Hormone Replacement Therapy Pittsburgh

AS WE AGE, HORMONES DECREASE….. AS HORMONES DECREASE, WE AGE.

Hormones for Women: There are six reasons you should consider bio-identical hormone therapy.

• Relief of menopausal symptoms such as:  disturbed sleep, irritability, headaches, bloated feeling, foggy brain, vaginal dryness, memory loss, joint pain, decreased libido.

With hormonal decline, our brain, bones, heart, vessels, joints, skin, mood and most importantly, quality of life, decline rapidly. But what are our options? Should hormones be replaced or should we age “naturally”?  Are bio-identical hormones safe? These are the most common questions asked by my patients.

What Are Bio-Identical Hormones ?

Bio-identical hormones are compounded in a pharmacy from yam or soy by removing and adding extra molecules so they have the same chemical structure as those hormones made by the body, and are recognized by your cells and tissues as your own.  Another example of this kind of hormone is Humulin insulin, now used instead of pork insulin.

Soy and yam hormones, are also available over the counter and although they have many health benefits; they are barely recognized by human estrogen and progesterone receptors. Therefore, they do not effectively reverse or treat the hormone deficiency.

What Are the Benefits?

Bio-identical hormone replacement  will significantly reduce symptoms associated with hormonal decline before, during and after menopause including hot flashes, vaginal dryness, skin thinning, memory loss, concentration loss, anxiety, depression, weight gain, irritability, fatigue, insomnia, decreased sex drive, urine loss, muscle weakness and joint pain. In addition to symptom relief, Bio-identical hormones protect your brain, heart, vessels, bones, skin, hair follicles and muscles from decline. Most patients who start on bio-identical hormones feel emotionally and physically better within two weeks.

Is There a Risk of Increased Cancer if you take Bio-Identical Hormones?

90% of postmenopausal women who develop breast cancer have never taken any hormonal replacement. The HRT Solution by Algrimm, 1999.

Are There Any Risks?

We know that bio-identical hormones have been used in Europe for over 60 years and studies show that they are both safe and effective.

They have been shown to protect against heart disease, high cholesterol, osteoporosis, and mental decline.

They do not increase the risk of breast cancer, and, in fact, there is data showing that they may protect against breast cancer. At precise doses that exactly replace your body’s deficiency, there are no known side effects. They have the exact same action on the body as our own hormones.

To date, when used appropriately and balanced, there is no risk of cancer, blood clots, heart disease, Alzheimers, osteoporosis.  In fact, these diseases are all seen to decrease in women on BHRT.

What are the Risks Using Synthetic Hormones?

In 2002, the Women’s Health Initiative Program halted its study on synthetic hormones three years early because of the increased risk of breast cancer in women taking these hormones.

The study results revealed the following on women taking Prempro, a combination of premarin (estrogen from horse urine) and progestins):

Synthetic hormones have extra molecules which are not recognized by the body. They are not broken down by our body’s enzymes and they may stay in the body for long periods of time as toxins and carcinogens. Despite the study results, Prempro is still being prescribed by MD’s, and insurance still covers the use of this drug.

Should You take BHRT?

Some ask, am I safe taking hormones. I ask how safe are you without your hormones? The cells in your brain, heart, vessels, bones, skin, hair follicles and muscles all have receptors for hormones. As the hormone levels dwindle, all these cells and tissues lose stimulation, leading to a rapid decline and advance of degenerative diseases. If you would correct a vitamin or mineral deficiency with bio-identical vitamin or mineral replacement, you should consider replacing a declining hormone.

Bio-identical hormones are an excellent and safe option for women interested in BHRT.. Make your appointment today to consult with Dr. Donaldson on which BHRT program is best suited for you and your needs.  Dr. Donaldson will order necessary tests and spend time with you in making this decision.

