Hormone Replacement Therapy for Men

Hormones are chemical messengers that regulate pretty much every system in the body. They can be adjusted to positively influence metabolism, energy production, muscle development, bone density, brain health (including mood), sleep quality, sexual function, and immune regulation. Although testosterone is the primary male sex hormone we know, other hormones can be as important for maintaining optimal health.

Testosterone deficiency is the most well-known hormone to decline in men, but it is certainly not the only one. Human growth hormone (HGH), DHEA, and melatonin also diminish with aging, while other hormones, such as progesterone and thyroid hormones, may become imbalanced (mostly decreased) as well. These hormones can all affect metabolism, muscle and fat mass, brain function, sleep quality, immune function, and overall health. Dr. Crawford measures these hormones to help identify hormone imbalances that may contribute to bothersome symptoms, and she provides treatment options beyond testosterone replacement alone. Note: In contrast with other hormones, estrogen levels in men may increase with age, causing belly fat, “man boobs,” mood issues, erectile dysfunction, and decreased libido; sometimes with normal testosterone levels.

Testosterone is the primary male sex hormone, produced mainly by the testes, directed by the pituitary gland and hypothalamus. It is, of course, essential for sexual and reproductive functions, but its effects are felt all through the body. Testosterone helps to maintain muscle mass, bone density, energy levels, libido (sex drive), cognitive function, mood, and metabolism.

Low testosterone (“hypogonadism”), can cause a wide variety of symptoms, including:

• Decreased energy and even persistent fatigue
• Reduced libido and, in some, erectile dysfunction
• Loss of muscle mass and increased body fat
• Poor sleep quality
• Depression, irritability, anxiety, reduced motivation or other mood changes
• Brain fog, difficulty concentrating, reduced speed of thought
• Reduced exercise tolerance
• Decreased bone density

Remember: Symptoms do not establish a diagnosis. Blood testing after a thorough medical evaluation is necessary.

Testosterone levels generally decline gradually with age, a process we call andropause, much like female menopause. However, many other issues can lower “T” levels. Excess body fat, insulin resistance, diabetes, chronic inflammation, medications, Excessive stress or body fat, pituitary dysfunction, testicular disorders, trauma, toxins, and chronic illness can all cause low testosterone.

Importantly, some underlying causes are reversible. Dr. Crawford evaluates all of these factors before determining whether testosterone replacement is necessary.

When testosterone deficiency is treated correctly, men usually experience improvements in energy, sexual function, muscle mass, overall body composition, mood, cognitive function, and even bone density.

Treatment is individualized, aiming to restore appropriate hormone levels of testosterone and estradiol and improve symptoms without the need for excessive levels.

Bioidentical hormone replacement therapy uses hormones that are chemically identical to those which are produced by the body. Testosterone is available in several formulations, including injections, topical creams, and gels.

Treatment may also involve addressing deficiencies in other hormones, depending on someone’s symptoms and laboratory findings. Dr.Crawford’s goal is to restore hormonal balance rather than simply prescribe testosterone to every man experiencing what they identify as testosterone deficiency symptoms.

This is one of the most common concerns men have about testosterone therapy. Current research does not support the older assumption that appropriately prescribed testosterone replacement necessarily increases cardiovascular risk. The TRAVERSE trial found no significant difference in major adverse cardiovascular events between testosterone therapy and placebo in men with hypogonadism and existing cardiovascular risk factors.

Testosterone therapy has not been shown to cause prostate cancer, although it can possibly increase PSA levels and requires appropriate prostate monitoring.

Yes, absolutely. Testosterone replacement suppresses the pituitary signals (LH and FSH) needed for normal sperm production, reducing both sperm counts and fertility. For this reason, Dr. Crawford prefers to use other testosterone-boosting methods to help men who wish to have children.

Medications such as clomiphene or hCG, or peptides such as Kisspeptin, may help stimulate the body’s own testosterone production while preserving fertility.

Potential side effects of testosterone therapy include fluid retention, erythrocytosis (increased red blood cell count), acne, and decreased sperm production. Testosterone can also exacerbate untreated sleep apnea.

Correct dosing and monitoring of testosterone, estradiol, red blood cell count (hematocrit), PSA, and other relevant laboratory tests help to minimize any risks and ensure appropriate treatment.

This isn’t necessarily an urban myth, but it’s not the problem everyone thinks it is. Although yes, testosterone deficiency can contribute to reduced libido and sometimes erectile dysfunction, most cases of erectile dysfunction are related to vascular disease, medications, inflammatory illness or diabetes.

Dr. Crawford always determines the underlying cause or causes of everything she treats. She can easily determine whether testosterone replacement, other treatments, or a combination is appropriate. Other treatments she offers include medications such as sildenafil (Viagra) and tadalafil (Cialis), as well as the peptide, PT-141, which works through a different pathway to support sexual desire and arousal.