Hormone therapy for men - health and longevity

Hormone replacement therapy for men (HRT) is pharmacological compensation for the lack of own hormones . For this purpose, both medications and herbal analogues are used. The lack of testosterone is most significant for men - it negatively affects health at any age, reduces emotional, physical, sexual activity, and disrupts mineral and carbohydrate metabolic processes. Hormone replacement therapy (HRT) in most cases significantly improves the quality of life, provided that the drugs are properly selected .

Why is there a need for hormonal (hormone replacement) therapy?

The content of the article

Hormones are biologically active substances secreted by cells located on the surface of the endocrine glands. Hormones themselves are not active until they meet target cells. The interaction of substances occurs due to blood flow.

Hormones interact with each other, their concentrations are interrelated, so problems in the production of some hormones lead to disruptions in the production of others. Thus, with diseases of the pituitary gland, there is a failure in the production of stimulating hormones, resulting in insufficient production of sex hormones. The entire hormonal system is in homeostasis, a state of self-regulation to maintain hormonal balance.

With age, for various reasons, some hormones begin to be released beyond normal limits, which leads to a significant deterioration in well-being and a decrease in quality of life. Both low and high levels of hormones are dangerous for men.

For men, the situation is aggravated by the fact that 60-65% of them are smokers, while 20% started smoking in adolescence. 19-26% of the population abuses alcohol. Smoking and alcohol have a direct effect on hormonal levels because they inhibit the functioning of the pituitary gland, which produces vital hormones.

Based on the fact that men are more prone to drinking alcohol and smoking tobacco, age-related hormonal disorders occur earlier in them and are more severe than in women. The first symptoms of androgen deficiency (lack of male sex hormones) are observed already at the age of 35 and even earlier, and already at the age of 40, against the background of hormonal imbalance, chronic diseases develop (atherosclerosis, arterial hypertension, type 2 diabetes mellitus).

The only way to normalize the balance of hormones is hormone replacement therapy, carried out strictly under the supervision of an endocrinologist. Self-medication poses a deadly threat because excess androgens lead to the development of malignant prostate tumors. Hormone therapy is prescribed solely on the basis of blood tests for hormones in accordance with the patient’s well-being.

At first, the patient is regularly observed by an endocrinologist and undergoes tests. Only if the prescribed medications have a positive effect - normalization of hormonal levels and improvement of well-being - will the doctor prescribe medications that the man can take for a long time.

The effectiveness of hormone therapy depends on the patient's age. The sooner a man seeks help, the more effective the treatment will be. A 60-year-old man with obvious androgynous changes will have a much longer and harder recovery than a 42-year-old patient who experienced the first signs of hormone deficiency.

Timely prescribed hormone therapy improves the quality and length of life, preventing the most common dangers of androgen deficiency - myocardial infarction, stroke, coronary heart disease, angina pectoris, tachycardia, diabetes mellitus, prostate tumors.

Potential side effects of HRT

Several bad things can happen during HRT. One of them threatens you only if you are diagnosed with prostate cancer before starting treatment.

There is a remarkable lack of any evidence that HRT causes prostate cancer, even after experts carefully reviewed thousands of studies and case reports. But for some reasons still unknown to us, hormone replacement therapy tends to aggravate the condition of those suffering from this disease. Therefore, it is necessary to undergo an annual digital rectal examination while continuing to monitor prostate-specific antigen (PSA) levels.

HRT can also lead to polycythemia (overproduction of red blood cells by the body). Instead of flowing freely through your veins, your blood thickens and moves in spurts, like soft-serve ice cream from a Dairy Queen machine. It is clear that because of this, heart attacks and strokes can occur when blood vessels are blocked by blood clots.

Therefore, you should monitor your hemoglobin and hematocrit. When hemoglobin is above 18.0, or hematocrit increases to 50.0, you should adjust your testosterone dosage, donate blood to the Red Cross, or undergo a procedure called therapeutic phlebotomy (routine bloodletting in a doctor's office).

What about gynecomastia and heart attacks?

The dreaded gynecomastia has never been observed in men undergoing testosterone hormone replacement therapy. Gynecomastia, or the growth of breast tissue in men, was diagnosed exclusively in those taking significant dosages of testosterone (1000-3000 mg per week) or its analogues. Hair loss is possible, but everything usually returns to normal by age 30. If you have reached your age without losing your hair, then it is highly doubtful that HRT will cause you to go bald.

Other popular horror stories about testosterone regarding heart attacks and other troubles are vile slander. On the contrary, men with low testosterone are more susceptible to a variety of ailments, including heart problems, diabetes, dementia and many other disorders typically associated with old age, death and frailty.

How to determine when hormone therapy is needed

40 years is a landmark age for both men and women. Although in representatives of the stronger sex the first signs of aging (internal) may appear much earlier, it all depends on the sexual constitution and lifestyle.

Signs of noticeable hormonal imbalance in a man:

obesity of the abdominal type (the stomach grows with relative thinness of the legs, arms and torso) with a decrease in the percentage of muscle mass;
depressive state (dissatisfaction with life, irritability, feeling of missed happiness, insolvency, unfulfillment in life for no apparent reason);
decreased libido, decreased sexual appetite, reluctance to have sexual intercourse;
loss of strength, desire to sleep and do nothing;
erectile disfunction;
high blood sugar;
high cholesterol;
swelling of the mammary glands.