 References

1. Morgentaler A. Testosterone for Life. New York: McGraw-Hill; 2008.

2. Morgentaler A, Crews D. Role of the anterior hypothalamus-preoptic area in the regulation of reproductive behavior in the lizard, Anolis carolinensis: implantation studies. Horm Behav. 1978 Aug;11(1):61-73.

3. Dominguez JM, Hull EM. Dopamine, the medial preoptic area, and male sexual behavior. Physiol Behav. 2005 Oct 15;86(3):356-68.

4. Rhoden EL, Morgentaler A. Risks of testosterone-replacement therapy and recommendations for monitoring. N Engl J Med. 2004 Jan 29;350(5):482-92.

5. Harman SM, Metter EJ, Tobin JD, Pearson J, Blackman MR. Longitudinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore Longitudinal Study of Aging. J Clin Endocrinol Metab. 2001 Feb;86(2):724-31.

6. Morley JE, Kaiser FE, Perry HM 3rd, et al. Longitudinal changes in testosterone, luteinizing hormone, and follicle-stimulating hormone in healthy older men. Metabolism. 1997 Apr;46(4):410-3.

7. Shores MM, Matsumoto AM, Sloan KL, Kivlahan DR. Low serum testosterone and mortality in male veterans. Arch Intern Med. 2006 Aug 14-28;166(15):1660-5.

8. Bain J. The many faces of testosterone. Clin Interv Aging. 2007;2(4):567-76.

9. Zitzmann M. Testosterone and the brain. Aging Male. 2006 Dec;9(4):195-9.

10. Kupelian V, Page ST, Araujo AB, Travison TG, Bremner WJ, McKinlay JB. Low sex hormone-binding globulin, total testosterone, and symptomatic androgen deficiency are associated with development of the metabolic syndrome in nonobese men. J Clin Endocrinol Metab. 2006 Mar;91(3):843-50.

11. Traish AM, Saad F, Guay AT. The dark side of testosterone deficiency: II. Type 2 diabetes and insulin resistance. J Androl. 2009 Jan-Feb;30(1):23-32.

12. Shores MM, Moceri VM, Gruenewald DA, Brodkin KI, Matsumoto AM, Kivlahan DR. Low testosterone is associated with decreased function and increased mortality risk: a preliminary study of men in a geriatric rehabilitation unit. J Am Geriatr Soc. 2004 Dec;52(12):2077-81.

13. Chuu CP, Hiipakka RA, Fukuchi J, Kokontis JM, Liao S. Androgen causes growth suppression and reversion of androgen-independent prostate cancer xenografts to an androgen-stimulated phenotype in athymic mice. Cancer Res. 2005 Mar 15;65(6):2082-4.

14. Tenover JL. Testosterone replacement therapy in older adult men. Int J Androl. 1999 Oct;22(5):300-6.

15. Pope HG, Jr., Cohane GH, Kanayama G, Siegel AJ, Hudson JI. Testosterone gel supplementation for men with refractory depression: a randomized, placebo-controlled trial. Am J Psychiatry. 2003 Jan;160(1):105-11.

16. Bhasin S, Cunningham GR, Hayes FJ et al. Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2006;91:1995-2010.

17. Lunenfeld B, Saad F, Hoesl CE. ISA, ISSAM and EAU recommendations for the investigation, treatment and monitoring of late-onset hypogonadism in males: scientific background and rationale. Aging Male. 2005;8:59-74.

18. Morgentaler A, Rhoden EL. Prevalence of prostate cancer among hypogonadal men with prostate-specific antigen levels of 4.0 ng/mL or less. Urology. 2006 Dec;68(6):1263-7.

19. Roddam AW, Allen NE, Appleby P, Key TJ. Endogenous sex hormones and prostate cancer: a collaborative analysis of 18 prospective studies. J Natl Cancer Inst. 2008 Feb 6;100 (3):170-83.

