Sunday, September 26, 2010
Bioidentical Hormone Replacement Therapy (BHRT) – Testosterone
recent years, testosterone replacement therapy has gained in popularity
amongst andropausal men to improve their sexual function, sense of well
being, muscle and bone mass and strength. In addition, it has also been found to be beneficial in preventing heart disease, diabetes, and Alzheimers Disease. There
is a growing trend over the last decade for both men and women opting
for the use of bioidentical, natural hormones for the treatment of
andropause and menopause, respectively. The trend away
from the use of conventional synthetic hormones towards bioidentical
hormones has been driven by several factors including a global trend
towards everything “natural” as seen in the increased interest in
organic foods and complementary and alternative medicine (CAM).
The testosterone used in BHRT is identical to that produced in the male human body. Although
bioidentical hormones have long been utilized in other countries, the
United States has predominantly used synthetic hormones for the past
40-50 years beginning with the introduction of oral contraceptives in
the early 1960s.
men start with BHRT, laboratory tests are necessary to determine if
there is a physiological need for testosterone replacement. Both free and total testosterone are measured, along with DHT and SHBG. If free and total testosterone levels come back within normal limits, BHRT may not be necessary. However,
if a man is experiencing symptoms of andropause and has lowered levels
of testosterone, it may be necessary to start on BHRT.
Prostate Specific Antigen (PSA) will also be run before beginning BHRT
to determine if there is a risk for developing prostate cancer while
supplementing with testosterone. There are mixed opinions in the medical field regarding the use of BHRT and its relationship to developing prostate cancer. Some
experts believe that there is a stronger risk of developing prostate
cancer while using testosterone, while others agree that testosterone
does not cause prostate cancer. Clinical trials have
demonstrated the latter, showing that PSA, the laboratory value most
indicative of a potential cancerous lesion of the prostate, does not
rise over 3-5 years of use of testosterone replacement therapy. These
same researchers showed that prostate cancer seems to develop most
commonly in older men when their testosterone levels are actually lowest
versus highest. Despite the evidence suggesting that
testosterone replacement therapy does not increase the risk of
developing prostate cancer, BHRT should not be started on men who have a
personal history of prostate cancer.
methods of administration of BHRT of testosterone include oral
administration, application of a transdermal patch, intramuscular
injections, and the implantation of pellets containing testosterone
under the skin of the buttocks. Oral testosterone is the most unfavorable method of administration, as it is poorly absorbed by the body. Most
of the oral testosterone is carried from the intestines to the liver by
the portal vein where the liver inactivates a sizeable portion of the
hormone. An oral micronized form of testosterone suspended
in oil can also be used which is slightly better than the
non-micronized form, however it is still poorly absorbed when compared
to the other routes of administration.
are usually given as a shot into the muscle of the buttocks and are
usually given at 2-4 week intervals. This seems to be the most favorable method of application of testosterone as it relatively painless, of higher compliance on therapy and less messy than creams. The number of injections is
variable and depends on how depleted testosterone levels are in an
andropausal man. The side effects are minimal and usually include swelling at the injection site. Blood tests are run at 3 month intervals to monitor patients on therapy.
Testosterone cream or gels . These work best if applied daily on a particular schedule and are applied to
the thin skin of certain areas of the body, including the thighs or the
back, where absorption is best. Creams are absorbed directly into the bloodstream. In addition, they seem to mimic the natural rhythm of testosterone secretion that occurs the human body throughout the day. The
male body produces the most testosterone during the nighttime during
sleep, which is why men so often wake with erections in the morning. By applying cream just before bedtime a similar effect can be achieved.
Potential side effects can include those listed as above for the individual methods of administration. Other side effects can include a rise in hematocrit, the proportion of blood volume that is occupied by red blood cells. Therefore, BHRT is contraindicated in individuals with high hematocrit levels. The rise in hematocrit is less commonly seen with the transdermal (cream/gel) form of administration. It has also been shown that BHRT can cause sleep apnea in younger patients and less frequently in older patients. This is due to the direct effect on laryngeal muscles. Rarely, testosterone can cause breast enlargement in males, called gynecomastia. This
is due to the fact that testosterone can be converted into estrogen
which leads to breast enlargement if in excess in males. One of the main complications of BHRT is the possibility of sterility following treatment. This is because sperm production and hormone production by the hypothalamus can be inhibited once starting on BHRT. It should be discussed with your doctor if you plan on retaining the option of fatherhood because of this potential side effect.
are many herbs and plants that have been researched and documented
clinically that show beneficial effects in improving symptoms associated
with andropause. The following is a list of some of the herbs that have been shown to be effective:
· Yohimbe (Pausinystalia yohimbe) – This herb is a well documented remedy for male impotence and lack of libido. Yohimbe
works by increasing the amount of blood that flows into the penis and
prevents blood from flowing out of the penis, thereby causing and
helping to maintain an erection. It may also stimulate areas of the brain involved in sexual desire. It has also been indicated for depression, although at very high doses, which has been found to be unsafe. Because
yohimbe works on blood vessels and the brain, it can cause dizziness,
nausea, insomnia, anxiety, rapid heartbeat and increased blood pressure
as potential side effects. It is good to be monitored while taking this herb, so talk to you doctor before starting to take this herb.