Methods of administering androgens

In modern medical practice, androgens are administered in various ways. Each method is characterized by its own advantages and disadvantages, so the choice is always made on an individual basis, taking into account the man’s condition, concomitant diseases, clinical manifestations, and other factors.

Oral

Oral hormone replacement therapy for men involves the use of tablets/capsules orally. They contain the active ingredient in the required dosage. Tablets are the very first form of hormonal drugs.

Ease of use.
Possibility of urgent drug withdrawal.
Self-use without visiting a clinic.
Relatively low cost.

Important: tablets/capsules are effective only for mild androgen deficiency in the male body.

The tablet/capsule form is sold by prescription only. It is not recommended to buy online or in dubious stores, since this form of the drug is the easiest to counterfeit. The replacement process is carried out using the following medications:

Andriol. The dosage is 150-200 mg per day;
Striant is taken 30 mg three times a day;
Proviron. The dose varies depending on the level of androgens in the blood. Prescribe from 30 to 80 mg per day.

The tablets must be taken in the dosage prescribed by a medical specialist. During treatment, the concentration of hormones in the blood should be constantly monitored.

Injectable

According to many doctors, it is necessary to “replace hormones” by injection, since this is the only way testosterone enters the body smoothly and naturally. In most clinical scenarios, testosterone therapy uses cypionate and enanthate. Literally 100 mg of the drug provides a weekly supply of androgens for the male body. The dose is always individual - some men need less, others much more.

The weekly dose is divided into two applications and administered at equal intervals, which ensures a stable concentration of hormonal substances in the body. The following drugs are used:

Delasteril. The dose ranges from 200 to 400 mg.
Nebido. Administer once every three months.
Sustanol. 250 mg is administered once every 1-2 weeks.

Fact: among all hormonal medications, Nebido is characterized by the most prolonged effect - one injection every 90 days and a minimal list of side effects.

The advantages of injection include the ability to create a high concentration of hormones in the blood; a wide range of new generation drugs.

Transdermal

There are other ways to “replace” the hormone in men. For this purpose, patches, creams and gels are used. Local agents ensure a gradual entry of the active component into the male body, which reduces the risk of side effects. However, according to medical experts, the therapeutic effectiveness of this method is the lowest.

HRT in men using the transdermal method is carried out using the following drugs:

Androderm or Testoderm - patches. Used every day in a maximum dose of 7.5 mg of a hormonal substance;
Andromene is a hormonal cream. The daily dosage is 15 mg;
Andractim is a medicine in the form of a gel; the dose is always determined individually.

During hormone therapy using gels and creams, you should not swim after applying medications. It is strictly forbidden for women and children to touch the treated area of skin, as this poses a health hazard. A significant disadvantage is that it must be applied several times a day, which significantly reduces the quality of life and the usual way of life.

Subcutaneous

Subcutaneous hormone therapy involves the use of an implant. The method is quite effective, but testosterone implants are not registered in Russia, which prevents many representatives of the stronger sex from using this option.

How testosterone replacement drugs work

Testosterone is the main male hormone. It is also found in the body of representatives of the fair half of humanity, but in much smaller doses.

In men, testosterone is produced by the testes under the influence of hormones produced by the pituitary gland, and in smaller quantities by the adrenal glands. The normal testosterone level is 12.5-40.6 nmol/l. This level is sufficient for the normal functioning of the prostate gland, ovaries, maintaining and increasing muscle mass, lowering cholesterol levels, maintaining an erection, etc.

Due to illness or age-related changes, the amount of testosterone in the blood decreases. This leads to a deterioration in health and the development of various diseases.

The first synthetic analogues of testosterone went on sale in the USSR countries in the 80s of the 20th century. The drugs were used not only for therapeutic purposes, but also in the sports world. It was during this period that bodybuilding flourished, because artificial androgens led to rapid growth of muscle mass and an increase in physical strength. But testosterone synthesis did not occur in the testicles, but in the liver, as a result of which toxins and carcinogens accumulated there. The liver was destroyed, and synthetic testosterone analogues were banned for some time until the invention of a new generation of drugs.

Testosterone itself is not active; it requires the enzyme 5-alpha reductase to activate it. It is he who converts the hormone into dihydrotestosterone, the active form of androgen. Only a doctor can determine what exactly the patient needs: a synthetic testosterone analogue itself or a 5-alpha reductase inhibitor. The result of treatment depends on this. Self-medication is strictly contraindicated because it leads to testicular cancer.

The endocrinologist prescribes blood tests for the patient several times a day: morning, afternoon and evening. Based on the dynamics of hormone production, it is determined whether the main problem is a lack of the hormone itself or its inhibitor. Then the doctor prescribes the drug itself.

There are several forms of release of the drug:

The oral form (tablets) is the most convenient. The advantages include: different dosages, the possibility of independent use, ease of use. Among the disadvantages of tablets are a high percentage of counterfeits, a cumulative effect, strict adherence to dosage and frequency of administration.
The injection form (injection) is more often used in replacement therapy. Advantages: the effect occurs immediately and lasts a long time, the active substance enters the blood immediately and is in a stable concentration, no control over daily intake is required. For some men, injections are contraindicated; they are performed under the skin, but this requires certain skills.
The transdermal form (plasters, creams) is used extremely rarely, because the percentage of the active substance entering the skin is quite small. In addition to keeping your skin clean, you should avoid exercising in the pool and gym. However, some men fell in love with this form of androgen administration. It does not affect the liver and ensures a smooth flow of testosterone into the blood.
Subcutaneous form (implants). In Russia, this form of androgen administration is prohibited. Its essence is this: an implant is inserted under the skin with a hormone applied to the surface of a certain dosage, designed for six months. The implant is then removed and a new one is inserted in its place.