20. Rhoden EL, Morgentaler A. Influence of demographic factors and biochemical characteristics on the prostate-specific antigen (PSA) response to testosterone replacement therapy. Int J Impot Res. 2006 Mar-Apr;18(2):201-5.

21. Calof OM, Singh AB, Lee ML et al. Adverse events associated with testosterone replacement in middle-aged and older men: a meta-analysis of randomized, placebo-controlled trials. J Gerontol A Biol Sci Med Sci. 2005 Nov;60(11):1451-7.

22. Morgentaler A. Testosterone therapy for men at risk for or with history of prostate cancer. Curr Treat Options Oncol. 2006 Sep;7(5):363-9.

23. Agarwal PK, Oefelein MG. Testosterone replacement therapy after primary treatment for prostate cancer. J Urol. 2005 (Feb);173(2):533-6.

24. Sarosdy MF. Testosterone replacement for hypogonadism after treatment of early prostate cancer with brachytherapy. Cancer. 2007 Feb1;109(3):536-41.

25. Rhoden EL, Morgentaler A. Testosterone replacement therapy in hypogonadal men at high risk for prostate cancer: results of 1 year of treatment in men with prostatic intraepithelial neoplasia. J Urol. 2003 Dec;170(6 Pt 1):2348-51.

Hormone Replacement Therapy Pittsburgh

Hormone Replacement Therapy Pittsburgh

Hormones for men: There are five reasons you should consider testosterone therapy.

With hormonal decline, our brain, bones, heart, vessels, joints, skin, mood and most importantly, quality of life, decline rapidly. But what are our options? Should hormones be replaced or should we age “naturally”?  Is testosterone safe? These are the most common questions asked by my patients.

Testosterone has very precise, specific effects on highly complex behaviors that originate deep in the brain.” 2    The pre-optic area is responsible for many aspects of reproductive behavior in humans as well,3 and the interaction of testosterone with the brain is a fundamental fact throughout the animal kingdom. 1

The  World Health Organization (WHO) report, states, ‘testosterone, drops about 10 percent every decade starting around age 30’. By age 50, 30 percent of men have testosterone levels low enough to cause symptoms and put them at risk.  That’s an estimated 2 to 4 million men in the US alone!

In addition to testosterone, other natural hormone levels can be deficient in Andropause. These hormones can include Human Growth Hormone (HGH or IGF-1), DHEA, thyroid hormone, melatonin and others. Although, declining hormones are a normal part of aging, they are accompanied by a gradual and undesired decline in sexuality, mood and overall energy. Declining hormones also increase the risk of more serious medical conditions such as cardiovascular disease, diabetes, stroke, and osteoporosis.

The medical profession has long believed that levels decline as a natural consequence of advancing age,5,6 and  therefore there is nothing we can or should do about it,  That’s like telling a middle-aged person that since vision typically deteriorates with age, there’s no point in prescribing glasses—or that we shouldn’t treat atherosclerosis to prevent heart attacks, because it too is an age-related phenomenon. It just doesn’t make sense!”

What are the symptoms?

Unlike menopause, male hormone levels drop gradually and produce changes in:

Psychological stress, alcohol, injuries, surgery, medications, and obesity can contribute to andropause onset.

 What are the risks of hormone deficiencies?

More over, studies show that a decline in testosterone contributes to the risk of health problems like heart disease, osteoporosis,  weak muscles, Type II Diabetes, stroke, mental cognitive decline, and an increase risk of prostate cancer, .

Men with low T die earlier than those with normal T.7,12   That alone is ample reason to take notice.

In men, lifestyle, nutrition and hormones such as testosterone and growth hormone play critical roles in the maintenance of bones. As testosterone declines, male bone density falls by up to 15 percent.  Approximately one in eight men over age 50 have osteoporosis, leading to an increased  risk of hip, wrist, and spine fractures.  After a hip fracture, up to one third of patients never regain full mobility.

How do you know if you are in Andropause?

