How to Measure and Treat Male Hormone Deficiency.

by Dr. John G. Alevizos, D.O.

This article will focus on how to measure and treat male hormone deficiency. It should be noted that the articles in the coming several months will not be as technical as the past articles, and will actually be a bit more fun and easier to attain.

When it comes to hormone optimization, there are certain basics that apply. Hormone optimization is the final touch on an active lifestyle, good nutrition, exercise, stress reduction, antioxidants, etc.

We use hormones when it is necessary to treat a deficiency. Our goal is to titrate the hormones to youthful levels and monitor both how we feel on them and what the lab numbers say. Although the clinical response of how somebody feels should be weighed more heavily than what the actual laboratory values state.

What I am about to outline are advanced treatments, which are backed up by current medical literature more than any other field of medicine. You all have the internet at your fingertips and I encourage you to do further research on what I touch on here. You must remember that hormone optimization is necessary for anti-inflammation. Chronic inflammation is the cause and effect of most illnesses and diseases that go along with aging, obesity, a sedentary lifestyle, etc.

Let’s begin with the topic of how to measure and treat testosterone deficiency. As men, our testosterone peaks at 25 years of age and is maintained steady until 30 years of age. At that time, something interesting happens. Our sex hormone binding globulin (SHBG) starts to go up. When our sex hormone binding globulin is attached to our bioavailable testosterone, the complex is too big to cross the cellular membrane.

Remember, once again, that the organ with the most concentrated testosterone receptors is the arteries of the heart, and this is followed by the brain, then bone, then muscle, then fat, and finally the genital organs. When testosterone is bound to sex hormone binding globulin, it’s like trying to drive a pickup truck through a front door; it simply does not fit.

From the ages of 25-30 years to 75 years, we get a 30-percent decrease in total testosterone. However, there is a 50-percent decrease in bioavailable testosterone, and this is the testosterone that should be measured and treated. Saying the same thing in a different way, our total testosterone stays constant for a very long time. However, our bioavailable testosterone decreases beginning at the age of 30. Therefore, when you ask your doctor to measure your testosterone level, please ask for a total testosterone, free testosterone and percent bioavailable testosterone.

Free testosterone is not actually free; it is also protein-bound. Bioavailable testosterone is the testosterone that is able to cross the cellular membrane. However, certain smaller laboratories may not be able to test for bioavailable testosterone and in that case, one should use the free testosterone levels, realizing that the actual bioavailable testosterone is probably lower.

In life, when it comes to hormones, diet, exercise, etc., there is normal and then there is optimal. For example, using Quest Laboratories, their normal level of bioavailable testosterone for somebody under 70 years old is 110 to 575. Most of the men I test in their early 40’s tend to have levels around 120 to 130. Certainly, those levels are normal; however, they are far from optimal. According to the American Academy of Anti-Aging Medicine, optimal levels of hormones should be in the upper one-third of the normal range.

Let me start out by explaining the five ways to increase testosterone levels without using a prescription.

1. Vitamin D. Ultraviolet rays can raise testosterone by 120 percent, based upon a study by Boston State University. Vitamin D increases the immune system and the ability to recover from injuries and exercise. Vitamin D has thousands of functions in the body and I will devote an entire article to it next month.
2. Who remembers my first two articles that talk about sugar? A study at the University of British Columbia found that a diet high in sugar can temporarily lower testosterone levels. Not only does having a high insulin level in response to a sugary meal decrease testosterone, but it is very well-documented to decrease human growth hormone.
3. We need fat. Fat is not evil. This is not the 70’s or 80’s. Low-fat diets mean low testosterone. The International Journal of Sports Medicine found that men who ate the most fat also had the highest testosterone levels. However, like stated in my previous articles, you should try to eat mostly “good” fats such as beef, avocado s, olive oil, salmon, etc.
4. Hit the bench press. Pumping iron causes your body to release more testosterone for the repair of muscles, which makes them stronger, bigger and thicker. A study in the Medicine Science in Sports and Exercise found that weight training at low, medium and high intensities all produced the same testosterone spike. I hear all the time “I don’t want to get big and bulky and look like Arnold Schwarzenegger.” Believe me, hitting the gym even five days a week without the unnatural chemicals that some body builders use will not cause us to look like that. The optimal frequency of weight lifting for hormones seems to be three to five times a week.
5. Protein. A study in the Journal of Clinical Endocrinology and Metabolism stated that the lower your protein intake, the higher your levels of SHBG. Once again, this is a chemical that attaches to testosterone and keeps it from being used in our bodies. To maximize levels of protein, it is recommended that we eat two to three grams of protein per kilogram of body weight per day. Red meats are recommended because they are rich in protein and zinc, which are two key nutrients in optimizing testosterone.

