Testosterone Replacement Therapy
Domlur, Bengaluru Feb 12, 2017
As men grow older, their testosterone levels fall, with a steeper decline in unbound or free testosterone relative to total testosterone concentrations. This condition is called “andropause” (male menopause). Unlike Menopause, Andropause is less recognised and treated, since the onset is insidious and symptoms being subtle and non-specific. Excessive Alcohol, certain medications/drugs and pesticides in food can also lead to low Testosterone level (Low-T).
The common symptoms of andropause include decreased sex drive, low energy level, malaise, fatigue, aches & pain, muscle wasting, increase in belly fat, memory lapse, irritability and depression. Low-T increases the risk of typical age related diseases such as Diabetes, Osteoporosis, Ischemic heart disease, Alzheimer’s Disease and Age Related Macular Degeneration.
A large number of studies indicate that Testosterone Replacement Therapy (TRT) actually helps to improve cardiac function, increase muscle mass, decrease fat mass and decreases insulin resistance. It can reverse metabolic syndrome.
Interestingly, Prostate Cancer occurrence has been found to be associated with low-T; low testosterone levels pretreatment are related to a poor prognosis in Prostate Cancer. Long term TRT, contrary to general belief, significantly reduces the risk of Prostate Cancer. This fact has been endorsed by American Urological Association at their Annual Meeting of 2016. However, TRT should not be provided to men who have untreated or metastatic prostate cancer, and all those who are on TRT should be periodically monitored for incidental occurrence or recurrence of Prostate cancer. Furthermore, recent studies appear to suggest that there is no substantial risk of cancer recurrence if TRT is given to those who have been successfully treated for prostate cancer.
TRT can be in the form of injections, Pellets, Patch, Sublingual tablets, nasal spray and transdermal cream. My personal preference is for Compounded Bio-identical Transdermal cream as this is a more physiological approach and relatively safe. Such creams are not available in conventional pharmacies and can only be provided by compounding pharmacies against a doctor’s prescription. While on one hand it is important to ensure that the dose is appropriate, it is equally important on the other hand, that the patient is monitored to protect against potential side effects, particularly those arising from high dosing. A pre-requisite for TRT is to confirm that blood Total and Free Testosterone is low or low normal in an individual with some of the above mentioned symptoms. It is equally important to optimise Vitamin D, Vitamin B12 and Vitamin C levels along with adequate dietary supplements of anti-oxidants, micro-nutrients and Probiotics.
Despite the cardiovascular benefits of TRT, It is important to stress that TRT is not an excuse to slack off on exercise, diet and on adopting healthy lifestyle choices. Normalising testosterone to youthful levels no doubt makes one age gracefully and infuses a “feel good” factor.
Women too benefit from Testosterone therapy. It improves libido, and provides all the health benefits as it does in men. Needless to say, the dose of Testosterone cream in women is significantly lower than that for men. While TRT can be a boon to those with low T by providing them with better quality of life and longevity, additional consideration should be given to designing and testing interventions that may prevent or ameliorate the age-related decline in testosterone levels in men.