Men don’t like to talk to the doctor unless they’re:
- Forced by the women in their lives
- In desperate need of a solution
We’re sure you’ve experienced situations where your male patients will even deny a health problem until it’s overwhelmingly affecting their lives.
Unfortunately, it’s up to you to talk about low testosterone levels and suggest hormone replacement therapy for your male patients. You can learn more about how to talk to your patients by dispelling the myths.
Challenges to HRT for Men
Most men want to feel more sexually active and accomplished. With low testosterone, this is a challenge. Most will cite rumors of how taking these supplements can harm their health. Fortunately, the studies show testosterone is safe and effective.
The Testosterone’s Effects on Atherosclerosis Progression in Aging Men study tracked men aged 60 or older who received either testosterone or placebo over three years. Researchers found that atherosclerosis did not appear any worse in the men receiving testosterone.
They did find the men receiving the actual testosterone had barely noticeable “sexual desire, erectile function, overall sexual function scores, partner intimacy, and health-related quality-of-life” improvements. In the study, it was noted that it did not differ significantly between the groups. The question in this study was if the men actually had low testosterone.
In a follow-up study of the Testosterone Trials, the National Institute of Health followed over 800 men with confirmed low testosterone counts. It concluded improvements in:
- All Aspects Of Sexual Function
- Walking Distance
- Mood And Depressive Symptoms
- Bone Density
- Bone Strength
However, it did not find that vitality or mental function improved. What slightly concerned the researchers was they did see a slight increase in the plaque in coronary arteries, contrary to previous studies, and the prostate-specific antigen, or PSA, used to detect prostate cancer increased. It was not determined if this increase was directly related to prostate cancer, or merely benign prostatic hypertrophy or other non-cancerous conditions.
According to Dr. Eric Orwell, a professor of medicine at Oregon Health & Science University, “A big problem is there are no sufficiently large or sufficiently long-term studies to answer this question [the risk of heart attack, stroke, prostate cancer, or the conditions]. On the basis of inadequate data, it appears there may be an increased risk of cardiovascular disease in older men who use testosterone and prostate cancer is theoretical, but unresolved, concern.”
Researchers and doctors note that the key to proper testosterone hormone replacement is adequately testing the levels of testosterone and matching the appropriate dosage.
One of the main problems noted by researchers is that some men use hormone replacement therapy, particularly testosterone, even though they have not tested for their levels. Many of these men experienced significant side effects of having too much testosterone in their system. Younger men tend to be more at risk of these side effects, which includes:
- High Blood Pressure
- Heart Attack
- Mental Health Decline
- Mood Swings
Surprisingly, nowhere in the research shows that increase testosterone levels from HRT show an increase of bulky muscle mass, sex-drive, or endurance for middle-aged or older men. The effects are only seen in younger men who are actively weight training regularly. Testosterone therapy may help prevent muscle loss, and marginally improve lean muscle mass, as noted in the studies above.
For these reasons, testing testosterone levels and matching treatment for that specific level is critical for the health of your patient.
HRT Options For Men
Most men use injections for testosterone hormone therapy. However, there are other options. Below are pros and cons of each delivery method and some information on the likelihood of your male patient’s compliance.
Creams and Gels
Primarily for hypogonadism, testosterone cream helps restore low-level testosterone deficiency, especially in younger men. Some brand names include AndroGel, First Testosterone, Fortesta, Testim, and Vogelxo.
A compounding pharmacist can produce creams that are absorbed better and are less likely to be transferred to partners and children. Some men prefer the easy application of creams and gels, noting the transdermal absorption of testosterone produces a better result. More frequent applications can be made during times of greater need, such as the anticipation of sex, although this increases the risk of toxicity.
Topical testosterone may produce side effects that include having the body change some of the testosterone into estrogen, which can increase breast tissue, pain, mood fluctuations, and hot flashes. Depending on the application and location, some men may experience skin problems, including itching, blistering, or dry skin. The skin problems may be relieved by changing the formula.