The benefit of hormone replacement therapy under the supervision of an endocrinologist is the fact that some men do not need an artificial testosterone analogue. They just need to take a course of stimulants, which will force the testicles to independently produce the required dose of testosterone.

This applies mainly to young men whose gonadal activity is suppressed due to physical and psychological stress. Based on blood tests, the doctor draws conclusions and prescribes treatment appropriate to the individual characteristics of the body. At the same time, a drug course with synthetic androgens can lead to the development of oncology if used by a healthy man.

Injection forms

Oily intramuscular injections of testosterone preparations are used more often than other forms, especially during early menopause. This is due to their long-lasting action, rapid development of effect, and high bioavailability. The disadvantage is considered to be fluctuations in hormonal levels, often not physiological.

Sustanon-250

It is a mixture of testosterone esters in the form of an oil solution. Once in the body, it is hydrolyzed into a natural sex hormone. It is administered deeply intramuscularly once every 3 weeks.

Contraindicated in case of oncological processes of the prostate gland (existing and in history), in case of individual hypersensitivity. Incorrect dose selection can cause the development of side effects: swelling, depression, decreased sexual desire, nausea, itchy skin, muscle pain, decreased amount of ejaculate. Analogue – Sustaretard.

Omnadren

Belongs to the group of androgens, includes 4 types of testosterone. The dose is selected by the doctor individually, on average - 1 ml of the drug intramuscularly once every 2 weeks, and after normalization of the condition - once every 3 weeks.

Long-term use can cause the development of tumors in the liver, gynecomastia, frequent erections, and pain, hyperemia, and itching at the injection site.

Testosterone propionate

The drug is available in the form of a 5% oily solution. Administered intramuscularly or subcutaneously. The period between injections is determined by the andrologist; it can range from several days to several months. Contraindications and possible side effects correspond to the drugs described above.

Changes in the proportions of follicle-stimulating and luteinizing hormones in men

First of all, you need to find out the reason for the decrease in testosterone, because age-related androgen deficiency is only one tenth of the probable factors.

Testosterone is synthesized by Leydig cells in the testicles from dietary cholesterol. Gonadotropins, hormones produced by the hypothalamus, are responsible for the synthesis. These include the luteinizing hormone LH (it supports the functioning of Leydig cells) and the follicle-stimulating hormone FSH (it controls spermatogenesis). Functioning is controlled by the hypothalamus.

Homeostasis is when there is insufficient testosterone production in the testicles, a signal is sent to the hypothalamus and it signals the pituitary gland to release more LH or FSH. The norm for follicle-stimulating hormone in a man is 1.5-12.0 mU/l, and for luteinizing hormone - 0.5-10 mU/l.

Unlike women, these hormones in representatives of the stronger half of humanity do not fluctuate throughout the month, but maintain a stable level. The ratio of proportions is also important. WASH should always prevail over LH, and a change in the opposite direction leads to a number of health problems.

Follicle-stimulating hormone affects Sertoli cells located on the seminiferous tubules. The cells contribute to the production of substances that support sperm activity. If there is a lack of FSH, little nutrient fluid will be produced, which will cause male infertility.

Diabetes mellitus, excess weight, tumors of the adrenal glands and brain lead to decreased production of FSH. Low FSH levels also occur with problems with the small intestine. Only a doctor can determine the true cause of the disease.

What is testosterone therapy?

Hormonal imbalances in the body lead to serious complications in all organs and systems without exception. Therefore, hormone replacement therapy after 40 years for men is often the only treatment that can significantly improve the quality of life and avoid health problems.

Hormonal drugs are prescribed not only to men over 40 years of age, but also at a young age, since testosterone deficiency is not always caused by age-related changes in the body. The cause may be injury to the spermatic cord, cancer, genetic pathologies, etc.

Worth knowing: symptoms of testosterone deficiency include decreased/lack of libido, chronic fatigue, depression, aggressiveness and irritability for no reason, erectile dysfunction, obesity due to the same diet, and enlarged mammary glands. If there are 3 or more signs, it is recommended to consult a doctor and take a blood test to determine the level of androgens in the blood.

Testosterone replacement therapy has been carried out since the dawn of the last century. But its beneficial effects were only confirmed 40 years ago. Moreover, there is still no clear opinion whether this method of treatment is necessary or not, which is due to severe side effects, sometimes irreversible.

Previously, hormone therapy was carried out using tablets that included artificial testosterone. After taking them, metabolism took place in the man’s liver, where most of the active substance was destroyed. As a result, the liver “suffered” from the negative effects of carcinogenic and toxic components. This led to disruption of the functionality of the internal organ, which became the reason for the ban on such treatment in many countries of the world.

However, when similar drugs appeared that were not characterized by such adverse reactions, the ban was lifted. Often these medications are used by men who play sports professionally, even though this is prohibited.

