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 Important Note:   Bio-Identical hormone replacement therapy is for recognized medical conditions.   Therapy is not prescribed for those seeking increase athletic performance, competitive or not. Therapy will only be prescribed to those after the appropriate lab testing, coupled with a history and physical that ascertains a medical condition exists. Acceptable conditions include androgen deficiency, and menopausal / peri- menopausal conditions.  Those patients under current therapy with a different provider will be required to have records faxed directly to us for review prior to being considered as a new patient

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   Updated Nov 15, 2013-Testosterone Replacement Therapy aka TRT is getting more and more press as pharmaceutical makes promote this new therapy in men’s health.  Along with this press coverage are individual practitioners and practices advertising on radio and in local newspapers with promise to screen and treat for an initial visit of $99.  Well truth be told, the diagnosis of testosterone deficiency is far more complex than $99.  They may be able to screen just your testosterone levels for $99, but if you end up meeting criteria for testosterone deficiency then a more complex and thorough evaluation is necessary.  Therefore, $99 is very misleading.  Do you want to trust your healthcare to misleading information?  Furthermore, treatment actually involves management.  Management of treatment includes proper lab testing to assure that potential side effects don’t occur.  This is the responsible way to go about TRT.  Do you want to trust your treatment to incomplete management?  Or do you want someone with experience and comprehensives? It is your choice.  

 

Testosterone Replacement Therapy TRT

Testosterone, if deficient, can be replaced in many methods. Cream, gel, injections, pills, and pellets.  

Symptoms of Testosterone Deficiency

Fatigue

Lack of stamina and energy

Mental Brain Fog

Loss of lean muscle mass

Increase body fat

Loss of sex drive

Loss of a.m. erections

Loss of erectile strength

Loss of interest in activities

In fact, some physicians conclude that the questionnaire for adult ADD looks a lot like that for testosterone deficiency. 

Testing?

After initial blood testing, repeat testing occurs at 6 weeks, 6 months, and 12 months. Then twice a year from then on.

We monitor standard blood tests, Lipids, PSA, and hormone levels. 

If PSA is above 4ng/mL, or a follow up test shows a 2ng/mL change, then a urological evaluation is dictated. 

Contraindications to Testosterone Therapy

This therapy is contraindicated with men that have prostate carcinoma or carcinoma of the breast. 

Hormone therapy is also not recommended in men with severe BPH-Benign Prostatic Hypertrophy. 

Testosterone therapy is not appropriate to enhance athletic performance. 

Testosterone therapy is not recommended in those men that want to conceive in the near future. Testosterone therapy can  temporarily decrease sperm counts, as well as cause a 20% decrease in the size of a testicle.  

Testosterone Replacement Methods

Creams and Gels

This method comes in pharmaceutical preparations or compounded preparations.  While easy and cost effective, some problems with maintaining proper levels can occur utilizing testosterone creams. The skin and subcutaneous fat  has enzymes that break down testosterone as it is absorbed.  5 alpha reductase converts testosterone into dihydrotestosterone (5 DHT).  Aromatase converts testosterone into estrogen. In men, elevated levels of estradiol, and/or 5 DHT can cause problems.  Additionally, creams and gels need to be applied daily. In women the sites need to be rotated as testosterone cream in the same place can lead to hair growth in that area. 

Intramuscular Injections

Intramuscular injections of testosterone bypasses the enzyme conversion in the skin, and can decrease the aromatization into estrogen.  Usually given in 1-3 week intervals, injections initially give a peak level that gradually dissipates and sometimes returns the patients testosterone level to below normal levels.   Because hormone levels are regulated by the brain through feedback loops, the injected testosterone signals the testicles to quit producing what ever amount they are naturally.  In an a testosterone deficient male, this is usually a low level of production from the testicles, but supplementing through injection can lower that even more. So once the injected testosterone is metabolized, the normal body levels drop even lower. Additionally, the serum testosterone bioavailability curve  looks more like a line of peaks and valleys. While this method is better for maintaining testosterone levels than creams, it is not problem free. 

 

Testosterone Pellets

Testosterone pellets insertion provides the best option of maintaining physiologically similar testosterone levels.  The heat fused pellets are placed in the subcutaneous tissue, several inches below the belt line in the buttocks. Using a small surgical instrument and local anesthetic, the pellets are places every 4-6 months.  The pellets provide a good supply of testosterone, and if demand increase because of increase activity, the resulting increase in blood flow increases testosterone absorption. 

