JOHN'S TRUE STORY

Let us begin with a case illustration of a patient of mine whom I met approximately one year ago. John is a professor of biochemistry at a major university in Southern California. He was about 65 years of age at the time he came to my office for consultation. He began going downhill, according to him, at the age of 45. The first symptom he encountered was allergies to certain foods (such as milk). At age 55, he developed arrhythmia for which he consulted a cardiologist and was monitored and medicated. There was no cure and no cause given by the cardiologist for the arrhythmia. At about the same time he began gaining weight and feeling a loss of energy. He went to the highly-touted Scripps Institute in San Diego and spent three days in the hospital for an in depth work-up, but they found nothing of significance.

On discharge, they told him, "You are 56 years old and just aging a little faster than normal. That's life, that's the hand that's been dealt to you, so play with what you've got." This extensive and expensive work-up did not include checking testosterone level. At this point, he began to explore alternatives and visited an MD who did RAST allergy testing. That doctor told him that he is allergic to a number of foods and put John on a program of vitamins and minerals which in fact did provide some minimal benefit. Although moving in a positive direction, he was still not satisfied, and in his continuing research he soon discovered that the body's control and feedback mechanisms were controlled by the body's hormones.

He approached a professor of endocrinology at the University of Southern California and offered as much as $25,000.00 to conduct research in an attempt to balance all his hormones to the approximate level of a 25-year-old male. As John was trying to explain his ideas, it became apparent to him that the professor of endocrinology did not have a clue as to what he was talking about. In retrospect, John realized that the doctor, who was about his own age, did not appear to be that healthy and probably looked older than him.

It took John another six months before he found me, a physician who was willing to work with him to check out his hormones and to bring them up to the level of a 25-year-old. At that time, he found out that his total testosterone level was 51 pg/dl, when the normal range is somewhere between 250 to 1200. Keep in mind that when we say the normal range if 250-1200 pg/ml the ideal is not 250 pg/ml. The ideal is not the same as the normal, the ideal being optimally 750-1200. Additionally, although his thyroid function tests were normal, his body temperature upon awakening averaged between 96.2 to 96.4 degrees F. He was immediately started on a hormone replacement program consisting of testosterone injections , thyroid hormone (T3) and DHEA (dehydroepiandrosterone).

At age 65, John now feels great and is full of energy. He is able to work with absolute mental clarity, has no allergies and is enthusiastic about life. He says, "The best of all my libido has returned and I feel like a man again," but he cautions, "Make sure that your wife follows a hormone replacement program at the same time or else you will be sexually frustrated." Eventually he also notes that his arrhythmia had totally disappeared and he did not have to see his cardiologist any more.

A NEW PRODUCT -TRANSDERMAL TESTOSTERONE CREAM

To treat men , like John, suffering from a testosterone deficiency, we are using a new product-for delivering natural testosterone directly into the blood stream without pills or shots. Free testosterone (FREE T) is the active form of testosterone in the body. Follow-up monthly testing by monitoring saliva levels of FREE T has proven that all men are able to absorb testosterone through their scrotal or any non-genital skin.

In a 3 year study, monitoring patients' blood levels monthly for "active " testosterone, FREE T, preliminary data show the safety and effectiveness of the transdermal testosterone. All men are monitored to be certain that they are absorbing testosterone and maintaining physiologic levels. Once blood levels stabilize, we monitor hormones every three months. We also check blood/saliva levels of Estrone (E), dihydrotestosterone (DHT), FREE T, Lutenizing hormone(LH) and PSA.

WHY DO BODYBUILDERS ABUSE ANABOLICS?

The problems with abuse of anabolic steroids occur when the increased "sense of well-being" provided by testosterone in the brain makes some men think that "more is better". Some bodybuilders can actually develop total testoserone levels approaching 3000 pg/dl (normal testosterone levels are 270-1270 pg/dl) and become "manic". Bodybuilders use more hormone because they still want to get bigger. Once addiction or dependence occurs, and it does occur due to the endorphin stimulating effect of testosterone in the male brain, men cannot stop using these high doses. When they " cycle" or stop using hormones periodically, they begin to feel terrible (withdrawal) and return to abuse with higher doses immediately.

