How long can you live on testosterone replacement therapy. Overview of hormonal preparations for men. Indications for hormone replacement therapy in men

In the treatment of age-related androgen deficiency, the basis is therapy aimed at normalizing the content of testosterone in the blood plasma!!!
There are two ways to increase testosterone levels:
. androgen replacement therapy
. stimulation of the androgen-producing function of the testicles with preparations of chorionic gonadotropin.
Currently, the generally accepted standard for prescribing androgen replacement therapy for age-related androgen deficiency is the appointment of testosterone preparations. Indications for the appointment of certain androgenic drugs are discussed in the relevant chapters of this review, but we will briefly talk about our own experience of this therapy.
Given the presence of significant risk factors for hormone replacement therapy in men over 45 years of age (risks of oncological pathology of the prostate gland and cardiovascular diseases), despite the thoroughness of the preliminary examination, in the debut of treatment, we prefer testosterone preparations with a short elimination period from the body. Further, in the absence of negative dynamics in the clinical condition and laboratory data, we recommend that patients switch to testosterone depot forms.
The criteria for the effectiveness of the treatment of age-related androgen deficiency will be:
. reduced symptoms of androgen deficiency: increased libido, improved overall sexual satisfaction, reduced severity or disappearance of vegetative-vascular and mental disorders;
. in the treatment of more than 1 year - an increase in bone mass density, a decrease in the severity of visceral obesity, an increase muscle mass;
. normalization of laboratory parameters: an increase in the level of hemoglobin or the number of red blood cells, a decrease in the level of low and very low density lipoproteins with an unchanged level of high density lipoproteins.

Testosterone therapy has a beneficial effect on sexual function.

Testosterone therapy leads to an increase in muscle strength.

Testosterone Therapy Reduces Risk Factors for Cardiovascular Disease

The effectiveness of testosterone therapy.

Despite the clear success of androgen hormone replacement therapy in age-related androgen deficiency, treatment with gonadotropic drugs has very authoritative supporters with very serious arguments.
Here are their arguments:
1. Hormone replacement therapy has a number of serious disadvantages.
Intramuscular forms of testosterone preparations lead to significant fluctuations in the concentration of testosterone in the blood serum, often not physiological.
Oral forms of testosterone preparations are unable to maintain the physiological concentration of testosterone in the blood for a long time.
Implantation of testosterone preparations creates a non-physiological distribution of testosterone concentration over time.
Transcutaneous forms are expensive and cause local reactions.
Carefully selected therapy with gonadotropic drugs is deprived of all these shortcomings.
2. Under physiological conditions, Leydig cells synthesize not only testosterone, but also many other sex steroids - estrogens and progestins. The appointment of androgen replacement therapy leads to blockade of the synthesis of luteinizing hormone, and a decrease in the concentration of luteinizing hormone inhibits the synthesis of all other sex steroids in the testicles.
Stimulation of the androgen-producing apparatus of the testicles (Leydig cells) with chorionic gonadotropin preparations seems to be more physiological, since the synthesis of not only endogenous testosterone, but also all other necessary steroids is stimulated.
3. There is no doubt that endogenous testosterone produced by Leydig cells is better than any synthetic analogue. Therefore, in cases with hypogonadotropic hypogonadism, as well as in cases with age-related androgen deficiency, when it is necessary to preserve the sperm-forming function of the testicles, preference should be given to preparations of chorionic gonadotropin, which stimulates the secretion of own testosterone by Leydig cells.
4. It should also be noted that there is a preservation of the effect of the use of chorionic gonadotropin preparations in patients within 1-6 months after discontinuation of therapy, which is a positive additional aspect of the use of this therapy.
In conclusion, it should also be noted the disadvantages of stimulating therapy with chorionic gonadotropin preparations for age-related androgen deficiency.
1. Treatment with this drug is possible only after a test with chorionic gonadotropin. If this test is negative, then there is no point in conducting this type of treatment - there are no reserve capabilities of Leydig cells, there is no substrate for stimulation.
2. The need for weekly intramuscular injections for a long time.
3. Since chorionic gonadotropin stimulates the production of not only testosterone, but also estradiol, this type of therapy increases the risk of hyperestrogenemia and gynecomastia
4. Long-term treatment with chorionic gonadotropin preparations can lead to the appearance of antibodies to chorionic gonadotropin and the development of resistance to this type of treatment.

Representatives of the following associations took part in the development of recommendations: the International Association of Andrologists (ISA), the International Association of Aging Men (ISSAM) and the European Association of Urology. Authors: E. Nieschlag, K. Swerdlof, H.M. Behre, L.T. Gooren, T.M. Kaufman, T.T. Legros, B. Lunenfeld, T.E. Morley, C. Schulman, C. Wang, W. Weidner, and F.C.W.Wu.

Recommendation 1.
Definition of age-related hypogonadism.
(Late onset hypogonadism, LOH). A clinical and biochemical syndrome associated with old age and characterized by typical clinical symptoms and circulating testosterone deficiency. This can lead to a significant deterioration in the quality of life, have an adverse effect on the function of a number of body systems.

Recommendation 2
Age-related hypogonadism as a syndrome is characterized by the following:
. Easily recognizable signs - a decrease in libido, a deterioration in the quality and frequency of erections, especially nocturnal erections.
. Mood changes with a concomitant decrease in intellectual activity, cognitive function.
. Sleep disturbance.
. A decrease in muscle mass of the body, associated with a decrease in its volume and strength.
. An increase in visceral adipose tissue.
. Decrease in hairline and change in skin turgor.
. A decrease in bone mineral density with the development of osteopenia, osteoporosis and an increased risk of fractures.