Testosterone HRT has strict medical indications:

Natural andropause, as a result of which there is a pronounced deficiency of testosterone in the blood;
Pathological conditions, regardless of the age group of a man, which are accompanied by hormonal disorders. For example, diseases of the pituitary gland, gynecomastia, cryptorchidism, obesity, which cannot be treated with traditional methods.

Hormone therapy for men is carried out only based on the results of laboratory tests. When prescribing medications with synthetic testosterone, all risks must be assessed.

Tests and ultrasound to identify hormonal problems in men

Luteinizing hormone also does not decrease or increase on its own. An endocrinologist takes several blood tests, from which he draws conclusions about the level of the hormone. Its value can be influenced by stress, so the psychological aspect is also taken into account.

If all tests show a consistently low level of LH, the patient undergoes an ultrasound examination of the thyroid gland and adrenal glands. Additionally, the doctor takes a blood test for thyroid hormones, and also conducts a biochemical blood test to determine the condition of the kidneys and liver. At the same time, the quality of sperm is checked, because LH affects the maintenance of their viability.

With a mild LH imbalance, the patient is advised to give up fast food, play sports and have regular sex life. If the hormone concentration is low, the doctor prescribes replacement therapy.

Hormone deficiency: causes and when treatment is necessary

Hormone therapy for men after 40 years of age is almost a natural process, but sometimes younger people may need such treatment. Aging is not always the cause of a decrease in testosterone production by the endocrine glands. Any injury to the testis can lead to such deficiency. This is facilitated by oncological pathologies and/or a number of genetic diseases. No less dangerous is an excess of iron in the body, which will suppress testosterone. Improper functioning of the pituitary gland, a number of medications, chronic diseases, including alcoholism and smoking inhibit the production of vital androgens.

Important! If there are symptoms of androgen deficiency, men under 40 years of age should undergo appropriate examination, and after 40 - do this regularly, even if there is no clinical picture of testosterone deficiency.

Hormone replacement therapy for men can only be prescribed after diagnosing the amount of hormones in their blood. This analysis is truthful and accurate. When he confirms androgen deficiency and the absence of cancer in the prostate gland, treatment will be prescribed to increase their levels. It is necessary to exclude oncology because androgen deficiency is often the beginning of the development of carcinoma. And if testosterone therapy is carried out, the patient may become worse.

The following signs of testosterone deficiency in the body should be alarm bells for men:

sexual desire is reduced or completely absent;
frequent manifestations of loss of strength;
depression;
decreased growth;
aggression and irritability that was not there before;
erection problems;
gaining excess weight;
constant desire to sleep after lunch;
enlargement of the mammary glands;
osteoporosis and anemia;
cholesterol plaques.

Any of the symptoms is dangerous, but if 3 or more are found, then a trip to the doctor should become a mandatory part of the man’s plan for tomorrow. Often, such therapy is resorted to when it is diagnosed:

Primary and secondary hypogonadal state.
Cryptorchidism.
Decreased erectile function and libido.
Androgen deficiency associated with age-related changes.
Gynecomastia.
Obesity that cannot be cured with traditional methods.

What are the stages of hormone replacement therapy in men?

Hormone replacement therapy is a set of measures aimed at restoring unbalanced body functions. The set of measures can be divided into several stages:

Restoring optimal testosterone levels;
Restoration of other hormonal parameters;
Normalization of weight, increase in muscle mass;
Treatment of cardiovascular pathologies - normalization of cholesterol;
Prevention of prostate cancer;
Restoring libido.

Contraindications for replacement therapy

Hormone replacement treatment is a serious step, so before prescribing drugs you need to make sure there are no medical contraindications. In addition, the doctor must tell the man about the possible side effects. Contraindications are relative - the use of hormonal drugs is allowed, but with caution and absolute - such treatment is strictly prohibited.

Testosterone replacement therapy is not carried out if a man is diagnosed with breast cancer (this is rare). The use of androgens can provoke an increase in the concentration of estrogen, which leads to the progression of the oncological process.

Important: testosterone replacement therapy is prohibited against the background of glandular cancer in men. Before treatment, cancer must be excluded. To do this, a rectal examination of the organ is performed, the level of PSA - prostate specific antigen - is determined.

The use of hormones is carried out carefully in the following pathological conditions and diseases:

Sleep apnea.
Gynecomastia.
Fluid retention in the body.
Swelling.
Polycythemia.
Prostatic hyperplasia.

If there are relative contraindications, constant monitoring by a medical specialist is required. The introduction of hormonal drugs can lead to serious complications - suppression of the production of own testosterone, inhibition of spermatogenesis, alopecia, atrophic changes in the testicles, etc.

The final choice of hormone replacement treatment method depends on the general condition of the patient, concomitant diseases and individual tolerance to certain medications. Testosterone in any form should be prescribed exclusively by a doctor; independent use is fraught with serious consequences.

Prevention of low testosterone consists of a healthy lifestyle (no smoking, alcohol, drugs), consumption of environmentally friendly products, control of your own weight, and timely treatment of any diseases.

Restoring optimal testosterone levels

Synthetic drugs have different dosages, so the type of drug is selected by a urologist, andrologist or endocrinologist.

Non-invasive products (gels, patches) are quite popular, but they have a low dosage, so they will not help everyone. Injections maintain testosterone levels for a long period, but cause a sharp jump in hormones, which is fraught with the development of oncological tumors. Tablets are the most popular drugs, however, they should not be taken without consulting an endocrinologist.

