Is Testosterone Therapy for Many Different Conditions?
By Abraham Kryger, MD, DMD (May 27, 2017)
While many men and yours truly have always been strongly interested in slowing aging and longevity, modern medicine, for the most part, has been slow to deliver any effective products. Bones, skin and hair still become more brittle every day as hormone levels drop with time, older men go gray, lose muscle mass, and gain more fat around their bellies. Overall energy and libido continue to decline at a relatively fast pace after age 50 for all of us. While average life expectancies have increased, up to 78 for men, and more people are living longer, we are not necessarily living better.
Some anti-aging researchers have claimed that natural testosterone supplement therapy can effectively "slow the hands of time". They theorize that by enabling the body to restore its hormone dependent tissues to more youthful levels, without the well-known negative side effects, skin delivery testosterone offers significant advantages over injectables. With fewer side effects than the synthetic esters of testosterone, efficient delivery through skin absorption is superior to oral delivery for several reasons, but particularly because oral and injectable testosterone delivery can cause serious liver damage.
Some physicians believe that Andropause, the so-called male equivalent of female menopause, really exists. The American government took a look at this question in late 2009. They recruited men over the age of 65 to determine whether low testosterone (T) lead to certain aging associated diseases. The specific aims of this study were to test the theory that transdermal testosterone treatment, using Androgel 1% gel, in elderly men with low serum testosterone, improved certain conditions. These men all had symptoms plus objectively measured abnormalities in at least one of five areas related to low testosterone: physical or sexual function, vitality, cognition, and anemia. The trials would determine if more favorable changes occur in those with a placebo treatment. (1)
So what did the researchers discovered thus far? To begin with, let’s see what they were looking at: “As men get older, they experience many conditions, often together, that eventually result in the inability to perform many activities of daily living, an increased propensity to fall, and decreased independence. These conditions include decreased mobility, disability and low vitality.” These are changes that take place in many aging men and some women that result directly from the study purpose.
Furthermore, “Elderly men also experience increased anemia, metabolic syndrome, decreased sexual function and memory impairment. These conditions likely have multiple causes, but one cause that could contribute to all of them was a low serum testosterone concentration. When young hypogonadal men are treated with testosterone, they experience improvements in sexual function, muscle mass and strength, bone mineral density and a sense of well-being. However, the benefits of testosterone therapy in older men with age-related decline in testosterone concentration are not known and were the subject of this investigation.” (2)
Which diseases could be affected in Andropause? Although the threshold for treatment seems to vary greatly and the guidelines change for different age groups, nonetheless there are multiple conditions associated with low T. According to Dr. B.B. Yeap and his colleagues at the University of Western Australia, total testosterone remains stable while free T drops in men over 70. (3)In the T trials, researchers were using a concentration of testosterone that is too low to result in observable changes. The dilemma was that the researchers were using only 75 mg of a one percent testosterone gel, Androgel®. Because low potency T-gels work best if a man uses a large quantity on a daily basis, absorption was poor. With an absorption of approximately 10 percent, these gels would deliver a portion of the normal testicular production for most men i.e. 5 to 15 mg/day. In this case about 7.5 mg/day.
Thus the study may have been doomed from the start by providing ineffective therapy, while only measuring total testosterone, therefore resulting in another failed trial. The T trials did not prove that aging men should be treated for low testosterone. The effects were minimal and the condition known as hypogonadism, failed to show a response in two years of testing.
In the Massachusetts Male Aging Study Andre Gay, MD, Harvard Andrologist, reported that, “Over 39 percent of men older than age 45 years, who are seen for primary care medical appointments, experience hypogonadism.” (4) Low T is still a serious problem for almost 13 million men in the US and possibly hundreds more worldwide.
Endocrinologists know that the age-related decline of testosterone definitely affects muscle mass and strength, bone mineral density, sexual performance, hair growth, skin thickness, lean body mass, moods, and memory. Doctors who are familiar with the treatment of these conditions know that sometimes cognitive impairment can be reversed through T replacement therapy. (5)
Testosterone replacement therapy (TRT) guidelines were first introduced back in 1996 by the AACE (American Association of Clinical Endocrinologists). Along with its prior use as a treatment for sexual dysfunction, anemia and osteoporosis, new applications were mentioned in this pamphlet. Testosterone levels were also found to be very low in HIV, AIDS or cancer wasting syndrome. In addition low T is linked to the following conditions: (5)
Chronic Opioid use 40%
Metabolic Syndrome 50%
Chronic Kidney Disease 40-50%
Erectile Dysfunction 30-40%
Low Libido- 60%
Cardiovascular and Respiratory Disease 15-25%
Andropause, retitled as Androgen Deficiency in Aging Males (ADAM) has the potential to become the new name of a future age- related testosterone deficiency condition.