Recommendation 3
In patients with presumed hypogonadism, a clinical and biochemical examination must be carried out. Special biochemical studies should be performed in the following scope:
1. Determination of the concentration of total testosterone in the blood serum and sex steroid-binding globulin (SHBG), for which it is necessary to take venous blood between 07.00 and 11.00 hours. To confirm the presence of hypogonadism, the most appropriate parameter is to determine the level of total testosterone and determine the concentration of free testosterone, using a mathematical calculation or its determination by a reliable method of equilibrium dialysis.
2. Currently, there is no generally acceptable value for the lower limit of the norm for total testosterone. However, there is general agreement that total testosterone levels above 12 nmol/l or free testosterone levels above 250 pmol/l do not require replacement therapy. There is a definitive consensus based on data from young adult men that total testosterone levels below 8 nmol/l or free testosterone levels below 180 pmol/l require testosterone replacement therapy. Since symptoms of testosterone deficiency begin to appear in the range of 8-12 nmol/l, the decision to prescribe therapy should be made for those specific patients in whom other causes of the present symptoms of hypogonadism have been excluded.
3. Determining the concentration of free testosterone in saliva is a fairly reliable approach. However, this methodology requires further standardization. Standards for adult men are not yet available in most clinics and reference laboratories.
4. In cases where the testosterone level is below or below the lower limit of the acceptable normal testosterone level characteristic of men, it is recommended to conduct a secondary determination of testosterone, as well as to investigate the content of luteinizing hormone and prolactin in serum.

Recommendation 4
1. It is well known that changes in the function of other endocrine systems are associated with age, but the significance of these changes is still poorly understood. In principle, the determination of thyroid hormones, cortisol, dihydroepiandrosterone and its sulfate form, melatonin, growth hormone and insulin-like growth factor-1 is not required in the definition of age-related hypogonadism. However, in cases where there are clinical symptoms of the corresponding endocrine disorders, the determination of the above hormones, as well as a number of others, is required.
2. Type 2 diabetes is common in older men. It is currently not clear what effect testosterone has on blood glucose and insulin sensitivity; therefore, treatment, first of all, should be aimed at compensating for diabetes, while it is also possible to prescribe testosterone preparations if the patient has a deficiency.
3. In aging men with complaints of erectile dysfunction, it is necessary to investigate the lipid spectrum of serum and the state of the cardiovascular system.

Recommendation 5
A clear indication based on clinical symptoms in combination with biochemical confirmation of low circulating testosterone levels should be provided by the clinician before prescribing testosterone replacement therapy.

Recommendation 6
1. Testosterone therapy is absolutely contraindicated in men who are suspected or already diagnosed with prostate and breast cancer.
2. Men with severe polycythemia, untreated sleep apnea, heart disease and severe symptoms of lower urinary tract obstruction, especially due to benign prostatic hyperplasia, are contraindicated in the appointment of testosterone replacement therapy. Minor obstruction is not an absolute contraindication to such therapy. After successful treatment of the obstruction, contraindications are removed.
3. In the absence of specific contraindications, the age of the patient, as such, is not a contraindication for the appointment of testosterone replacement therapy.

Recommendation 7
1. Natural testosterone preparations should be used for replacement therapy. All currently available intramuscular, subcutaneous, intradermal, oral, and buccal testosterone preparations are safe and effective. The treating physician should have sufficient knowledge and a specific understanding of pharmacokinetics, as well as be informed about the positive and side effects of each drug. The choice of drug should be made jointly by the doctor and the patient.
2. In the event of contraindications during treatment (especially prostate carcinoma), rapid discontinuation of testosterone replacement therapy is required. Short-acting drugs (transdermal, oral, buccal) in patients with age-related hypogonadism should be preferred over long-acting drugs (intramuscular, subcutaneous).
3. There are insufficient data to determine at what level it is necessary to maintain circulating testosterone during replacement therapy, taking into account its effectiveness and safety. At the moment of our knowledge, it is necessary to strive to maintain the concentration of testosterone in the blood at a level characteristic of young men. It is important to avoid superphysiological testosterone levels. Despite the desirability of maintaining a circadian testosterone rhythm, this should not be sought when conducting replacement therapy.

Recommendation 8
eleven . Alkyl substituted testosterone preparations such as 17a-methyltestosterone are absolutely contraindicated as they are hepatotoxic and therefore should not be administered to patients.
2. There is insufficient evidence to date to recommend replacement therapy for older men with dihydrotestosterone, as well as other steroids such as dehydroepiandrosterone, dehydroepiandrosterone sulfate, androstenediol and androstenedione.
3. Chorionic gonadotropin (hCG) stimulates the production of testosterone by Leydig cells, but in aging men this effect is weaker than in young men. Since there is insufficient information on the efficacy and side effects of human chorionic gonadotropin treatment in older men, its use is not recommended for the treatment of age-related androgen deficiency.

Recommendation 9
Improvement in the signs and symptoms of testosterone deficiency should be carefully monitored, and if there is no improvement, the patient's condition worsens, testosterone therapy should be discontinued.