Symptoms are often vague, the first of which can be mild anxiety. Because of vague symptoms, physicians often do not think of low testosterone and attribute patient’s  symptoms to other medical conditions and ‘normal aging’.

Accurate diagnosis and treatment requires a thorough clinical history, physical evaluation and lab work to measure hormone levels.

How do you treat Andropause?

Any strategy to reduce the symptoms and risks of Andropause should be based on lifestyle approaches such as optimal diet, regular exercise, nutritional replacement, stress-management and the reduction of tobacco and alcohol intake. These critical factors affect hormone levels and their effects.

No patient is too old to start hormone replacement therapy  if it is indicated. As for any medication, hormones should be taken under a physician’s care, with appropriate follow-up evaluations. They are dispensed by injection, creams, gels, patches and oral capsules.

How does Viagra/Cialis work in Andropause?

Viagra or Cialis,  act on the penis only to maintain an erection. Testosterone works on the whole body, brain and all aspects of the sexual response including erectile quality and sexual desire.

What are the benefits of testosterone hormone replacement?

Clinical studies support the use of exercise, nutritional replacement, testosterone and growth hormone to treat the symptoms and prevent disease. Hormone replacement with testosterone and growth hormone has been shown to significantly improve sexual performance, libido, energy, mood, memory, brain function, heart disease, vessel disease, muscle strength, muscle tone, muscle mass, abdominal fat, bone density and overall sense of well-being. These effects are usually noted within just a few weeks.

What are the risks of testosterone replacement?

A recent 2004 study in the New England Journal of Medicine concluded that there were no long term risks of replacement therapy which aims to restore normal hormone levels. Historically, testosterone use has been associated with aggression and hypersexuality. These effects stem from the use of testosterone by men with normal testosterone levels who took testosterone at doses which were much higher than supplementation doses that are used in men going through Andropause.

In conclusion, correction of nutritional and hormonal deficiencies is important for the treatment of andropause symptoms and the prevention of degenerative diseases such as osteoporosis and cardiovascular disease.

Benefits of Testosterone

Androl 1992

Understanding Risks

The only conditions in which you should never use testosterone replacement therapy is:

What is a Normal Testosterone Level?

According to the FDA, “a ‘normal’ total T level is 300 ng/dL, “Strictly interpreted that would mean that a man with a level of 299 is low, while a man with a level of 301 is normal. That’s simply not a sensible approach. The Endocrine Society, produced guidelines that mirror the FDA, though they do point out that no single number should be used and that symptoms should guide the diagnosis.16 The International Society for the Study of the Aging Male17 uses a higher number, 348.  The point is that we need to interpret these numbers in the context of a man’s signs and symptoms.   In other words, if a man’s symptoms are consistent with low T and his level is anywhere near the low end of these scales, he and his physician should consider a trial of T replacement therapy.   In addition,  it’s the “free” testosterone that actually affects risk and performance, and standard testing measures only total T (free plus bound).

Side Effects

Testosterone therapy is very safe.  Testosterone hormone replacement is identical to endogenous testosterone. Side effects are minimal with appropriate treatment:

All reported side effects go away as soon as treatment is stopped.  And unlike the effects seen in body builders who use high-dose androgen injections and other non-testosterone hormones,  T therapy doesn’t cause kidney, liver, or cardiovascular disease. Patients are monitored by checking T and PSA levels, other hormone levels and nutritional factors,  skin and breast exam periodically, and blood counts once or twice yearly.

Testosterone Replacement and PSA levels

There’s no difference between PSA ‘trigger events’ (PSA over the threshold of 4 ng/dL) in men receiving T replacement and those who aren’t,” 20,.21

Testosterone Replacement and Prostate Cancer

There is a persistent fear T therapy causes prostate cancer which influences physicians and patients alike.