The endorphin release by high testosterones makes a man feel powerful and extra strong , but this gives a false sense of security. It is the "rush of endorphins" which can become addicting. It is up to the physician to monitor and control these potential abusers. Most men are happy merely to have defined powerful muscles, feel good, have lots of energy and a return or stimulation of their sex drive (Libido).

Our transdermal testosterone is safe and has not been found to cause unpleasant or dangerous side effects. Testosterone cream is only available from a compounding pharmacist by prescription.

HOW IS TESTOSTERONE SAFELY USED FOR TREATING AGING IN MEN?

There appears to be an increasing interest in the aging phenomenon of the male. For years, much has been written about the menopause of the aging female which occurs around the late forties and early fifties. However, research has recently begun to focus on the "male menopause" called Andropause. This name is not really accurate since there is no "sudden cessation" or pause of hormones as occurs with females. When the female menopause occurs there is a physiologic change to announce its arrival, the loss of menstrual periods. In contrast, there is no obvious physiological event that takes place to warn a male when the Andropause has arrived. Also it arrives slowly and later in life ( between 55-65).

One must understand that when the Andropause occurs, the drastic drop of serum levels of free testosterone cause many physical changes and complaints . The rate of this drop is about 1.5 percent per year. While the total testosterone of a male does not drop drastically, the free testosterone, T free, which is the biological active part of the testosterone, does drop precipitously with aging. In fact, a significant drop in FREE T can occur as early as the late 30's in some gay men. Why this occurs is unknown at this time.

LOW TESTOSTERONE AND IMPOTENCE IN MEN

Research has suggested that when a man becomes impotent, he dies about 20 years earlier than he would if he were treated with hormone replacement. Impotence is an alarming signal, as all the other organs degenerate along with the degeneration of the male testes.

At 40 years of age, roughly 2 % of the male population has become impotent, at 50, approximately 5%, at age 60, 18%, at 70 years, 27% and at 80 years of age 75% of men are impotent. Once a man becomes impotent he loses his drive for life, has impaired erections, his muscles become thinner as his mental acuity fades. He frequently becomes depressed and has aches, pains and stiffness as well as decreased mobility. (Studies indicate that testosterone and DHEA are essential for normal joint lubrication). In some cases, there is excessive perspiration and "hot flashes" similar to menopause in a woman.

MONITORING TESTOSTERONE REPLACEMENT

Studies have shown that men with higher testosterone levels live longer, healthier and maintain a higher sexual potency. Recent studies also show that testosterone has the ability to stop the spread of breast cancer in females. Additionally, for many years research has shown that testosterone has a protective effect against autoimmune diseases, which is why lupus and rheumatoid arthritis occur more predominately in the female and are rarely found in the male population.

Although testosterone replacement is essential, one must treat it with caution as Dihydrotestosterone , DHT, (a metabolite of testosterone) has been blamed for accelerating prostate enlargement, male pattern baldness and even prostate cancer growth. Interestingly enought, in France a new treatment for prostate cancer and impotence uses a topical DHT gel.

Therefore, before a male patient is placed on testosterone, his physician should obtain a, DHT , FREE T and a total and a "free prostate specific antigen test" which is called a Free PSA test. The free PSA is a very sensitive indicator for the presence of prostate cancer . Should the patient have a PSA above 4 with a low % age of "free PSA", then there is an increased likelihood of prostate cancer. In these case testosterone replacement therapy is contraindicated. Physiologic doses (normal amounts) of testosterone replacement have absolutely no adverse side effect as proven during the development of Androderm® and Testoderm® which release about 5 mg. of free T daily. Testosterone does not cause prostate cancer but it can make it grow.

The best method of initiating testosterone replacement in the new millenium is via the transdermal method, using natural testosterone rather than synthetic testosterone. While synthetic testosterone (taken orally or by injection) for the most part causes hepatotoxicity or liver damage (their use is not recommended) natural transdermal testosterone is safe and effective. The natural testosterone can be delivered transdermally either in a gel or cream form as well as by a patch.

The latest research in balancing estrogen/progesterone/testosterone action and the consequences of DHT/testosterone ratio are presented at HormoneNews.com .

At Hormone News , you can find more detailed information about various hormones used in medical practice.