After 17 years of treatment "andropause", might be "rediscovered" as a condition for which there are now safe, existing therapies. The many transdermal forms of T delivery, used in place of injections, have been incorporated into patches, gels, nasal sprays and underarm solution plus compounded creams. (6)
Today male hormone replacement therapy has become more widespread in other countries like Australia and Europe rather than in America, and there is still some reluctance on the part of most primary care physicians to diagnose or treat it. A recent online physician survey estimates that ninety percent of physicians are not aware of the Andropause diagnosis nor do they feel comfortable with the treatment of hypogonadism or “low T”.
They simply don’t believe the condition exists. How or when to treat has become quite a problem for many physicians. Since the majority of doctors are unwilling or not comfortable with TRT, less than 10 percent are willing to prescribe testosterone products. Without more certified medical education or CME programs about hypogonadism and treatment, there is little hope for the millions of baby boomers who could develop serious degree of hypogonadism over the next few decades. (7)
New T products were emerging on an annual basis, but although they were made for males, some are basically only strong enough for females. Yes, females too sometimes need TRT as they age, but there is no product available. About 3 percent is the highest potency transdermal testosterone product available. Perhaps the major problem with rubbing T gels all over your skin is the transference issue.
Transference occurs when a woman or child is exposed to the residual amounts of testosterone on a man’s shoulders, thighs, armpits and arms after applying a gel. Alcohol, which holds the testosterone in suspension, once evaporated leaves a fine residue of powder on the skin. The manufacturers recommend that men should wear T-shirts when having sex to prevent transference or use a nasal or buccal patch.
Testosterone is critical for most of the male abilities possessed by younger men. TRT can restore cognitive function, libido, spontaneous erections and energy, at the same time creating a wonderful sense of well-being.Testosterone may also help to improve sleep and dreaming for men with hypogonadism, diabetes, metabolic syndrome, obesity, erectile dysfunction and even heart failure.
The apparent benefits of testosterone therapy in heart conditions could be related to increased cardiac output, increased muscle mass, anti- inflammatory and immunosuppressive effects, a rise in hemoglobin, and enhanced baroreceptor sensitivity, "Which has the potential to improve muscle sympathetic nerve activity with concomitant increased muscle arteriole vasodilation and function," according to a Harvard physician who reviewed these studies. “The percentage of patients who improved at least on New York Heart Association class was greater with testosterone (35% versus placebo at 9.8%, P=0.003)”. (8)
Yet recently studies have emerged that indicate super high levels of testosterone may increase heart failure and heart attacks in older men who already have heart disease. The VA trials used injectable, synthetic testosterone products, which routinely result in supraphysiologic levels, leading to excess estrogen, high cholesterol and thickening of the blood.
In my forty-five years of medical practice and the treatment of thousands of men using a compounded, higher potency, 5 to 10 percent testosterone, I have not found any increase in heart disease or increased risk of cancer. Generally my patients are happy, motivated and feel more like themselves again, while noticing a reversal in many of the “low T” problems plaguing them for decades once their testosterone levels fell below normal.
To hear their stories and to help you understand how testosterone works in the male body, read, "Listen To Your Hormones, A Doctor’s Guide to Sex, Love and Long Life." Paperback and audiobook (MP3 CD) versions of this book are available here in our online health store.
Thank you for your interest.
- Abraham Kryger, MD, DMD, CEO Testocreme® Inc.
3. Yeap, BB, et al. In men older than 70 years, total testosterone remains stable while free testosterone declines with age. The Health In Men Study. Eur J Endocrinol 2007; 156: 585-594.
4. Feldman HA, et al. Age trends in the level of serum testosterone and other hormones in middle-aged men: longitudinal results from the Massachusetts Male Aging Study. J Clin Endocrinol Metab 2002; 87: 589-598.
5. Yeap, BB, Are Declining Testosterone Levels A Major Risk Factor for Ill Health in Aging Men? Int J Impot Res. 2009;21(1):24-36. © 2009 Nature Publishing Group http://www.medscape.com/viewarticle/586876_print
6. Swerdloff RS, Wang C. Androgens and the ageing male. Best Pract Res Clin Endocrinol Metab 2004; 18:349-362.
7. More information on Male Hypogonadism at: http://www.medscape.org/viewarticle/755954.
8. Neale, T. Testosterone May Have Benefit in Heart Failure. MedPage Today Published: April 17, 2012 Reviewed by Dori F. Za http://www.medpagetoday.com/Cardiology/CHF/32222