Recommendation 10.
Rectal palpation of the prostate gland and determination of serum prostate specific antigen (PSA) is mandatory in men over 45 years of age, as well as determination of the volume of the gland before testosterone therapy is prescribed. In the first 12 months of treatment, the condition of the prostate is examined quarterly, and then once a year. Ultrasound-guided transrectal biopsy of the prostate is indicated only if the results of rectal palpation and serum PSA levels indicate a possible carcinoma of the prostate.

Recommendation 11.
Testosterone therapy is usually accompanied by an increase in mood and an improvement in overall well-being. The appearance of significant negative deviations in the patient's behavior during testosterone treatment dictates the need to modify the dose of the drug or stop therapy.

Recommendation 12.
Polycythemia periodically develops during testosterone treatment. Periodic haematological examination is necessary, for example, before the appointment of therapy, every 3 months for the first year, and then once a year. You may need to change the dose of the drug.

Recommendation 13
Density bone tissue increases during replacement therapy, it is possible to reduce the frequency of fractures. Therefore, assessment of bone density is desirable at an interval of once every 2 years.

Recommendation 14
In some patients with erectile dysfunction and low testosterone, treatment with testosterone alone does not work. In this case, in addition to therapy, phosphodiesterase-5 inhibitors can be included. Conversely, patients with erectile dysfunction and low testosterone levels who do not respond positively to phosphodiesterase inhibitors require the inclusion of additional testosterone drugs in therapy.

Recommendation 15
Patients who have been successfully treated for a prostate tumor and who develop clinical hypogonadism are candidates for testosterone replacement therapy long enough after completion of treatment for a prostate tumor. In this case, it is necessary to exclude the presence of a residual tumor. The patient should be informed about the possible risks as well as the positive effects of such therapy. In this case, the patient should be closely monitored. There are no solid arguments for and against this recommendation. The doctor must have good experience and knowledge to make a decision in each case.

Here's what you should know...

Testosterone replacement therapy can be called not only a science, but also an art. Unfortunately, most doctors do not turn out to be artists.
A "normal" testosterone level is an illusion. Without a definition of total, free, and bioavailable testosterone, you won't get the whole picture.
Hormone replacement therapy (HRT) with testosterone is prescribed based on symptoms, not blood tests. If you feel powerless, gain fat easily, have difficulty gaining muscle, have a low libido, and suffer from depression, then you may need HRT.
Low testosterone is treated with injections, gels, creams, capsules and food additives. In this case, testosterone injections are most effective.
HRT with testosterone is not replete with side effects. The main contraindication is prostate cancer. Also, such therapy can lead to thickening of the blood, but this condition is easily treatable.
Some results of HRT appear quickly, while others may take years to reproduce. You will get rid of low libido in a couple of weeks, as well as depression. But shedding excess fat and gaining muscle mass will begin gradually, will pass after a few months of a plateau, and will continue for years at a slow pace.

Hormone replacement therapy testosterone

Are your testicles doing their job?

So, in a testosterone blood test, you see a figure of 600 nanograms per deciliter (ng/dL). You know that the "norm" ranges from 200-1100 ng/dL. You sigh with relief, and mentally give "five" to your testicles, which were able to "squeeze out" a normal indicator. But what does this number really mean?

"Normal" testosterone is a dummy

Unfortunately, a testosterone level of 600 ng/dl means absolutely nothing. There are a lot of inaccuracies in a laboratory blood test for testosterone levels. Its concentration in the blood is constantly changing. The only way to get at least some reliable data will be to pass the urine collected during the day to the laboratory to measure the amount of testosterone and its metabolites. Alternatively, you can take at least three blood samples at different times of the day. In the laboratory, they will be connected together and tested.

However, almost no one does this. It is more expensive, longer and more troublesome. Besides, if you suggest this to a doctor, he will take you for a madman. And, really, who are you to doubt his competence, you are a miserable mortal? And why are you so worried about your testosterone? You should be content with useless blood tests, approximate testosterone levels, and supposedly functioning testicles, like most of the human herd on the planet.

And even if you donated a few blood samples, this is not a reason to draw any conclusions. First of all, because a "normal" testosterone level may not be normal for YOU.

Perhaps when you were in your 20s, your testosterone levels were off the charts, reaching 1100 ng/dl. However, now that you've barely hit the minimum 600 ng/dl, you spend your days scouring Facebook and other sites for information. If you had determined your testosterone background when you turned 30, now you would be able to judge the "normality" of the results. But then again, no one does.

Other team members: SHBG and estradiol

Another source of problems is sex steroid-binding globulin, or SHBG. It is a glycoprotein that literally binds sex hormones, which include approximately 60% of your testosterone. This number has been growing over the years.

The higher your SHBG level, the more your testosterone is bound, which reduces the amount of free hormone available to do its job. Therefore, even if your testosterone is 600, the lion's share of it is connected. That's just terrible. It's like you have a genie in a bottle, but you can't open it.

That is why, in trying to calculate the level of testosterone, the doctor should at least order an analysis for total, free and bioavailable testosterone, in order to understand the situation at least a little. But, as you may have guessed, no one does this, except perhaps a couple of doctors from the classical school.

We must not forget about estrogen, or rather, about the level of estradiol in men. Your testosterone may be normal, but elevated levels of estradiol will thwart any attempt by testosterone to make you the man you could be.

As you can tell, measuring testosterone levels is a rather laborious and tricky undertaking. Therefore, regardless of the results of laboratory tests, given their ambiguity, it is better to focus on the symptoms and a simple desire to be better from a hormonal point of view.