Additional Issue with Testosterone Replacement / Supplementation

Testosterone supplementation requires monitoring with lab work.  In the first year you usually have blood labs drawn 3-4 times.  Initially, prior to first visit to determine if there is a deficiency, then at 6 weeks post therapy, again at 3 months, 6 months, and 12 months. After the first year, if your history, physical, and labs remain normal, then lab work is done every 6 months. 

It is important to make sure your physician doesn't just monitor your testosterone levels.  Intermittent lab test should look at estradiol levels, as well as PSA, and Hemoglobin/Hematocrit levels. 

Important Note:   Testosterone replacement therapy is for recognized medical conditions.  Testosterone therapy is not prescribed for those seeking increase athletic performance, competitive or not. Testosterone therapy will only be prescribed to those after the appropriate lab testing, coupled with a history and physical that ascertains a medical condition exists. Acceptable conditions include androgen deficiency.

 

Articles

The August 2006 issue of Circulation magazine— “Anabolic Deficiency in Men with Chronic Heart Failure/Prevalence and Detrimental Impact on Survival.”

The studied looked at four variables in men with CHF (congestive heart failure)  : (1) circulating total testosterone ; (2) free testosterone; (3) DHEA; and (4) insulin-like growth factor-1 (IGF-1).

They concluded men:

  • Men with CHF had hormone deficiencies in all four categories, most averaged out in the lower 10th percentile of their peers.
  • Survival rates of men with CHF and a hormone deficiency in one of these categories showed a 74% three-year survival rate. Those having deficiencies in two had a 55% three-year survival rate; and  those with deficiencies in all three had a 27% three-year survival rate.
  • Men with CHF but no deficiencies in any of the four hormone classes had the best three-year survival rate at 83%.



LOW TESTOSTERONE LEVELS ASSOCIATED WITH INCREASED RISK OF DEATH IN MEN

Men who have a low testosterone level after age 40 may have a higher risk of death over a four-year period than those with normal levels of the hormone, according to a report in the August 14/28 issue of the Archives of Internal Medicine.

  • Low testosterone correlated with higher mortality rates

........Molly M. Shores, M.D., and colleagues at the VA Puget Sound Health Care System and University of Washington, Seattle, studied the relationship between hormone levels and death in a total of 858 male veterans older than age 40 years. All participants received care in the VA Puget Sound Health Care System and had their testosterone levels checked at least twice between 1994 and 1999, with at least one week and no more than two years elapsing between tests. The men were followed for an average of 4.3 years and a maximum of eight years, through 2002

...................... Men with low testosterone levels were still 68 percent more likely to have died. "The persistence of elevated mortality risk after excluding early deaths suggests that the association between low testosterone and mortality is not simply due to acute illness," they write. "Large prospective studies are needed to clarify the association between low testosterone levels and mortality."
(Arch Intern Med. 2006;166:1660-1665

Study Finds No Direct Links Between Testosterone Therapy, Diseases
A retrospective analysis by researchers at Beth Israel Deaconess Medical Center published in The New England Journal of Medicine found no causal relationship between testosterone replacement and prostate cancer or heart disease risk

1/28/2004

Low testosterone level is an independent determinant of endothelial dysfunction in men.
Hypertens Res. 2007 Nov;30(11):1029-34
PMID: 18250551

 

 

 

 


Dr. Fox serves patients needing testosterone supplementation or bio-identical hormones therapy from Seattle, Bellevue, Redmond, Kirkland, Bellingham, Tacoma, Olympia, Puyallup, Medina, Auburn, Kent, Des Moines, Alaska, Spokane, and Idaho. 

 


Serving the Greater Puget Sound Area
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Copyright © 2015 Dr. Scott Fox

Information on this site is meant for patients of Fox West Medical & Aesthetics Only

 * These statements have not been evaluated by the FDA. These products are not intended to diagnose, treat, cure, or prevent any disease. Contact your primary care provider prior to adding, changing, or stopping any medications you may be taking, or adding any supplements to the medications you take. A thorough discussion with your primary care physician is imperative prior to any changes in medications or supplements.

 

 

 

 

 

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