Complications

You should not treat hormonal therapy negligently, because if the dosage indicated for the patient is exceeded, side effects will not be long in coming. The physiological parameters of the whole organism will be disrupted, which will lead to:

the body's inability to produce androgens on its own;
swelling and delayed fluid excretion;
covering the skin with acne and seborrhea;
baldness and hair loss throughout the body;
testicular atrophy;
inhibition of sperm production.

Problems with excessive androgen levels most often occur in young people who are passionate about sports and physical body perfection. They are the ones who abuse testosterone-containing drugs, which negatively affects their health. This is not a joke, and the selection of such a remedy should only be carried out by a doctor and strictly for medical reasons.

Normalization of weight, reduction of adipose tissue and increase in muscle mass

Men after 30 live with the memories of their youth, when they could eat anything, and at the same time many people told them “why are you so thin.” Good metabolism and good hormonal levels did their job; most boys 16-25 years old can boast of a toned figure and lack of fat without any special diets or training.

After 25 years, to maintain definition, you need to visit the gym - a man quickly gains muscle and loses fat. After 31-35, the situation changes dramatically: muscles lose elasticity, a noticeable belly appears, any exercise becomes more difficult, and physical activity is accompanied by tachycardia and shortness of breath.

These are the first signs of androgen deficiency, and it is at this stage that measures should be taken. If you miss the moment, the recovery will take a long time, and the effectiveness of hormone replacement therapy will not be noticeable immediately.

Normalizing weight after 40 is impossible without a balanced diet. Testosterone increases not only with the help of hormones, but also with food. 20-30% of the diet should consist of foods rich in healthy fats - avocados, fish, olives, nuts. Protein foods should dominate carbohydrate foods.

Physical activity is of great importance. Without them, weight normalization is impossible. If a man has never played sports, it is difficult for him to regain optimal physical shape.

The process of normalizing weight will take more than one year, but in many ways this will allow you to achieve the required level of testosterone. In case of significant problems, hormonal therapy is prescribed to restore the balance of the male hormone.

Transcutaneous and implantation forms

These drugs are quite expensive to use, so they are not so common. In addition, gels often cause unwanted skin reactions. Representatives - Androgel, Androgel, Dihydrotestosterone Gel. Gels are applied to the skin of the shoulders, forearms or abdomen (not on the genital area!), leaving until completely dry.

Implants may become dislodged or pushed outward after implantation, and bruising or infection may occur. Injectable forms have completely replaced implantation methods of hormonal therapy.

The choice of management path is based on the general condition of the patient, his hormonal levels, and the severity of the clinical signs of andropause. Early initiation of treatment will ensure a favorable outcome of male menopause.

Treatment of cardiovascular pathologies caused by excess “bad” cholesterol

Androgen deficiency is often accompanied by high cholesterol, which poses a health threat. In women, blood vessels are protected by the hormone estrogen, so they fall into the risk group after 50 years, and men much earlier - already at 35.

In Russia, 60% of cardiovascular disorders are caused by the “attack” of very low density lipoproteins. They settle on the walls of blood vessels, forming a plaque. It clogs the vessels, narrowing their lumen and impairing the blood supply to the organs. Even more dangerous is the tearing of the plaque by the bloodstream. The result will be stroke and death.

On the other hand, the lack of very high density lipoprotein also negatively affects hormonal levels. 50% of sex hormones consist of cholesterol, which is also responsible for maintaining the cell membrane. Smoking, alcohol, lack of physical activity, stress at work - all this contributes to an increase in “bad” cholesterol.

The upper limit of “bad” cholesterol should not be higher than 3.5 mmol/l. Diabetes mellitus also contributes to a change in proportions in favor of “bad” lipoproteins. The only non-drug way to reduce cholesterol is to review your diet and give up bad habits. Even without changing your usual menu, but by replacing frying with boiling, you can reduce cholesterol levels by 20%.

If the patient cannot cope with the problem on his own, and he has a high risk of heart attack or stroke, the doctor prescribes cholesterol-lowering drugs. Self-medication in this case is prohibited, otherwise the hormonal imbalance may worsen.

Predicted results and possible surprises

Testosterone deficiency in a man's body comes with age, weakening the body and spirit, aging him prematurely. But in order to help your own body, you should not wait for obvious signs of old age. It should be understood that there cannot be a temporary decrease in the hormone - the level will continue to decrease.

Therefore, it is necessary to start replacement treatment with testosterone drugs at the age of 40-50 years. But there is one more nuance that awaits the aging body of a man. It happens that in standard tests the hormone level is within the normal range, but a deficiency is clearly present. Why? It's simple: the level of the male hormone can change literally every minute, so it is advisable to take the test not only in the morning, when its concentration is most significant, but, for example, to collect the daily volume of urine for an extended study.

This parameter depends not only on replacement treatment, but also on diet, physical activity, and lifestyle. Feeling great is the most important thing noted by all men without exception who have started hormone replacement treatment. The only disadvantage of therapy is its lifelong use.

Prevention of prostate cancer with hormones

Prevention of prostate cancer is of great importance, because malignant neoplasms of the prostate gland are the 5th leading cause of death in men under 70 years of age. Cancer develops very slowly and is detected only when metastases spread to other organs - liver, kidneys, lungs.

