BY MARK SCHOLZ, MD
is really cool. It improves concentration,
energy, strength, and libido. Both men and women experience enhanced
performance with higher testosterone levels. The problem is that testosterone
tends to decline with age. Also, testosterone-blocking therapy to treat
prostate cancer can have lingering effects, even after the treatment is
stopped. For women, testosterone levels often decline sharply after menopause.
testosterone causes many undesirable effects including muscle atrophy, weight
gain, tiredness, osteoporosis, low libido and impotence. Absent testosterone in
women* is usually a secondary effect of menopause, so it usually occurs in
conjunction with low estrogen. In women the loss of estrogen and testosterone
causes weight gain, tiredness, osteoporosis vaginal atrophy and low libido.
administration of testosterone in men and a combination of estrogen and
testosterone in women, can dramatically improve quality of life. Bioidentical
hormone therapy is the term often used by the doctors who specialize in this
area. The idea is to restore hormone levels back to normal.
Risks of Testosterone
might be expected, like any powerful tool, misuse of testosterone can be
dangerous. Administering testosterone in men with prostate cancer is
controversial (see below). However, there are also risks even in men without
prostate cancer. One reason is that when testosterone is administered to men
estrogen levels also rise. Higher estrogen in men may increase the risk of
heart attacks and strokes. Therefore, estrogen levels should be monitored and
compensatory treatment with Femara®, an estrogen blocking pill, may be
necessary in some cases.
men, testosterone may also cause an excessive increase in the red blood cell
count (RBC). Overly high RBC levels have also been linked to higher risks of
heart attack or stroke. The RBC count, therefore, needs to be monitored by
measuring the hematocrit, a component of the complete blood count (CBC). If the
hematocrit rises above 50% men should consider lowering their testosterone
dosage or undergoing a phlebotomy (donating a unit of blood). In women,
excessive amounts of testosterone can cause masculinization. Estrogen
replacement also slightly increases the risk of breast and uterine cancer.
Obviously a full discussion of all the risks and benefits is essential before
bioidentical hormones is as much an art as a science. The hormones themselves
are delivered in the form of creams, pills or shots. Studies show that the
measurement of hormone levels in the blood stream or in saliva is moderately
helpful for guiding the selection of an
appropriate dosage. A better indication of proper dosage, however, is the
subjective sense of well-being reported by the person receiving the treatment.
Therefore, starting hormone therapy should proceed slowly with an incremental
escalation of dose while closely observing for the appearance of side effects.
to Men with Prostate Cancer
every man with a history of prostate cancer from receiving testosterone is
ridiculous. Studies clearly show that about half the men in their 50s and
almost all men in their 80s harbor minor forms
of prostate cancer; most is low-grade and harmless. Almost all of these men
have substantial testosterone coursing through their blood (from their
testicles). They seem to do just fine. As long as men are regularly screened to
ensure the absence of clinically significant prostate cancer, the risks of
restoring low levels of testosterone back to normal should be quite low.
Living Longer and
in our lifetimes we are observing a dramatic enhancement of human longevity.
When I was in oncology training at USC just twenty-five years ago, the attitude
toward a patient’s death while in his in early 70s would have been, “He lived
a full life.” That attitude is no longer accepted. Now men and women are not
only living longer, they are retaining substantial youthfulness into their 80s.
As part of an overall health program that includes diet, exercise and
appropriate healthcare, restoring sex hormone levels back to normal can be
transformational. Since giving small amounts of testosterone to females is a
foreign idea to many people, in my next blog I will elaborate on this concept
Premenopausal women normally have testosterone in their blood, albeit at much
lower levels than men.