Signs of low testosterone

Are you familiar with the loss of strength? Have you ever gained fat for no reason, which you later could not get rid of? What about loss of muscle tone and lack of training progress? Do you have erection problems? Do you think about your lawn more than women's charms?

What can you say about premature aging? Problems with concentration and memory? Depression? Or maybe you lack "healthy aggression" when you do not take the initiative in matters of the heart?

Maybe you are too irritable, always on edge, and ready to rip off the head of that fat man in front of you in line who bought the last cinnamon roll? Any of these conditions can indicate low testosterone, including, paradoxically, the last item on the list about unjustified anger.

Historically, low testosterone, or hypogonadism, was characteristic of the Middle Ages and subsequent eras. According to a 2006 study, 39% of men over 45 suffered from this problem. According to another survey, 13 million men living in the United States had a testosterone deficiency, and only 10% of them received treatment.

There are changes. However, keep in mind that these statistics only include those men whose testosterone deficiency has been confirmed by a clinical examination, i.e. laboratory test results. Therefore, millions of men remain - mostly young or relatively young - whose tests are within the normal range, but their well-being indicates a clear hormonal imbalance.

It also doesn't count young people who don't test their testosterone at all. Millions of such people may also experience a lack of this hormone. The reason does not always lie in the aging of the body. Rather, it is due to the influence of estrogen from environment, inhibition of the functions of the pituitary gland and testicles chemicals in general, as well as a well-fed, comfortable, modern, comfortable lifestyle, where there is no place for bursts of testosterone.

It is said that the testosterone level of the modern average man is about half that of his grandfather at the same age and living conditions.

Get tested wisely

Your first task is to find a forward-thinking doctor, or specialist, who is at least not intimidated by motivated patients. Fortunately, in any country there are now enough centers to combat testosterone deficiency. But most of them, regrettably, were organized hastily, and are not distinguished by high competence in the matter. This is an additional incentive to understand the topic on your own.

When you find a good doctor, describe your condition to him, express your desire to undergo testosterone replacement therapy, and ask him to order tests for you. But be sure to go through the procedure of laboratory research in the following way. (For example, if you do not specify that you need a specifically “sensitive” estradiol test for men, then laboratory assistants measure it for you as if you were a ballerina from the Bolshoi Theater suffering from menstrual irregularities).

You need the following tests:

Testosterone, total
Testosterone, bioavailable
Testosterone, free
Estradiol (sensitive assay)
Follicle stimulating hormone (FSH)
luteinizing hormone (LH)
Dihydrotestosterone (DHT)
Complete blood count (CBC)
Prostate specific antigen (PSA)
Blood chemistry
Comprehensive metabolic panel

The indicators of these analyzes will serve as a reference point. With them, you will compare the results of the examination after three or six months to judge the correct dosage of the drugs and the manifestation of any hidden side effects.

What drugs are used in testosterone replacement therapy?

If you are found to be deficient in testosterone, or you are suffering from symptoms of its manifestation, you will probably want to get rid of it. To this end, a huge range of additives has been developed. (Alpha Male® and Tribex® are most effective). They are very effective and are recommended for healthy guys who want to increase testosterone levels to progress in bodybuilding. Obviously, such drugs will not the best choice for patients with clinical testosterone deficiency who decide to embark on the path of lifelong testosterone hormone replacement therapy (HRT).

1. Injections

Testosterone injections are among the elite means of HRT. While testosterone gels (see below) do align with the natural fluctuations of testosterone in the body, injections, when used properly, allow for greater muscle building, provide a boost in libido, and provide many other benefits.

In America, there are two types of testosterone injections: testosterone enanthate and testosterone cypionate. These esters have slightly different half-lives, but this is not so important, especially if you adhere to an adequate dosage and the appropriate method and schedule of application.

Most men need 100 mg of each drug per week. But some may need a lower or higher dose, about 200 mg per week. If you inject more, then it will no longer be testosterone replacement therapy, but a lightweight steroid cycle for bodybuilders.

Even with weekly injections (always on the same day), you can still suffer from signs of low testosterone, increasing with each new day after the injection. To avoid this, many men split the dose in half and inject it twice a week. So your testosterone levels will be more or less stable throughout the week.

Most athletes also tailor their hardest workouts to the hormonal ups and downs of HRT. But these are unnecessary troubles, especially if you inject testosterone twice a week. Such a small interval between injections will provide you with a constant testosterone rise.

In addition, instead of intramuscular injections, you can also give subcutaneous injections. Dr. John Crisler, the recognized testosterone guru, insists that subcutaneous injections are more effective, since 80 g of testosterone administered in this way corresponds to 100 g of the drug injected into the muscle. In addition, he notes that in this way you do not have to riddle the muscular abdomen with hundreds of holes during long-term HRT.

All you have to do is pinch the skin on your buttocks, thighs, or even your stomach, and insert a tiny needle into that crease at a 45- or 90-degree angle. Press the plunger all the way down, release the skin, and you're done. Whether Chrysler is right or wrong about this benefit of subcutaneous injections is not known for sure. But there is definitely some truth here, so it's worth a try.

2. Testosterone gels

As mentioned above, testosterone gels support the natural androgenic rhythm, and it can be assumed that mimicking the natural rhythms of the human body will give the best result. However, many believe that they are inferior to injections in their effectiveness.

Moreover, gels have their drawbacks. They should only be applied to freshly washed skin. For at least an hour you can not swim and sweat. Also, in no case should children and women (especially pregnant women) be allowed to touch the treated area of the skin until the substance is completely absorbed.

