Posted: 10. June, 2011
If you are a male over fifty years old, and believe that you may need testosterone-hormone-replacement therapy (THRT), you should seek out a knowledgeable physician and have your levels of total and free testosterone measured. Again, you will want to determine how your plasma levels compare to an average man of twenty-five, not to other males your age who undoubtedly also have experienced a decline in biologically active testosterone.
One of the reasons some physicians may balk at giving you THRT, even if your levels of bioavailable testosterone are quite low, is that they are afraid you will develop benign prostatic hypertrophy (an enlarged prostate gland), or even prostate cancer. In fact, there is no compelling evidence that THRT causes benign prostatic hyper¬trophy or prostate cancer, only evidence that if you already have these disorders, THRT may make them worse. This is why if you are considering THRT, you must have a complete blood chemistry done that includes a hematocrit, a digital prostate exam, and a pros¬tate specific antigen (PSA) blood test.
If you and your doctor decide to start you on a testosterone regime, you should continue to monitor your hematocrit, PSA, and prostate size every few months to see if there are any adverse changes. If your PSA or hematocrit rises significantly, and/or your prostate enlarges, you need to cut back the dose of testosterone. If the problems fail to resolve, you need to cut back even further, or consider stopping the use of THRT altogether.
Another unfounded fear is that THRT increases the risk of heart disease in men. The reality is that while some synthetic versions of testosterone raise blood levels of LDL cholesterol and lower levels of HDL cholesterol, natural testosterone itself does not seem to adversely affect plasma-cholesterol profiles. Thus, the bottom line is that most older men can find a level of THRT that is safe and effective.
One last point: As of quite recently, it is no longer necessary to inject synthetic testosterone or testosterone-like drugs into muscle. The FDA has approved a testosterone patch with the brand name Androderm that releases natural testosterone in levels that mimic the body’s own release of testosterone, bringing levels up to those seen in young men. This user-friendly form of testosterone is ,a welcome arrival, as only about 250,000 of the estimated four to five million men in the United States alone with testosterone deficiency (most of it age-related) actually receive THRT.
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