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Testosterone Replacement in Men
Balancing hormones in men and women is routinely practiced in the medical world. Areas that are routinely balanced or replaced include patients with hypothyroidism, diabetes, growth hormone deficiency, and Cushing's disease. These areas of medicine require replacement or balancing; in the case of diabetes and Cushing's, those patients would possibly die without replacement.
Hormone-related diseases fall under the specialty of endocrinology, and the list of conditions is almost 50 in number. There is quite a variety in that group of 50. Treatment protocols are not created equal. I say that because when dealing with conditions such as thyroid or diabetes, they are being addressed and monitored at an early stage in the condition to help prevent further disease progression. It doesn't seem like our sex hormones receive the same attention, but if we did treat earlier, could that prevent other issues that would be secondary to low levels?
Why is it that some areas are so readily accepted while others seem to be controversial? We could probably begin by stating that replacing testosterone, estrogen, or progesterone is not a lifesaving treatment, at least not immediately. The second fact about these therapies is that they are not patentable, so there is very little interest from the pharmaceutical industry because they don't have a way to benefit financially. That comment is strictly my opinion.
What we know about hormones is that God made us and gave us our hormones. In the case of sex hormones, they start to climb after puberty and remain elevated in our 20s and 30s before they begin to decline. For women, perimenopause, menopause, and post-menopause all affect these hormones differently. On the other hand, men see a slow decline of their primary hormone, testosterone, over this time. As we age, our hormones decline, leading to our bodies' degradation and eventually death.
Inevitably, we will all die. The questions that remain are when and how. I have written about longevity and vitality in the past outlining solutions for extending our vitality so that we can continue to do the activities we love without restrictions. Part of the solutions involves balancing or replacing our hormones to levels that will protect our bodies. Unfortunately, this is not the current standard of care in medicine.
Why is that? It may come from an FDA safety warning on testosterone-containing products after the release of studies that showed increased cardiovascular disease (CVD) events in patients on testosterone therapy. These studies were later found to be critically flawed and some experts felt that aspects of the FDA position were lacking in scientific evidence.
The Mayo Clinic did a review article on Testosterone and Cardiovascular disease in 2018 which came away with the following information:
· The increase in coronary artery disease and CVD death in men abusing anabolic steroids has led to the belief that testosterone harms the male heart.
· There is mounting evidence that normal testosterone levels benefit the male cardiovascular system.
· Testosterone deficiency is associated with an unfavorable metabolic profile including an increase in fat deposits, insulin resistance, diabetes, and adverse CVD events like heart attacks and even death.
The review said that newer evidence suggests that normal physiological levels of testosterone benefit the male cardiovascular system and that there is much good science to back this stance. The review concluded that "the benefits of treatment of low testosterone levels with testosterone therapy in men and women substantially outweigh any risks, according to the current data."
Another area of testosterone research has been looking at testosterone levels and how they correlate to Covid risk. Here is some of the research:
· A 2021 study in the Frontiers of Endocrinology looked at testosterone deficiency being a risk factor for severe COVID-19. Hospitalized men with COVID-19 present with a relatively low testosterone level translating into increased risk for ICU admission or death.
· In a 2021 European study looked at low testosterone and high estradiol to testosterone ratios being associated with hyperinflammatory state and mortality in hospitalized me with COVID-19. The study showed a significantly higher proportion of non-survivors had low testosterone compared to survivors. Low T and high estradiol to testosterone may serve as a marker for severity in this population.
· A 2021 study looking at Testosterone's Role in COVID-19 showed that low testosterone levels are associated with increased all-cause mortality in male ICU patients. The primary cause of death from COVID-19 is the cytokine store, an overactive immune response. Testosterone suppresses inflammatory factors and is protective against immune dysregulation, making low testosterone a risk factor
Looking at the data, it appears that testosterone can benefit your cardiovascular system. A low testosterone level may increase your risk of not responding adequately if you end up with a COVID-19 infection. If you are an aging male, it would be in your best interest to have these levels checked when you see your provider for a physical exam.
If you feel this is an area you would like to explore, it should begin with a conversation with your medical provider. If you come to a roadblock with your provider, you may have to look for a provider more aligned with your thought process. We work with many providers open to working on hormone balancing, which has not always been the case.
Keep in mind this is one piece of the puzzle. Testosterone therapy is not a one size fits all approach, nor is it any other area of medicine. Please stop or call the pharmacy if you want further information on this topic. Please visit my website at www.irsfeldpharmacy.com to find this and other archived articles in the blog section. Until next time, be vigilant about your health!!
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