Which Men May Need Testosterone and Why: Dr. Phranq Tamburri discusses the many factors involved and potential treatment options.
May 31, 2013 11:36AM
● By Phranq D. Tamburri, NMD
Testosterone clinics are gaining in popularity by promising men over 40 a Fountain of Youth, and often they are less expensive than visiting an M.D. Questions remain about diagnoses, application and side effects that can have serious consequences if misinterpreted.
Many men are led to believe that when their libido is low or erections are difficult that it must be caused by a testosterone imbalance. Although this may be true, other conditions must be ruled out before a lifelong course of a powerful hormone replacement is conducted.
Symptoms include adrenal fatigue, depression, anxiety, diabetes, drug interactions, irregular blood pressure and others. Because testosterone treatments represent a quick cure for their problem, men might not spend adequate time determining other underlying medical problems of erectile dysfunction or libido decrease.
The issue of whether or not taking sex hormones is natural is often discussed, because many patients visit a naturopathic physican for simple, safe, commonsense treatments. Although people make decisions such as eating organic foods, practicing regular exercise and refraining from using pharmaceutical drugs, they may still resort to unnatural treatments like bio-identical hormone replacement therapy.
When a man or woman gets older, they naturally reduce their sex hormone output. Menopause in women is a natural process. It is a signal from Mother Nature that we are entering a new phase of the life cycle. Resisting this natural flow is a disruptive process that both patients and physicians must be made aware of. This is not to say that hormone treatments are unnecessary or exceptionally dangerous.
Before any legitimate hormone treatment is pursued, adequate medical rule-outs are necessary first. In addition, a comprehensive hormone panel is required that includes: total testosterone, free testosterone, bio-identical testosterone, dihydrotestosterone (DHT), estrodiol, progesterone, prostatic acid phosphatase (PSA), and the percentage of free PSA. The latter two help rule out the risk for prostate cancer. In addition, a 24-hour cortisol test (saliva preferred) is recommended to rule out low stress hormone production that can mimic low testosterone symptoms.
There are three main forms of testosterone. Although testosterone propionate and testosterone enanthatre comprise two of the three forms given, by far the most common is testosterone cypionate. Men that have taken all three have reported differences between them. For example, one may increase libido, but also increase aggression. Another might increase energy, but not affect libido. The type of hormone must be discussed with a physician and often experimented with at the beginning of treatment.
The most common delivery vehicles are oral capsule, injection, surgical pellet and topical cream (or gel). Pellets are the most convenient, but least safe if there is any risk for prostate cancer. Injectables yield the quickest and often most reliable effect, but they are not convenient for many men and also may present a higher cancer risk. The oral form is the safe form for men, and the topical option is also a great option when first determining a safe dose because it can be easily modified or removed completely if a prostate cancer concern appears.
If too much testosterone is given, irritability, anger outbursts and restlessness can occur. Ironically, if too little is given, a further decrease in hormone levels can ensue. This is a common mistake with inexperienced prescribers and often seen with the safer topical or oral administration. Of course, the main concern with testosterone treatment is prostate cancer.
Although research has determined that testosterone does not create prostate cancer, it can make prostate cancer worse. The physician must properly monitor a patient’s PSA and percentage of free PSA levels before and during hormone treatment.
Although specialized testosterone clinics are widespread, they are less likely to consider any other health concern than simple testosterone treatments. A primary care physician such as a medical doctor or naturopathic physician is highly recommended for the initial health screen and general consideration of all options. Once a physician has ruled out all other potential concerns for a patient's low libido or energy, a proper dose and form of testosterone is determined. Once this is properly completed, phasing to a specialty hormone medical center might be a suitable option. Note that the PSA values must be closely monitored at each hormone check-up.
Low testosterone levels can cause low libido, unexplained weight gain, especially around the belly, and low energy and motivation. But despite what the technical lab values for testosterone indicate, how does the patient feel? There is no point in supplementing a powerful DNA-affecting hormone if it isn’t needed.
Phranq D. Tamburri, NMD, is a naturopathic physician specializing in men's health, with a sub-specialty in prostate cancer, at Longevity Medical Health Center, in Phoenix. For more information, call 602-493-2273 or visit LongevityMedical.com.