Hormone replacement therapy is an important part of preventive work in the fight against prostate cancer, since androgens, or more precisely, androstenediones, are responsible for the functionality of this organ. These sex hormones are converted into estrogens (estradiol) in the prostate gland. Under unfavorable conditions (excess fat, smoking, alcohol), an imbalance of testosterone and estrogen occurs, leading to changes in cells.

One way to recognize a predisposition to prostate cancer is the PSA test. The technique detects antigen in the prostate epithelium. Through the fluid produced by the prostate gland, the antigen enters the blood serum. The norm is considered to be 4 ng/ml. Borderline indicators indicate hyperplasia - uncontrolled proliferation of adenoma cells.

Hormone replacement therapy requires regular examination of the prostate gland through the rectum.

Pitfalls of testosterone therapy

26.04.2018

10940

In the next episode of the program “An Hour with a Leading Urologist” Stepan Sergeevich Krasnyak, employee of the Department of Andrology and Human Reproduction of the Research Institute of Urology and Interventional Radiology named after. N.A. Lopatkina of the Russian Ministry of Health, spoke about the problems associated with prescribing hormonal replacement therapy with testosterone drugs in men.

As Stepan Sergeevich noted at the beginning of his speech, the topic of testosterone therapy is extremely controversial and raises many questions among both doctors and patients. The prevalence of testosterone therapy today is growing rapidly, but the negative aspects of such treatment, according to the guest of the program, are often forgotten.

S.S. Krasnyak recalled the main areas of influence of testosterone on the male body. In particular, this hormone provokes the growth of body hair, is involved in the synthesis of whey proteins in the liver, causes enlargement of the penis and triggers spermatogenesis, affects thinking and mood, helps to increase strength and muscle mass, and from the kidneys is involved in the synthesis of erythropoietin, as well as supports bone growth in length and increase in their density. Accordingly, the less testosterone in the body, the less pronounced male sexual characteristics. Fortunately, according to Stepan Sergeevich, the decrease in the amount of this hormone is usually reversible.

Boundary between normality and pathology

It's no secret that testosterone levels tend to decline with age. However, is this process normal or pathological, and where is the line that allows us to distinguish between these two conditions? Most often, problems with testosterone occur in men over the age of 45–50 years. There are a number of criteria for identifying age-related hypogonadism. These include a decrease in serum testosterone (total <11 nmol/l, free <220 pmol/l), erectile dysfunction, decreased libido and decreased frequency of morning erections (EMAS data). The doctor emphasized that testosterone drugs are prescribed to treat not sexual dysfunction or obesity, but hypogonadism as such. The testosterone level threshold for prescribing hormone replacement therapy is 9.7–10.4 and 6.9 nmol/l.

Stepan Sergeevich noted the importance of a personalized approach to the patient: there are people with high receptor sensitivity in whom even low testosterone levels do not cause clear clinical manifestations. Accordingly, the question arises as to whether hormonal therapy is needed in such patients. Current clinical recommendations today indicate that, as a rule, it is not necessary. In practice, according to the lecturer, one must proceed from a combination of clinical symptoms, probably associated with low testosterone levels, and its laboratory confirmation. At the same time, it is important to avoid uncontrolled and excessive prescription/reception of testosterone.

In general, cases of symptom discrepancy (20–40% of the general population) and low circulating testosterone levels (20% of men > 70 years) are quite common. According to these criteria, only 2% of people aged 40 to 80 years have age-related hypogonadism and actually need testosterone therapy.

Hormone replacement therapy – billions of dollars

Today, testosterone replacement therapy is widely used throughout the world to treat hypogonadism and associated isolated symptoms. The alarming aspect of this trend, however, is that it has emerged without any serious scientific evidence regarding the benefits and risks of this type of therapy.

Today, injectable and gel testosterone preparations are mainly used. In the United States, sales of testosterone preparations between 2005 and 2010 has doubled and continues to grow. Similar trends can be seen all over the world. From 2000 to 2011, total sales of testosterone in the world increased 12 times to $1.8 billion. According to forecasts, in 2020 sales of testosterone preparations in the United States alone will amount to $3.8 billion. Involuntarily, as Stepan Sergeevich noted, the question arises: is it really Have men become so much more likely to suffer from hypogonadism lately? It is possible that large scale overtreatment is occurring.

The doctor also spoke about the presence of scattered but numerous data indicating an increasing trend in the number of patients suffering from obesity associated with taking testosterone.

Replacement therapy, Stepan Sergeevich emphasized, should be offered to the patient only after a conversation that in the long term the beneficial and unfavorable consequences of this treatment for him are unknown. Thus, in 2020, at the Congress of the American Urological Association, a so-called urological “trial” was held, where, with the participation of practicing lawyers, a case of prescribing testosterone drugs to a patient with a high risk of cardiovascular diseases was examined, which ultimately led to his death. Interestingly, virtually no somatic diseases are contraindications to hormonal therapy. However, the doctor emphasized, this does not mean that it should be prescribed to everyone, including the most severely ill patients. Patients with a high risk of concomitant diseases must undergo specialized studies.

It is also noteworthy that many of the studies available on the topic today included men without symptoms of hypogonadism, while various testosterone thresholds, drugs, and dosage regimens were used for evaluation. Thus, it is very difficult to bring together data that would allow an objective assessment of the safety of testosterone therapy.

