Men experience the highest testosterone levels of their life around age 20. The levels decrease from 1 to 3% per year after the peak. If you are fortunate, you are closer to the 1% instead than the 3%. Many men start having low testosterone or “Low T” symptoms around age 40 to age 50. The symptoms commonly include the following:
Fatigue
Poor sleep
Irritability
Mood swings
Low libido
Loss of interest in enjoyable activities
Erectile dysfunction
Loss of physical strength and stamina
Weight gain
Fortunately, most of the above symptoms respond favorably to replacement with natural or Bio-identical testosterone. Natural testosterone can be prescribed to help lessen the symptoms of Low T and is administered in two ways.
The first is a dissolving tablet or troche that you place under your tongue. After about five minutes, it is fully absorbed by your oral mucosa, which is considered a transdermal absorption. Each dose peaks in about an hour and is broken down in about four hours. This helps to mimic the normal physiology of testosterone production. Using the troche twice a day follows the normal diurnal (twice daily) production by healthy testicles. The drawback to the sublingual delivery is that a small amount may be swallowed, and in some men, will cause or worsen acid reflux.
The second way to deliver natural testosterone is a topical cream applied to the skin twice daily. The difference from the troche is that the cream will peak in approximately three hours and is broken down in about six hours. The drawback to the cream delivery is that it will not be completely absorbed for about two hours and if you sweat, swim, or shower during that time you may not get the full dose.
Another method to supplement testosterone is to use a weekly injection therapy, which involves an injection into a large muscle. The problem, aside from giving yourself an injection into your muscle which causes soreness or pain, is that it is not natural testosterone. Injection therapy uses testosterone cypionate, testosterone enanthate, or testosterone proprionate. These are not identical to the natural testosterone produced by the testicles. The second part of each molecule is cleaved by the liver to supply just the testosterone molecule. In my experience, injectable testosterone leads to more side effects than the topical or sublingual natural testosterone. The topical or sublingual natural testosterone is immediately available when it is absorbed across the skin or oral mucosa and does not require processing in the liver.
Pellet therapy has gained quite a bit of attention as it is very convenient. It involves making a small incision in the buttocks and inserting testosterone pellets that slowly breakdown over four to six months. The problem with injection or pellet therapy is that they do not mimic the twice daily up and down levels with the normal diurnal production of testosterone.
I do feel that any testosterone replacement is better than none. I strongly favor the use of natural testosterone, but I do prescribe injection therapy if the patient chooses. I do not perform the pellet insertion, but I can refer interested patients to another provider.
The process begins with a patient interview, examination, previous history, and baseline blood work to evaluate pertinent data to decide if therapy is indicated. If therapy is indicated and the patient chooses to begin treatment, supplemental testosterone is prescribed. In six to eight weeks the lab is repeated. Then the patient comes in for a visit to see whether their testosterone level has improved and how the patient is doing with the therapy.
Many men will be in the lower portion of the “normal” testosterone range, but are having symptoms of Low T. If treated, and their level increases to a higher level within the “normal” testosterone range, their symptoms normally improve. This means the higher level is associated with the “optimal” testosterone level even though it is still within the “normal” range. Response is variable among patients regarding the timing and magnitude of improvement.
The real benefits of testosterone replacement include the reduction in the risk of heart disease, stroke, mental decline, and increased lifespan. Testosterone raises good cholesterol (HDL) while lowering CRP (a measure of inflammation) as well as helping normalize blood clotting.
Women need testosterone therapy, too. The difference is that women need their estrogen levels to be much higher than their testosterone levels. Otherwise, they are subject to developing masculine side effects. This does not negate the fact that they may need testosterone supplementation; they just need a much smaller dose. Since the range for testosterone levels in women is lower than for men, their dosing is much lower. Instead of twice daily, I normally dose once a day. Methods for administration are the same as for men. Improvements in women are like that seen in men, including improvements in energy, libido, body fat, workouts, and skin.
I do not think it is a coincidence that the highest natural hormone levels of our life correlate to the healthiest time in most of our lives. Around age 20, we have survived the childhood illnesses and do not have the chronic illnesses of adulthood. It appears that as we lose our natural production of hormones, the chances of contracting many chronic illnesses, including the risk of cancer, heart disease, stroke, diabetes, and high blood pressure, increase. This logically is an inverse relationship, not a direct one. The better hypothesis is that the loss of our natural hormone levels is related to development of chronic disease, therefore replacement should benefit us. The current thinking by most physicians is that natural hormone replacement is harmful. My 13 years of natural hormone replacement therapy experience does not support this thinking. One of the most rewarding aspects of my career is the use of natural hormone replacement in my patients.
It is difficult for me to believe that replacing your hormones with the identical molecule God designed could be harmful. In fact, I am convinced that natural hormone replacement can be an asset in living a happier, healthier, more productive life. I also believe that reading God’s word, praying daily, and being involved in a church home are vital to living the best life here, and more importantly, in Heaven for eternity.
– David Jayne M.D.
Edited by Ann Jayne