Dr Morgantaler** has done most of his research in this area and states:

“The last, and possibly greatest, hurdle to overcome is the persistent idea that TRT causes prostate cancer,” As I point out in my book, this concept turns out to be based on a very few, very sketchy, and very old reports, most of which have also been very inaccurately cited—but cited so frequently that they’ve taken on the aura of truth. In fact, while prostate cancers do usually need testosterone to grow, there’s interesting laboratory evidence that prostate cancer cells behave less aggressively in the presence of testosterone than they do without it, suggesting that normal levels of testosterone may even turn out to be beneficial for men with prostate cancer.13    Most of my research and scientific writing has been on the purported relationship between T therapy and prostate cancer.  The concerns have a historical basis—it’s long been known that reducing testosterone or its effects in men with metastatic prostate cancer makes the cancers smaller and slows their growth. That, perhaps naturally, led to the assumption that increasing testosterone would make the cancers larger and speed their growth.”

But in the past ten years, Morgentaler and other scientists have been aggressively challenging that assumption. “Long-term studies looking for increased incidence of prostate cancer in men with naturally high T levels have consistently failed to show any relationship at all,” notes Morgentaler. “Other studies showed that PSA was unchanged in men who received treatment that increased their T levels to more than twice the ‘normal’ range.” In fact, Dr. Morgentaler has published data showing men with  testosterone levels of less than 400, actually have an increased risk for prostate cancer!18

Other world-class researchers have become interested. A “pooled data” study by dozens of scientists in the Endogenous Hormones, Prostate Cancer Collaborative Group and published in the Journal of the National Cancer Institute reviewed 18 prospective studies that included 3,886 men with prostate cancer and 6,438 control subjects.19   The conclusion? serum concentrations of sex hormones were not associated with the risk of prostate cancer.

Based on the overwhelming wealth of data, Dr. Morgentaler is now beginning to provide T replacement therapy to men who’ve had prostate cancer—something that would have been anathema just a few years ago.22 Other experts are beginning to follow suit.23,24   Even more impressively, Morgentaler and his colleague Emani Rhoden at Harvard have also begun T therapy in men at high risk for prostate cancer—men who have biopsy-proven prostatic intraepithelial neoplasia (PIN), which is considered to be a precancerous condition.25

Cautionary note: Although quite a number of urologists and oncologists will now offer TRT to men with a history of prostate cancer, primarily after successful treatment of the cancer, many others are still concerned that treatment may increase the risk of cancer recurrence. And language mandated by the FDA for all commercial testosterone products advises against using TRT in men with any history of prostate cancer. The field still awaits large studies to determine the degree of safety of TRT in men with prostate cancer.  Currenty, it looks like testosterone replacement may decrease prostate cancer.

 

References

1. Morgentaler A. Testosterone for Life. New York: McGraw-Hill; 2008.

2. Morgentaler A, Crews D. Role of the anterior hypothalamus-preoptic area in the regulation of reproductive behavior in the lizard, Anolis carolinensis: implantation studies. Horm Behav. 1978 Aug;11(1):61-73.

3. Dominguez JM, Hull EM. Dopamine, the medial preoptic area, and male sexual behavior. Physiol Behav. 2005 Oct 15;86(3):356-68.

4. Rhoden EL, Morgentaler A. Risks of testosterone-replacement therapy and recommendations for monitoring. N Engl J Med. 2004 Jan 29;350(5):482-92.

5. Harman SM, Metter EJ, Tobin JD, Pearson J, Blackman MR. Longitudinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore Longitudinal Study of Aging. J Clin Endocrinol Metab. 2001 Feb;86(2):724-31.

6. Morley JE, Kaiser FE, Perry HM 3rd, et al. Longitudinal changes in testosterone, luteinizing hormone, and follicle-stimulating hormone in healthy older men. Metabolism. 1997 Apr;46(4):410-3.

7. Shores MM, Matsumoto AM, Sloan KL, Kivlahan DR. Low serum testosterone and mortality in male veterans. Arch Intern Med. 2006 Aug 14-28;166(15):1660-5.

