March 7, 2011

Hormone Replacement for Men

 Hormone Replacement and InjectablesHormone replacement for men is beginning to become more popular, but many physicians have little experience and training in hormone replacement therapy.  Also, the negative media reports of anabolic steroids have frighten physicians and patients alike.

Hormone Replacement for Men

Hormone replacement for men is becoming more common and with it more questions. There is a tremendous difference in using physiologic doses of hormones in men who are deficient to improve their health and minimize their risk of future disease, and the use of supraphysiologic (extra high) doses of anabolic steroids used by athletes solely to improve performance.

Declining Hormones in Men

The two hormones that most frequently decline in males, and therefore are typically replaced include DHEA (dehydroepiandrosterone) and testosterone. Hormone replacement for men centers around these two hormones. Growth hormone is a third hormone that declines in some men and can be replaced in men suffering from Adult Growth Hormone Deficiency.

DHEA: The Mother Hormone

DHEA is the most abundant hormone in the body and is sometimes referred as the “mother of all hormones” as it is involved in the production of testosterone, estrogen, progesterone, and corticosterone.  DHEA production peaks to about age 25 then declines rather sharply, so that by age 65 a man is making only 10% to 20% of what he did at age 20.

DHEA seems to protect against cancer probably by stimulating the p53 gene and some studies have shown it to prevent prostate cancer and benign prostatic hypertrophy.  DHEA also shows anti-diabetic properties and has been shown to increase insulin sensitivity in animal studies.  Some patients report needing less insulin while supplementing with DHEA.

In a double-blind crossover study DHEA was shown to stimulate human growth hormone.  DHEA enhances immune function and shows some anti-inflammatory properties.   In some, it promotes fat loss probably by inhibiting glucose-6-dehydrogenase blocking the body’s ability to store fat.

Blood levels of DHEA can help determine a replacement dose.  Most men respond to doses in the 25 mg to 100 mg range.  Side effects are the result of too high of a replacement dose and include acne, increased facial hair, and increased perspiration.  Less common side effects include breast tenderness, mood alteration, and oily skin.

Testosterone: More than a Sex and Muscle Hormone

Called the sex or muscle hormone, testosterone provides benefits to nearly every part of the body. Numerous studies have shown an association between low testosterone and heart disease.  It reduces serum levels of inflammatory markers, improves insulin sensitivity, improves smooth muscle and endothelial function of the blood vessels, and normalizes cholesterol levels.

See related article “Low Testosterone Symptoms“.

Testosterone Therapy

Several options exist for replacing testosterone.  See “Testosterone Therapy”.  Intramuscular injection of testosterone is the gold standard and the best way to obtain optimal blood levels.  Injections are typically given once week for most men.  Some men get more consistent levels with a twice a week injection protocol.  Other treatment options include creams, gels, and patches applied to the skin, pellets place under the skin and even sublingual preparations now exist.  Dosage is determined by degree of symptoms and blood testosterone (total and free testosterone) levels.

Side effects of testosterone therapy include testicular atrophy (shrinkage), decreased sperm counts, increase red blood cell counts, conversion of testosterone to estrogen leading to breast development and/or tenderness.  Though testosterone does not cause prostate cancer it may increase tumor growth in men with existing prostate cancer.  Most side effects can be easily managed by adjusting the dose and other interventions.

More Than a Growth Hormone

Growth hormone is the most abundant hormone produced by the anterior pituitary gland located in the brain.  There is an association between low growth hormone levels and closed head injury, and some of the lingering post-concussive symptoms may be related to low growth hormone.  In adults, growth hormone is needed for growth and repair of tissues.

Benefits observed from growth hormone replacement include decreased body fat, increase muscle mass, improved lung function, protection against heart disease, improved energy, improved sleep, regrowth of vital organs, enhance immune function, increased bone density, faster wound healing, younger looking skin, regrowth of hair, improved mood and cognition, and better visual acuity.

For men meeting the criteria for Adult Growth Hormone Deficiency, growth hormone can be replaced in the form of daily injections into the subcutaneous tissue.

Hormone replacement for men is slowly gaining acceptance as it improves the quality of life for many men.

See related articles.

“Better Living Through Hormone Replacement Therapy?”

“Suffering From Low Testosterone Levels?”

“Testostereone Pellets for Men and Women”

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Dr. Joe Jacko


Dr. Joe is board certified in internal medicine and sports medicine with additional training in hormone replacement therapy and regenerative medicine. He has trained or practiced at leading institutions including the Hughston Clinic, Cooper Clinic, Steadman-Hawkins Clinic of the Carolinas, and Cenegenics. He currently practices in Columbus, Ohio. Read more about Dr. Joe Jacko

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