· Tribulus terrestris
– Tribulus is an herb that has been used for thousands of years by
Chinese herbalists and in Aruvedic medicine to increase testosterone
levels through the stimulation of precursor hormones in the brain. It has been used to boost libido and raise fertility in men with low testosterone. Potential side effects are minimal but can include upset stomach and gynecomastia, or the enlargement of breasts in men.
· Saw Palmetto (Serenoa repens) – This herb is the most effective and well-researched natural remedy for BPH. It
has been shown that saw palmetto is just as effective as Proscar in men
with both mildly and severely enlarged prostate glands with mild to
severe symptoms of BPH. This herb also has many less side effects than medications used to treat BPH and has a wide array of mechanisms of action. It
helps to relieve urinary urgency, inhibits binding of DHT to androgen
receptors in the prostate gland and exhibits mild 5 alpha-reductase
activity. A study by Carraro JC et al (1996) concluded
that saw palmetto does not have an effect on the actual size of the
prostate, nor does it change serum PSA levels.
· Stinging Nettles Root (Urtica dioica)
– Androgens such as testosterone and estrogen bind to sex hormone
binding globulin (SHBG) and cause cell proliferation, leading to BPH and
potentially prostate cancer. Andropause causes men’s SHBG levels to increase making him more susceptible to abnormal cell growth. The
chemical constituents of Nettles root are able to bind to SHBG limiting
the amount of testosterone and estrogen that can bind to it and
influence cell proliferation. It has been shown that
Nettles improves urinary flow, the amount of urine left in the bladder
after urination, and decreases SHBG levels in blood.
· Pygeum (Pygeum africanum)
– Pygeum is a plant that has been used frequently for both its affinity
for the genito-urinary tract and for its role in boosting a man’s
libido. By reducing the abnormally high levels of
prostaglandins found in men with BPH, this herb helps to reduce
frequency of urination, especially at night, dribbling and decreased
stream of urine flow, and feelings of bladder fullness.
A healthy diet with a concentration on whole foods is key to achieving good hormone balance and vitality. A
large proportion of the diet should be comprised of lots of leafy
greens and other fruits and vegetables along with adequate protein
sources, healthy oils and whole grains. Foods that impair
hormone balance include harmful fats found in margarines and refined
vegetable oils, packaged foods containing hydrogenated or partially
hydrogenated fats and refined sugars found in most foods like bread and
pasta. Organic foods, especially vegetables, fruits, beef,
poultry and fish, should be eaten as frequently as possible as
non-organic food sources often contain pesticides and herbicides that
can have estrogen-like effects on the body and disrupt hormone balance. Milk
and dairy products should be consumed in moderation as they also have
been found to contain hormonal residues that disrupt normal hormonal
biochemistry as well.
there are many vitamins and nutrients that are very important for
adequate hormonal functioning, specific nutrients have been researched
and found to be beneficial for men’s health and for counteracting the
effects of andropause. A few of these nutrients are listed below, although this list is not all-inclusive. Your
naturopathic doctor can discuss what other vitamins, minerals and
co-factors are important for you to take to assist you with your
· Essential Fatty Acids – There is a group of fats that the body is incapable of synthesizing on its own known as “essential fatty acids” (EFAs). They include omega 3 (linolenic) and omega 6 (linoleic) fatty acids. EFAs
are required constituents of every cell membrane in the body and are
required to maintain the fluidity of these membranes, aid in producing
and balancing hormones and play an essential role in managing
inflammation. Classic signs of deficiency include
depression, mood disorders, memory loss, hyperactivity, anxiety, dry
flaking skin, inflammation, arthritis, decreased bone density, muscle
spasm, food allergies, fatigue, increased body fat and most important to
our discussion, hormonal imbalance. Prostate health is also directly tied to adequate essential fatty acid intake and levels in the body. A
group of researchers recently found that men with Benign Prostatic
Hyperplasia (BPH) have less omega 3 fatty acids in their serum and
prostate cancer patients have substantially less omega 3 fatty acids
compared to men without BPH or prostate cancer.
· Zinc – The prostate gland has a unique characteristic of storing high levels of zinc. Healthy prostate tissue contains higher concentrations of zinc than all other tissue in the human body. Therefore,
it is no coincidence that the level of zinc in the prostate gland
declines dramatically in patients with BPH and even more so in patients
with prostate cancer.
· L-Arginine – L-Arginine
is an essential amino acid that can be very effective for erectile
dysfunction that can help to produce harder and longer-lasting erections
and increasing libido. Supplementation with arginine has also been shown to improve low sperm counts and male infertility. Arginine promote the production of nitric oxide, a substance that opens up blood vessels in the penis much like the drug Viagra. But unlike Viagra, arginine is free of side effects like Viagra and is relatively inexpensive. Arginine also helps to stimulate the release of growth hormone which also acts to stimulate sex drive. For men, losing muscle mass and gaining more fat mass during andropause can be very frustrating. Arginine, along with a healthy exercise regimen can help to increase muscle mass and decrease fat mass.
is the oldest form of medicine, dating back thousands of years. It is
an energy-based medicine which acknowledges the existence of unseen
electrical energy in the body which flows in documented patterns and
pathways. Disease occurs when there is an imbalance or blockage of
energy. Acupuncture is used to treat many conditions
ranging from pain relief to chronic disease, to addictions (e.g. smoking
cessation). More importantly acupuncture is a great
treatment modality to use in conjunction with the aforementioned
therapies to treat hormonal imbalances and fertility problems in men,
combat aging and stress and assist with insomnia, depression and pain.