About pitfalls

At the very least, there are absolute contraindications for prescribing HRT. These include prostate and breast cancer, as well as liver tumors. Relative contraindications include prostate-specific antigen (PSA) level >4 ng/ml (or 3 ng/ml in men at high risk of developing prostate cancer); hematocrit >50%; severe lower urinary tract symptoms caused by benign prostatic hyperplasia (above 19 points on the IPSS scale); and poorly controlled congestive heart failure and sleep apnea.

There is some evidence that testosterone supplements increase prostate volume, ultimately causing a modest increase in PSA levels in older men. In 2005, the Journal of Gerontology published a report showing that the total number of prostate-related adverse events (prostate biopsies, cancer, serum PSA levels greater than 4 ng/mL, increased IPSS scores) was significantly higher in the group of patients those receiving testosterone than those receiving placebo (odds ratio 1.90; 95% CI 1.11–3.24; p<0.05). There are also data showing the results of testosterone supplementation in patients with locally advanced and metastatic prostate cancer (PCa). According to these data, in patients with aggressive and non-aggressive forms of the disease, the levels of total testosterone and sex hormone binding globulin were significantly different: in patients with an aggressive form of prostate cancer, testosterone levels were significantly higher. It is unclear whether we can talk about a cause-and-effect relationship here, but the fact of correlation has been revealed.

Another significant factor is hepatotoxicity. It is because of this that oral forms of testosterone preparations are prohibited in most countries today. Their use has been associated with the development of liver failure, benign and malignant liver neoplasms, intrahepatic cholestasis, hepatic purpura, hepatocellular adenoma and carcinoma.

In addition, a factor such as polycythemia was noted. A very common complication of taking testosterone drugs is erythrocytosis (hematocrit greater than 50%). Two meta-analyses performed in recent years have shown significant negative effects of testosterone therapy compared with placebo in this regard. There is a correlation between high testosterone levels and high hemoglobin levels. Erythrocytosis is more often dose-dependent and develops in older men during therapy with injectable forms of testosterone. The risk of such complications is especially high in the presence of other chronic diseases, for example, chronic obstructive pulmonary disease. Therefore, when prescribing testosterone drugs, control blood tests should be performed.

As for the effect of testosterone drugs on the cardiovascular system, this issue remains controversial. Due to the steady increase in cardiovascular mortality rates, it becomes especially acute. There is, in particular, evidence that testosterone intake correlates with the progression of heart failure, but the cause-and-effect relationship remains a matter of debate. The use of testosterone in coronary artery disease is thought to have a stimulatory atherogenic effect due to its negative effect on the lipid profile. However, normal physiological levels of testosterone have been shown to be beneficial for the male heart, and low levels are associated with an adverse risk of coronary disease outcomes. But, as S.S. Krasnyak emphasized, it is impossible to guarantee that a particular patient will achieve exactly the physiological level of testosterone without serious fluctuations.

In 2006, the New England Journal of Medicine published a study of 106 older men with a mean age of 74 years with low total testosterone, limited mobility, a high prevalence of hypertension, obesity, diabetes, pre-existing heart disease, and hyperlipidemia. For 6 months, patients underwent testosterone therapy in daily doses of 5 to 15 g. A placebo group was also allocated. The incidence of cardiovascular events was significantly higher in patients taking testosterone drugs (23% vs. 5%). Thus, Stepan Sergeevich summed up, it is impossible to assert the safety of such therapy, especially long-term therapy, in patients with existing diseases.

Testosterone and Fertility

Another serious issue is the effect of testosterone drugs on male fertility. There is evidence of a decrease in the volume of patients' testicles and a decrease in the number of sperm up to their complete absence (azoospermia) while taking testosterone drugs. In this case, the sperm count most often returns to its original level within 6 months after stopping therapy, but this does not always happen. This is especially important for young men, some of whom take hormonal medications to achieve rapid improvements in physical and athletic performance. Today there are even developments in the use of testosterone drugs as a means of male contraception.

Other factors

An important factor is also changes in the psyche: psychotic symptoms, excessive libido and aggression, in addition to physical and psychological dependence with withdrawal syndrome, quite rarely, but still noted by attending physicians in patients taking testosterone. In this sense, as the doctor noted, the hormone, like many things in the world, has dark and light sides. Taking testosterone may increase the patient's level of entrepreneurship and courage, but may also lead to aggression and suspiciousness. Here a lot depends on the innate qualities of the man himself.

A known side effect of testosterone drugs is gynecomastia. It is associated with the aromatization of testosterone to estradiol in peripheral adipose and muscle tissue. In this case, the ratio of estradiol to testosterone, as a rule, remains normal.

In addition, testosterone replacement therapy is associated with worsening sleep apnea. Its severe forms are a relative contraindication for therapy. In case of occurrence or exacerbation of obstructive apnea, a reduction in the dosage of the drug or discontinuation of therapy is required.

Like any anabolic steroids, testosterone preparations can cause nitrogen, sodium and water retention - the mineralocorticoid effect. Edema in such cases can worsen the condition of patients with heart, liver and kidney diseases.

The use of cutaneous forms of testosterone is associated with the phenomenon of hyperandrogenism in sexual partners of patients. Transdermal formulations may be associated with a range of skin reactions, mainly erythema and pruritus, which are also common with patch use. Intramuscular injections of testosterone, in turn, can cause local soreness and bruising.