Having chosen the gel, you will have to apply it once (in extreme cases, twice) times a day. But it is not recommended to smear it with your hands. The gel left on the hands will not penetrate into the bloodstream. It's like smearing on an old impenetrable baseball glove. Instead, squeeze the gel onto your forearms and rub them together. That way you won't lose a drop.

3. Other forms of release

Other forms of testosterone preparations, including creams, capsules, and sublingual tablets, are out of the question. Creams can be very effective, but they leave a lot of dirt and absorb less than gels. Capsules and tablets are either completely useless or impractical. In addition, it is almost impossible to guess their exact dosage.

There are also other treatment protocols that have proven effective in combating secondary hypogonadism (in which the hypothalamus for some reason does not signal the pituitary gland to produce LH and FSH, which in turn cause the testicles to produce testosterone), for example, selective estrogen- receptor modulators (SERMs).

The two most common of these are Clomid (clomiphene) and Nolvadex (tamoxifen). They stimulate the production of LH by the pituitary gland, which activates the testicles. Detailed description these protocols are beyond the scope of this article.

HRT, your testicles and hCG

The greatest concern about HRT is associated with infertility and shrinkage of the testicles. It is true that HRT reduces the amount of sperm produced, but it is foolish to think that a replacement dose will protect you from fatherhood. In most cases, the testicles shrink and the volume of semen decreases. But this phenomenon is easily prevented by the concomitant use of human chorionic gonadotropin (hCG).

This drug duplicates the action of LH, so your testicles will continue to function. They will still produce sperm and testosterone, so no atrophy will occur. In addition, LH receptors are located throughout the body, and hCG binds to this entire system. It's funny, but still, thanks to this, men undergoing HRT or HCG therapy assure of their excellent health.

HCG is injected subcutaneously with insulin syringes and is easily available with a doctor's prescription. The recommended starting dose is 100 IU per day. Over time, you can increase the daily dosage, or vice versa, inject 200 or 500 IU twice a week.

Potential side effects of HRT

Several bad things can happen during HRT. One of them threatens you only if you have been diagnosed with prostate cancer before starting treatment.

Remarkably, there is no evidence that HRT causes prostate cancer, even after carefully reviewing thousands of studies and case histories. But for some reasons that are still unknown to us, hormone replacement therapy tends to exacerbate the condition of those suffering from this disease. Therefore, it is necessary to undergo a digital rectal examination annually, while continuing to monitor the level of prostate-specific antigens (PSA).

HRT can also lead to polycythemia (increased production of red blood cells by the body). Instead of flowing freely through your veins, your blood thickens and jolts like soft ice cream from a Dairy Queen machine. It is clear that because of this, heart attacks and strokes can occur when blood vessels are clogged with blood clots.

Therefore, you should control your hemoglobin and hematocrit. When the hemoglobin is above 18.0, or the hematocrit rises to 50.0, then you should adjust your testosterone dosage, donate blood to the Red Cross, or undergo a procedure called therapeutic phlebotomy (routine bloodletting in the doctor's office).

What about gynecomastia and heart attacks?

The fearsome gynecomastia has never been observed in men undergoing testosterone hormone replacement therapy. Gynecomastia, or the growth of breast tissue in men, was diagnosed exclusively in those taking significant dosages of testosterone (1000-3000 mg per week) or its analogues. Hair loss is possible, but everything usually returns to normal by the age of 30. If you have lived to your age without losing your hair, then it is highly doubtful that HRT will make you bald.

Other popular horror stories about testosterone about heart attacks and other troubles are vile slanders. On the contrary, men with low testosterone are more prone to various ailments, including heart problems, diabetes, dementia, and many other disorders typically associated with old age, death, and frailty.

Effects of hormone replacement therapy with testosterone

Testosterone affects the body in the most wonderful way, but not immediately. Despite the improvement in well-being, bordering on elation, which appears soon after the start of therapy, many physiological processes are launched only after some time.

sexual benefits. They begin to fully manifest themselves in the third week of therapy, after which a plateau effect occurs from 19-21 weeks.
Depression. If you have depression, it will begin to recede around week 6, but full recovery takes longer.
Anxiety, sociability and stimulation of the cerebral cortex (controlling attention and even creativity). Improvement occurs from week 3, and the plateau effect appears after three months of therapy.
insulin sensitivity. Increases in a few days, providing tangible results (loss of excess fat) in 3-12 months, and often lasts for years.

Most men with low testosterone levels report improvements in energy, sexual arousal, and mood after testosterone therapy. If testosterone is not enough, why not replace it? Don't be in a hurry. In fact, people with low testosterone do not need treatment.

Substitution therapy has side effects, and what benefits it brings and how much it can threaten health is unknown. Only men with symptoms of low testosterone and blood tests showing it to be a problem should consider therapy. Only in consultation with a doctor can you determine that this therapy is right for you.

Testosterone replacement therapy - video

Hidden symptoms of testosterone deficiency

Symptoms of testosterone deficiency are sometimes obvious, but can be difficult to discern. Testosterone levels in men generally decrease with age, but they can also decrease due to various conditions.

weak sexual excitability (libido);
erectile disfunction;
fatigue and lack of energy;
decrease in muscle mass;
hair loss on the face and body;
depression;
distraction;
irritability;
deterioration in health.

If a man has these symptoms and the test shows low testosterone levels, the doctor may prescribe treatment. Millions of men with relevant symptoms but normal test results therapy is not recommended. It is also not suitable for men whose testosterone levels decline with age.