Zinc is crucial to a man’s diet. Did you ever wonder why oysters are considered an aphrodisiac? It is because they are very high in zinc. All of us have body fat. In our fat, we have the aromatase enzyme, which takes testosterone and cleaves it into estrogen. The brain tastes the bloodstream, tastes the estrogen and then tells our male organs “I have enough testosterone and there’s no need to make any more.”

A man’s brain cannot tell the difference between testosterone and estrogen, and that feedback loop shuts down our natural production, and the estrogen has obvious unmanly effects on our bodies. At times, depending on our levels of obesity, it causes the development of breasts and it causes us to be shaped like pears rather than a V.

I encourage anybody who is more than 20 pounds over their ideal body weight to consider taking over-the-counter zinc, 25 mg, once or twice a day in order to block the aromatase enzyme that converts their hard-earned testosterone into estrogen.

There are many different prescriptions one can use for testosterone. There is the oral methyltestosterone, which is not recommended. Anything we put in our mouths that goes through the digestive system has a first-pass effect through the liver, and methyltestosterone is hepatotoxic (toxic to the liver and thus, can damage the liver). There is another form of oral testosterone that does not affect the liver, which is called Testosterone Undecanoate; however, this is not available in the U.S. and it must be taken three times a day.

Another method is the administration of pellets, which involves a minor surgical procedure. The pellets reportedly last approximately six months. However, the effects of inserting seven to 14 pellets under the skin actually last approximately four months and this is a very expensive alternative.

Most doctors prescribe transdermal testosterone, which is a cream or a gel that is applied mainly to the upper body. With my patients who do not apply it to the upper body where there is good circulation and actually use their buttocks, abdomens or sides, I have noticed that they achieve lower absorption. The downside to the use of testosterone gel is the fact that it can get on our wives or children. It can increase hair growth in the area of application, but unfortunately, not on our heads. In addition, some men simply do not absorb the gel well. Another downside is the cost. Commercially available AndroGel and Testin, if one does not have insurance, costs $350 per month. Even with insurance, there could be a $40 copay. A better way to go, if you are going to use gel, is to find a local compound pharmacist to make it for you, even in a dose that is stronger than the commercially available ones. Depending upon where you live, the gel made at a compound pharmacy will cost $25 to $50 cash per month.

I have observed, in my practice, that men who weigh less than 175 pounds do pretty well on the gel and are very close to the upper one-third of normal on laboratory testing. However, men who weigh more than 175 pounds need something more, and most of my patients receive injections. There is testosterone cypionate, which, unfortunately, has to be given once a week. For most of my patients, I administer testosterone Enanthate, which lasts 30 days. With an injection, as you can imagine, you get the same amount every single time and contrary to oral administration, it is not dependent on saliva, acid in the stomach or clearance by the liver; and contrary to skin applications, it is not dependent upon whether you swim, take showers or have a type of skin that does not readily absorb it.

I know that this is a lot of information and to all men who do not have the energy that they used to, whose tempers are shorter, who do not enjoy life, and who are simply living rather than living optimally, I recommend that you try hormones at least for one month before you decide whether or not they are for you.