Transdermal patches work very well for delivering testosterone in small, measured doses. Most patches are applied every one to three days and used without worrying about bathing, swimming, or exercise. Although, there is an increased chance of excessive sweating causing the patch to fall off.
Many men find the patch convenient because of the ease of application and limited visits to the doctor’s office. It is often not recommended for men who have employment where they work outside during the summer or have jobs that require heavy lifting because of the risk of the patch falling off. The patch has an increased risk of creating skin problems, including redness and swelling. The testosterone causes some of the issues, while other times, it’s the adhesive.
One of the most common brand name patches is AndroGel. In some cases, an increased risk of cancer is associated with repeated use of the patch in the same location, such as near the breast tissue. There is an increased risk of over-application, primarily if multiple patches are used at the same time, especially where men hope the increased testosterone will help improve sexual activities.
Oral testosterone medication has not provided the most consistent or safe levels of testosterone over time. Although the FDA has approved many new drugs, they don’t often last long on the market. And, because the specific nature of some of the medications, they can only be used for certain types of low testosterone levels, as determined by a doctor.
The current type of testosterone used in oral medications is methyltestosterone, a similar, but not identical molecule. This form has been linked to heart disease, stroke, liver disease, mood problems, and impaired bone growth in younger men.
The most significant concern for oral therapy is the impact on the liver. Many oral medications are damaging to the liver, and it is noted with both estrogen and testosterone therapy, these medications have an increased risk of damaging the liver. There’s also a risk of leg cramps and fluid retention when using oral hormone replacement therapy.
Another concern is OTC supplements. These often are mislabeled, miscategorized, or simply misleading. They may cause various significant side effects.
The most common form of hormone replacement for men is injections delivered to the gluteal muscles or thigh muscles. Most men respond reasonably well to injectable testosterone therapy, as long as it is maintained on a regular schedule.
There are several downsides to injection therapy; the biggest one is that it needs to be done often at the doctor’s office. Most insurance companies will cover the cost of the medications, but will not cover the cost of office visits. In some cases, the doctor may allow you to deliver your own injections, but insurance often rejects this at-home treatment.
Injectable testosterone therapies also show a risk of increased blood clots and possible risk of cysts or tumors near the injection area. Although not replicated in studies, anecdotal evidence shows it uneven muscle growth near the area where the testosterone gets injected. Some men note one side of the body become stronger than the other, which is especially true if one thigh or one gluteal muscle gets favored over the other.
Bioidentical pellet therapy is relatively new and involves a small crystalline pellet injected just under the skin. It releases a measured dose of testosterone over four to six months. Studies show that pellet therapy does not affect blood pressure, glucose levels, or liver function in any adverse way and has a near-perfect compliance record. Additionally, pellets do not affect any clotting factors, increase the risk of thrombosis, or affect the chances of breast cancer. In fact, several studies show that testosterone pellet therapy is cardio-protective and may help preserve bone density.
Pellet therapy shows only rare side effects. At less than one-tenth of a percent, side effects are incredibly rare. The top side effect was the body spontaneously expelling the pellet out of the skin. Most people who have issues and side effects with other hormone therapies find a higher success rate with pellets.
At the Hormone Therapy Center of America, we work with the provider to be able to safely and effectively offer bioidentical hormones, increasing bioavailability, and lowering the side effects of the therapy.
As the longest-lasting therapy, ranging between four and six months, pellets maintain physiological levels consistently of the appropriate hormone. There are no peaks and valleys causing mood swings, inconvenient sexual desire, or other health problems associated with too much or too little hormones.
Discussing with your male patients the benefits of hormone replacement therapy should focus on decreasing mood swings, increasing healthy sexual drive, and having more energy. Of all the various methods of delivery for HRT, bioidentical pellet therapy provides consistent and safe dosage. We encourage you to talk to one of our representatives to review the studies available and learn how you can offer this HTCA pellet therapy to your patients.