Types of drugs with testosterone

patches (transdermal type): "Androderm" - a patch that is attached to the arm or torso, is taken once a day.
gels: "Androgel" and "Testim" - bags with a transparent gel. Testosterone is absorbed into the skin, applied once a day. "Androgel", "Aksiron" and "Fortesta" are also available in the form of aerosols, which makes it convenient to take the daily dose prescribed by the doctor. "Natesto"-gel is applied to the surface of the nasal cavity.
absorbed in the mouth: "Striant" - a small tablet, attached to the upper gums over the incisors for resorption. It is taken twice a day and restores testosterone levels in the blood for a long time.
injections and implants: testosterone is also injected directly into the muscles or implanted in small granules into the soft tissues of the body. Gradually, it is absorbed into the blood.

Why not just take a testosterone pill? Some experts believe that these forms of drugs adversely affect the liver. All other forms - patches, lozenges, injections - deliver testosterone directly into the bloodstream and bypass the liver.

What are the benefits of testosterone therapy?

What can you expect from testosterone treatment? It is impossible to say for sure, because the body of each person has its own characteristics. Most men note improvements in potency and energy. Testosterone also increases bone hardness, muscle mass, and, in some people, insulin sensitivity. Men also report an uplift in mood after replacement therapy. These changes are pronounced or barely noticeable - they are very individualized.

About one in ten men are enthusiastic about therapy, and about the same number say almost nothing. Most of the reviews are generally positive, with little variation from each other.

What are the dangers of testosterone therapy?

Side effects of replacement therapy are mainly rashes, itching, or irritation where testosterone enters the body.

However, there have been cases of heart attack or seizures associated with the use of testosterone drugs. Experts emphasize that the benefits and harms of long-term therapy are unknown, since large-scale clinical studies have not yet been conducted. Testosterone therapy can lead to:

benign prostatic hyperplasia (BPH): prostate increases under the influence of testosterone. In most men, it increases with age, impinging on the urethra, leading to trouble urinating. So, BPH can worsen due to testosterone therapy.
prostate cancer: Testosterone may contribute to the development of prostate cancer. Most experts recommend screening for cancer before starting replacement therapy. Men with prostate cancer or increased level content of prostate specific antigen (PSA) therapy is contraindicated.
temporary cessation of breathing during sleep (apnea): this problem can also develop and intensify under the influence of testosterone. It will be difficult for the man himself to identify it, but the person sleeping with him can tell about it. To make a diagnosis, a sleep study (polysomnography) is needed.
Blood clots: The Food and Drug Administration reports that testosterone replacement drugs are dangerous because they can cause blood clots. This develops the risk of deep vein thrombosis, pulmonary thromboembolism (its life-threatening blockage). The drugs can also cause blood clots due to polycythemia, an increase in the volume of red blood cells in the blood, which also develops under the influence of testosterone. Now this applies even to men who do not suffer from polycythemia.
heart failure: testosterone therapy is also not recommended for men with heart failure, as it can only worsen the condition.

It will be years before large laboratory studies give results and answer the question of what are the benefits and what are the harms of testosterone replacement therapy. As with any treatment, it is up to you and your doctor to decide if a therapy is worth the risks it poses.

Hormone replacement therapy is a way to maintain hormone levels at their natural levels through exogenous intervention, which is necessary if endogenous hormone production is reduced. Hormone replacement therapy is used, as a rule, at the age of 40-45 years and older, since it is at this age that the natural production of all hormones decreases. It goes without saying that the natural level for each person is individual, therefore it is recommended to take tests at the age of 30-35, so that in the future you can rely on this figure, and not proceed from general criteria. The bottom line is that reference values have a range, so for one person the upper value of the reference range may be the norm, and for another the lower one. It is not worth raising the level to the upper value for everyone in a row, because this will disrupt the homeostasis of the body, and HRT is a wellness procedure, and not a way to achieve sports results.

Hormone replacement therapy should be taken under the supervision of a doctor, since this procedure requires permanent monitoring of the condition endocrine system body, the work of internal organs and cancer. Unfortunately, there are not so many specialists who can provide competent assistance in this matter, and those who do are very expensive, so self-education in the field of medicine, and in particular endocrinology, is the way out. This article, of course, will not reveal even the thousandth part of the question, since, firstly, this is impossible, here you need to write a textbook and not one, and, secondly, the author does not pursue such a goal. The purpose of the article is to familiarize the reader with this topic, designate the main pros, cons, possible risks and directions in which to dig if the reader is interested in this type of treatment. In addition, the article will provide recommendations on lifestyle regulation and safe self-treatment for those who have test results that make them sound the alarm.

Benefits of hormone replacement therapy

1) An increase in libido, both in men and women, however, hormone replacement therapy itself differs depending on gender, but a general surge of strength, suppression of depression, in general, everything that is called an increase in the quality of life - all this can be provided by HRT, both men and women. In addition, cognitive functions improve, which include memory, thinking speed, etc., which allows you to lead a full-fledged professional life, which also helps slow down aging, and slowing down aging, not just symptoms, but aging, is the main goal and ability of hormone replacement therapy. .

2) Prevents a number of diseases: osteoporosis, atherosclerosis, regulates lipid metabolism, which helps prevent the development diabetes and "mirror disease" in men, improves immunity, reduces the likelihood of a heart attack by normalizing the ratio of testosterone and estrogen. It is worth noting that injections of testosterone or drugs that increase its endogenous secretion also prevent the secretion of cortisol, which, in general, is the main hormone of "aging", if we consider this process as the predominance of catabolism over anabolism of protein structures.

