As men age, their testosterone levels slowly decline. When aging men have low levels of testosterone, the condition is often referred to as “andropause” because testosterone is included in a class of hormones known as androgens. Androgen deficiency is strongly associated with common medical conditions including metabolic syndrome, obesity, diabetes, hypertension and atherosclerosis; as well as elevations in triglycerides (TGs), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C). Androgens may provide a protective effect against the development and/or progression of atherosclerosis in men, and studies show that appropriate therapy can help relieve or partially reverse the progression of these problems in testosterone-deficient men.
Hypogonadism is the clinical term for low levels of serum testosterone in association with specific signs and symptoms, including:
- diminished sex drive and sense of vitality
- erectile dysfunction
- heart disease or worsening lipid profile
- reduced muscle mass and bone density
- increased fat mass
Hormone therapy is recommended for men with symptoms of hypogonadism and low total testosterone levels or high estrogen levels.
Testosterone replacement therapy (TRT) has relieved symptoms and improved the quality of life for many men. Laboratory values and clinical response should be monitored frequently so that any adjustments can be made to the therapy protocol. Studies have found that TRT was associated with beneficial effects on insulin resistance, cardiovascular risk factors, and symptoms in hypogonadal men with type 2 diabetes and/or metabolic syndrome.
By administering testosterone transdermally (through the skin) in a cream or gel, adequate amounts of testosterone can be absorbed to mimic the normal daily production. Testosterone can also be administered as a sublingual drop or a lozenge that dissolves in the mouth. Compounded preparations can be very advantageous because customized therapies increase compliance.
- the specific dose of hormone(s) needed by each man can be compounded as a dosage form that is most appropriate for the individual.
- there is no need to shave the scrotum to apply a patch and there is no skin irritation from patch adhesive.
For optimal results, it is vital that hormone therapy be combined with adequate exercise, proper nutrition, and appropriate use of nutritional supplements. The presence of prostate or breast cancer is an absolute contraindication for androgen replacement therapy. Guidelines recommend that TRT should not be initiated in older men with PSA serum levels above the normal range. Testosterone should be used with caution in men with severe heart, kidney or liver disease, increased red blood cell counts, and sleep apnea.