Non-drug ways to increase testosterone

In addition to hormone replacement therapy, physical exercise, proper nutrition and regular visits to a urologist help maintain and increase testosterone levels at any age. Stress control also plays an important role. Many patients benefit from, for example, reducing their working hours. If there is a large volume of overtime work, the working day should be reduced to 10 hours. It is useful to spend at least 2 hours a day doing something you love that is not related to work: for example, reading or listening to music.

Regarding physical activity, there is a recent Japanese study (Kumagawa et al., 2015), which showed that after 12 weeks of high physical activity there was a significant increase in testosterone levels without hormone replacement therapy. Another study of 83 men (Trumble, Benjamin C. et al.) found that one hour of chopping wood increased testosterone levels by 48% (P < 0.001). Another work was carried out with the participation of 30 young men aged 18–27 years (Devi S. et al., 2014). They exercised on an exercise bike for 15 minutes a day with a heart rate of 125–150 beats per minute. After 12 weeks of such exercises, an increase in testosterone levels of up to 20% was observed.

There is also evidence that testosterone levels correlate well with waist circumference. Thus, getting rid of excess fat mass will in any case lead to an adjustment in the level of this hormone. It is weight loss that can be considered as a first-line therapeutic measure in patients with hypogonadism caused by obesity. There is a possibility that if weight loss is successful, the man will not need hormone replacement therapy in the future.

In the 21st century, prolonging life and maintaining its quality come to the fore among the tasks of medicine. Accordingly, patients should be given a number of simple recommendations that will help reduce the risk of developing metabolic syndrome and problems with testosterone levels. First of all, a man should change his diet and stop drinking excessively, and approach this systematically, and not as a temporary measure. However, the doctor emphasized, the patient does not need to be severely limited in the consumption of fats, including saturated fats: they are involved in the production of sex steroids, including testosterone. There is evidence of a strong correlation between high-density lipoprotein (HDL) levels and free testosterone levels (Heller, R.).

There are also a number of herbal remedies that have an evidence base for increasing testosterone levels. For example, 14-day consumption of Eurycoma longifolia extract has been shown to increase circulating testosterone levels by 30.2%. Another study found that the same extract increased the number of men with normal testosterone levels from 35.5 to 90.8%. In addition, 6-week consumption of Peruvian maca extract showed an increase in testosterone production by Leydig cells (Ohta Y. et al., 2016).

Stepan Sergeevich, however, noted that he understands the skepticism of some doctors regarding methods other than hormone replacement therapy. But, as he recalled, many of the active ingredients of the drugs synthesized today were initially obtained from plant materials. Therefore, the use of herbal remedies in addition to changing the amount of physical activity, adjusting diet and reducing daily stress levels may well bring results.

Stepan Sergeevich Krasnyak, employee of the Department of Andrology and Human Reproduction, Research Institute of Urology and Interventional Radiology named after. N. A. Lopatkina, Ministry of Health of Russia

The article was published in the journal “Urology Digest” No. 2/2018, pp. 26-34

Topics and tags

Testosterone

Comments

Oreshkov Vasily Sergeevich - 06.13.2018 - 17:42:36

Thank you very much for the informative report

Kiselev Evgeniy Alekseevich - 04/30/2018 - 11:14:14

I came across a statement that a new type of treatment undergoes damped fluctuations in assessment from “panacea” to “ineffective and harmful.” Over time, as application experience accumulates, a balanced position is formed. In the case of testosterone, these fluctuations are apparently far from dying out. Despite the fact that it has been used for about 80 years. Maybe non-medical factors intervene, artificially maintaining disputes?

Chernega Sergey Vasilievich - 04/26/2018 - 18:00:31

Thanks for the informative report

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Libido restoration

Regular sex life is an excellent prevention of prostate cancer, but at the same time it is difficult with androgen deficiency.

The fluid secreted by the prostate is naturally released during sexual intercourse. When you refuse sexual activity, fluid stagnates in the ducts, causing hypoxia. This enhances proliferation - the growth of cells through their division. With prolonged abstinence, the risk of prostate development increases several times.

In women, libido is based on an emotional component, while in men it has a physiological basis. Without normal testosterone levels, it is impossible to bring male libido back to normal. However, taking synthetic drugs on your own is very dangerous; this must be done under the supervision of an endocrinologist, who will select the dosage based on the patient’s health and hormonal background.

To do this, the patient takes a testosterone test; based on the results, the dose will be calculated and the drug will be selected.

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Oral agents

Medicines in tablets or capsules for menopause are used less frequently than other forms. This is due to their inability to maintain the necessary hormonal levels in the body for a long time. In addition, their toxic effects on the liver are known.

The only widely used medication is Andriol. The product is available in capsules, each of which contains testosterone dissolved in oleic acid. A single dose of the drug is accompanied by the achievement of the maximum concentration of the active substance in the blood within 8 hours.

Taking Andriol requires paying attention to the following conditions, in the presence of which the drug should be used with caution:

renal and hepatic failure;
epilepsy;
arterial hypertension;
migraine;
diseases of the heart and blood vessels;
benign prostatic hypertrophy.

A decrease in the activity of the drug occurs when barbiturates or Rifampicin are used simultaneously with it.

The specialist may also prescribe the following drugs: Halotestin, Methandren, Vistinon, Striant.