8. Bain J. The many faces of testosterone. Clin Interv Aging. 2007;2(4):567-76.

9. Zitzmann M. Testosterone and the brain. Aging Male. 2006 Dec;9(4):195-9.

10. Kupelian V, Page ST, Araujo AB, Travison TG, Bremner WJ, McKinlay JB. Low sex hormone-binding globulin, total testosterone, and symptomatic androgen deficiency are associated with development of the metabolic syndrome in nonobese men. J Clin Endocrinol Metab. 2006 Mar;91(3):843-50.

11. Traish AM, Saad F, Guay AT. The dark side of testosterone deficiency: II. Type 2 diabetes and insulin resistance. J Androl. 2009 Jan-Feb;30(1):23-32.

12. Shores MM, Moceri VM, Gruenewald DA, Brodkin KI, Matsumoto AM, Kivlahan DR. Low testosterone is associated with decreased function and increased mortality risk: a preliminary study of men in a geriatric rehabilitation unit. J Am Geriatr Soc. 2004 Dec;52(12):2077-81.

13. Chuu CP, Hiipakka RA, Fukuchi J, Kokontis JM, Liao S. Androgen causes growth suppression and reversion of androgen-independent prostate cancer xenografts to an androgen-stimulated phenotype in athymic mice. Cancer Res. 2005 Mar 15;65(6):2082-4.

14. Tenover JL. Testosterone replacement therapy in older adult men. Int J Androl. 1999 Oct;22(5):300-6.

15. Pope HG, Jr., Cohane GH, Kanayama G, Siegel AJ, Hudson JI. Testosterone gel supplementation for men with refractory depression: a randomized, placebo-controlled trial. Am J Psychiatry. 2003 Jan;160(1):105-11.

16. Bhasin S, Cunningham GR, Hayes FJ et al. Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2006;91:1995-2010.

17. Lunenfeld B, Saad F, Hoesl CE. ISA, ISSAM and EAU recommendations for the investigation, treatment and monitoring of late-onset hypogonadism in males: scientific background and rationale. Aging Male. 2005;8:59-74.

18. Morgentaler A, Rhoden EL. Prevalence of prostate cancer among hypogonadal men with prostate-specific antigen levels of 4.0 ng/mL or less. Urology. 2006 Dec;68(6):1263-7.

19. Roddam AW, Allen NE, Appleby P, Key TJ. Endogenous sex hormones and prostate cancer: a collaborative analysis of 18 prospective studies. J Natl Cancer Inst. 2008 Feb 6;100 (3):170-83.

20. Rhoden EL, Morgentaler A. Influence of demographic factors and biochemical characteristics on the prostate-specific antigen (PSA) response to testosterone replacement therapy. Int J Impot Res. 2006 Mar-Apr;18(2):201-5.

21. Calof OM, Singh AB, Lee ML et al. Adverse events associated with testosterone replacement in middle-aged and older men: a meta-analysis of randomized, placebo-controlled trials. J Gerontol A Biol Sci Med Sci. 2005 Nov;60(11):1451-7.

22. Morgentaler A. Testosterone therapy for men at risk for or with history of prostate cancer. Curr Treat Options Oncol. 2006 Sep;7(5):363-9.

23. Agarwal PK, Oefelein MG. Testosterone replacement therapy after primary treatment for prostate cancer. J Urol. 2005 (Feb);173(2):533-6.

24. Sarosdy MF. Testosterone replacement for hypogonadism after treatment of early prostate cancer with brachytherapy. Cancer. 2007 Feb1;109(3):536-41.

25. Rhoden EL, Morgentaler A. Testosterone replacement therapy in hypogonadal men at high risk for prostate cancer: results of 1 year of treatment in men with prostatic intraepithelial neoplasia. J Urol. 2003 Dec;170(6 Pt 1):2348-51.