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Low T: the male “disease”

Written by: Dr. Fred Harvey, MD

There is a lot of hype around testosterone replacement for men these days. We see clinics and ads hawking shots or creams for fixing every malady under the sun. Primarily sold as the answer for erectile dysfunction or just low libido, testosterone replacement has become a real fad. However, it is a potent chemical that is so risky to use that the FDA made it a controlled substance like opiates and sedatives. Misuse of it can cause metabolic changes in folks who do not want a beard. It can close the bone growth centers in adolescents and stunt their growth. Additionally, it can cause liver damage when taken in high dose orally. Therefore, I recommend the use of this strong and useful hormone judiciously due to those risks. At the Harvey Center we use science and laboratory testing to guide hormone replacement.

Let’s define Bioidentical. This means exactly like in the living organism. Androgen refers to the line of human hormones that produce masculinizing effects. So Bioidentical hormone replacement therapy (HRT) would use testosterone, the principle human male hormone, rather than synthetic steroids that mimic human ones. My preferred method is topical daily replacement with a cream gel, because our human diurnal (day-night) physiologic cycle involves a daily morning spike in testosterone which drops off steadily until night resulting in less stimulation for good sleep. One drawback of HRT topical cream is that the user must be diligent to wash hands and to keep the area of application covered when in intimate contact if the cream has not yet absorbed. Also, linens and clothing should be washed separately to keep the testosterone away from others. Weekly injections are another relatively convenient method of administering testosterone HRT. This way the testosterone gets to reach a low once weekly instead of daily. Pellets are one method that I do not recommend because they artificially override the normal axis of control between the master glands in the brain and the testes. Male fertility is also in question with that method. It seems safe in testing, but I prefer a more natural rhythm to mimic life’s normal diurnal pattern as we see with daily cream use.

DHEA is a bioidentical precursor hormone to testosterone, and it can support a lagging testicular production of testosterone. I always test DHEA when treating male hypogonadism (Low testosterone syndrome). Supplementation with DHEA can be helpful to support testosterone production. Estradiol is metabolically created from testosterone. Alcohol increases metabolic conversion of testosterone to estrogen; thus, excess alcohol may decrease available testosterone supplies. We also monitor the estradiol level to make sure that men are not wasting their testosterone through conversion to estradiol.

Call the Harvey Center to discuss whether science guided HRT is right for you. The Harvey Center is location at 3982 Bee Ridge Rd, Sarasota, FL. Ph 941-929-9355. Telehealth and second opinion consultations are available upon request. We can help you to achieve hormone balance, feel stronger and get better results in mental and physical activities!

Fred Harvey, MD doc@harveycenter.com

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