Indications and contraindications

Testimony to the use of hormone replacement therapy may be: an underestimated level of free testosterone or total testosterone, or an overestimated level of estradiol. All other indicators, whether luteinizing or follicle-stimulating hormones, or globulin indicators, are checked after violations in the ratio of testosterone and estradiol have been identified, so the main indication is the level of free testosterone. But, it is important to understand that the goal is not the anabolism of contractile proteins, therefore, it is impossible to underestimate the values of estradiol. Moreover, too low levels of estrogen will negatively affect the human condition, especially when it comes to women. In general, it is important for women to monitor both the level of androgens and the level of estrogen.

Contraindications: prostate or ovarian cancer, breast cancer, or liver disease, or venous thromboembolism. In the event that a person has cancer, then testosterone or growth hormone cannot be recommended for use, since both of these hormones stimulate division cancer cells. Testosterone affects the development of prostate, ovarian and breast cancer, and growth hormone affects any type of cancer. In this case, on the contrary, it is recommended to take drugs that prevent the conversion of testosterone to dihydrotestosterone, which slows down the development of the disease. With liver diseases, an excess hormonal load will create excessive stress, so you first need to cure the liver, and only then think about hormone replacement therapy. As for heart disease, recent studies show that testosterone, on the contrary, has a beneficial effect on the cardiovascular system, but the presence of diseases can still be a contraindication, although not unambiguous.

Tests and compatible lifestyle

Need to submit: general blood test and its chemical profile; analysis of total testosterone and its free form, as well as dihydrotestosterone; get tested for estradiol and progesterone; prostate specific antigen for men and predisposition to breast cancer for women; homocysteine and luteinizing hormone. But the main and primary are blood tests and tests of testosterone and estradiol.

Table #1 Optimal reference values for men aged 20-49

Source	LabCorp	SmithKline	Quest Laboratories
total testosterone	600-1000 ng/dl	500-833 ng/dl	500-1000 ng/dl
Free Testosterone	26-40 pg/ml	128-194 pg / ml	138-210 pg / ml
Estradiol	15-30 pg/ml	15-30 pg / ml	15-30 pg / ml

Table number 2 Optimal reference values for women aged 20-49

Low Free Testosterone: with normal values of total testosterone and estradiol, the cause may be the binding of testosterone to globulin - it is necessary to pass an analysis for globulin. If the tests show high globulin, aromatase inhibitors and / or antiestrogen are needed.

Low Testosterone: can be caused by an excess of aromatase, as a result of which testosterone is converted to estradiol, this process can also be caused by liver dysfunction; low levels of luteinizing hormone; if aromatase, liver and luteinizing hormone are normal, then most likely the problem is in the testicles, and it is necessary to administer an exogenous analogue of testosterone, if there is a problem with luteinizing hormone, treatment can be carried out with hCG, and for women with aromatase inhibitors or antiestrogens.

High estradiol: in this case, it is necessary to take antiestrogen and / or aromatase inhibitors; from self-medication recommendations may include zinc, magnesium, and vitamin D supplementation, reduced alcohol intake to the point of total withdrawal, reduction of subcutaneous fat, and reconsideration of other medications that may suppress testosterone secretion or promote aromatization. In general, these recommendations are relevant for the cases listed above.

Sources:

Fatieva I.Yu. "Human Anatomy. How Your Body Works"

Terney A. L. "Modern Organic Chemistry"

After the age of 40, hormonal changes are observed in men, which significantly suppress physical and sexual activity, mental abilities. Outwardly, this is manifested by obesity in the abdominal region, a decrease in muscle mass, a deterioration in general well-being, and sometimes a depressive syndrome develops. For treatment, HRT is prescribed for men - testosterone replacement therapy. Preparations based on hormonal components help to restore the level of testosterone in the blood, which avoids the harmful effects. Consider what hormone therapy is, to whom it is recommended, and what are its contraindications?

What is Testosterone Therapy?

Hormonal disorders in the body lead to serious complications in all organs and systems without exception. Therefore, hormone replacement therapy after the age of 40 for men is often the only treatment that can significantly improve the quality of life and avoid health problems.

Hormonal drugs are prescribed not only for men over 40 years old, but also in young age, since testosterone deficiency is not always due to age-related changes in the body. The cause may be injury to the spermatic cord, cancer, genetic pathologies, etc.

Worth knowing: the symptoms of testosterone deficiency include decreased/lack of libido, chronic fatigue, depression, aggressiveness and irritability for no reason, erectile dysfunction, obesity against the background of the previous diet, enlargement of the mammary glands. If there are 3 or more signs, it is recommended to consult a doctor and take a blood test for the level of androgens in the blood.

Testosterone replacement therapy has been around since the dawn of the last century. But its beneficial effects were only confirmed 40 years ago. Moreover, there is still no unambiguous opinion whether such a method of treatment is needed or not, which is due to the most severe side effects, sometimes of an irreversible nature.

Previously, hormone therapy was carried out with the help of tablet preparations, which included artificial testosterone in their composition. After taking them, the metabolism occurred in the liver of a man, where most of the active substance was destroyed. As a result, the liver "suffered" from the negative effects of carcinogenic and toxic components. This led to a violation of the functionality of the internal organ, which became the reason for the prohibition of such treatment in many countries of the world.

