of Bioactive T ( BT),
BT =TT-FT+SHBG (see Why measure Sex
Hormone Binding Globulin? )
Why monitor
5-dihydrotestosterone(DHT)? Saliva
measure?
Over 95% of
dihydrotestosterone is produced in the
peripheral
tissues from testosterone by the action
of 5 alpha reductase ( 5AR)..
Therefore 5-dihydrotestosterone should be
measured in all males receiving
testosterone therapy. Free DHT , in
saliva, is responsible for libido and
anabolic effects of T. There are two
types of 5AR which convert T to DHT.
The salivary or skin 5 AR-1
produces DHT in saliva by gingival
fibroblasts. The 5AR-2 in serum produces
DHT which resides mainly in the prostate.
Unfortunately DHT also produces cell
growth and the potential of prostate
hypertrophy and even prosthetic carcinoma
in some patients when excess
5-dihydrotestosterone is produced. The
DHT/T ratio provides an indication of 5
AR activity.
Dihydrotestosterone is more
potent as an androgen than testosterone
with anabolic/androgenic ratio of about
4/1 and blood levels must be kept within
the normals for age. If DHT levels are
high, testosterone therapy should be
reduced or suspended or an anti-androgen
such as progestorone ( P4) should be
added.
Why monitor Estrone?
Estrone is the principal
estrogen found in both the postmenopausal
woman and the aged male. The increase in
estrone is due to the increased
conversion of androstenedione and T to
estrone ( E1). There is evidence that
high E1 levels may indicate increased
tendency to cancer cell growth.
Androstenedione (A) is a metabolic
product of DHEA, and is a major source of
E2 and E1 in women; therefore patients
receiving DHEA should be monitored by
saliva for increases in estrone to
supra-physiological levels.
Why measure Sex
Hormone Binding Globulin (SHBG)?
Sex Hormone Binding Globulin
(SHBG) increases with age due to
increased estrogen production. Therefore,
it is important to monitor
males receiving testosterone replacement
therapy. If the synthesis
rate of SHBG is high, more testosterone
will be bound by SHBG and consequently
free testosterone levels will be low, but
the total testosterone levels will be
unchanged. Giving more testosterone
therapeutically will not increase the
free testosterone blood levels. A high
free testosterone blood level and a low
SHBG is an indication of other problems
such as liver disease or nutritional
deficiency such as Zinc (these result in
a low SHBG). In this case, testosterone
therapy should be reduced.
Why monitor DHEA?
DHEA & DHEA-S:
Dehydroepiandrosterone, the principal
adrenal
androgen, and its sulphonated ester
DHEA-S, decrease with age in the male. In
addition to its androgenic function, DHEA
has been reported to have multitudinous
other functions e.g. on carbohydrate
metabolism, neurological function, and
general mental well being. Both DHEA and
DHEA-S are interchangeable and both are
metabolized to testosterone via
androstenedione. DHEA levels should be
monitored because it is a potential
source of additional testosterone and it
is currently available as an over the
counter preparation that many patients
may be taking without informing their
physician.
Why Monitor
Prosthetic Specific Antigen (PSA)?
Any male over 50 years
should have prosthetic specific antigen
levels performed annually. This is even
more important for males receiving
testosterone replacement therapy. TOTAL
PSA gives a crude idea of prostate volume
but increased levels of Free PSA ( fPSA)
indicate possible prostate cancer.
Disclaimer | Privacy Statement | Physician's
Info | Men | Women | Athletes | What is TestoCreme? | How
do I get it? | Research | Testimonials | Home
|