However, when similar drugs appeared that were not characterized by such adverse reactions, the ban was lifted. Often these medications are used by men who are professionally involved in sports, although this is prohibited.

HRT with testosterone has strict medical indications:

Natural andropause, due to which there is a pronounced deficiency of testosterone in the blood;
Pathological conditions, regardless of age group men who are accompanied by hormonal disorders. For example, diseases of the pituitary gland, gynecomastia, cryptorchidism, obesity, which cannot be treated with traditional methods.

Hormone therapy for men is carried out only on the basis of the results of laboratory tests. When appointed medicines with synthetic testosterone, all risks are necessarily evaluated.

Methods of administration of androgens

In modern medical practice the introduction of androgens is carried out different ways. Each method has its own advantages and disadvantages, so the choice is always made in individually taking into account the condition of the man, concomitant diseases, clinical manifestations, etc. factors.

Oral

Oral hormone replacement therapy for men involves the use of tablets / capsules inside. They contain the active substance in the required dosage. Pills are the very first form of hormonal drugs.

Advantages of the method:

Ease of use.
The possibility of urgent withdrawal of the drug.
Independent use without visiting the clinic.
Relatively low cost.

Important: tablets / capsules are effective only with a mild degree of androgen deficiency in the male body.

The tablet/capsule form is sold by prescription only. It is not recommended to buy online and in dubious stores, since this form of the drug is the easiest to fake. The replacement process is carried out with the help of such drugs:

Andriol. The dosage is 150-200 mg per day;
Striant take 30 mg three times a day;
Proviron. The dose varies depending on the level of androgens in the blood. Assign from 30 to 80 mg per day.

Tablets must be taken in the dosage prescribed by the medical specialist. During treatment, you should constantly monitor the concentration of hormones in the blood.

Injectable

According to many doctors, it is necessary to “replace hormones” with the injection method, since this is the only way testosterone enters the body smoothly and naturally. In most clinical pictures, cypionate and enanthate are used for testosterone therapy. Literally 100 mg of the drug provides a weekly supply of androgens for the male body. The dose is always individual - some men need less, others much more.

The weekly dose is divided into two applications, administered at regular intervals, which ensures a stable concentration of hormonal substances in the body. The following drugs are used:

Delasteril. The dose ranges from 200 to 400 mg.
Nebido. Administer once every three months.
Sustanol. The introduction of 250 mg every 1-2 weeks is carried out.

Fact: among all hormonal medicines, it is Nebido that is characterized by the most prolonged effect - one injection every 90 days and a minimal list of side effects.

The advantages of injection include the ability to create a high concentration of hormones in the blood; a wide range of new generation drugs.

transdermal

There are other ways to "replace" the hormone in men. For this, patches, creams and gels are used. Means of local action provide a gradual flow of the active component into male body which reduces the risk of side effects. However, according to medical experts, the therapeutic efficacy of this method lowest.

HRT in men by the transdermal method is carried out using drugs:

Androderm or Testoderm - patches. Used every day in the maximum dose - 7.5 mg of a hormonal substance;
Andromen is a hormonal cream. The daily dosage is 15 mg;
Andraktim - medicine in the form of a gel, the dose is always determined individually.

During hormonal therapy with gels and creams, you can not swim after applying medications. It is strictly forbidden to touch the treated area of \u200b\u200bthe skin of women and children, as this poses a health hazard. A significant disadvantage is that it must be applied several times a day, which significantly reduces the quality of life and habitual way of life.

Subcutaneous

Subcutaneous hormone therapy involves the use of an implant. The method is quite effective, however, implants with testosterone are not registered in Russia, which does not allow many representatives of the stronger sex to use this option.

For information, the main advantage of the method is the uniform release of testosterone throughout the entire period of the implant - 6 months.

The disadvantage of the method is surgical intervention, since the operation appears to be the only way to install the implant. Therefore, to side effects from hormonal treatment increased risk of complications after surgery.

Replacement therapy contraindications

Hormone replacement treatment is a serious step, so before prescribing drugs, you need to make sure that there are no medical contraindications. In addition, the doctor must tell the man about the likely side effects. Contraindications are relative - the use of hormonal drugs is allowed, but with caution and absolute - such treatment is strictly prohibited.

Testosterone replacement therapy is not carried out if a man is diagnosed with breast cancer (rarely). The use of androgens can provoke an increase in the concentration of estrogens, which leads to the progression of the oncological process.

Important: testosterone replacement therapy is prohibited against the background of cancer of the glandular organ in men. Before treatment, oncology must be excluded. To do this, a rectal examination of the organ is carried out, the level of PSA, a prostate specific antigen, is determined.

The use of hormones is carried out carefully in the following pathological conditions and diseases:

Apnea during sleep.
Gynecomastia.
Fluid retention in the body.
Puffiness.
Polycythemia.
Hyperplasia of the prostate.

In the presence of relative contraindications, constant monitoring by a medical specialist is required. The introduction of hormonal drugs can lead to serious complications - suppression of the production of one's own testosterone, inhibition of spermatogenesis, alopecia, atrophic changes in the testicles, etc.

The final choice of hormone replacement treatment depends on general condition patient, concomitant diseases and individual tolerance of certain drugs. Testosterone in any form should be prescribed exclusively by a doctor, independent use is fraught with serious consequences.

Prevention of testosterone decline consists in the right lifestyle (quitting smoking, alcohol, drugs), the consumption of environmentally friendly products, weight control, and the timely treatment of any diseases.