Dad is weak; Can T help?

Here’s a nice, concise description of T deficiency and treatment, which is consistent with everything I’ve been reading:

Low Testosterone Diagnosis and Treatment by Jeffrey Dach MD .

Low Testosterone Diagnosis and Treatment, the Male Andropause

Beginning around age 50, there is a decline in major hormone levels in both men and women with associated symptoms. For women this is called Menopause, and for men, it is called Andropause. For men, the decline is gradual and symptoms can be ignored for awhile. However, by the time men reach their seventies, most men have 30 to 50 percent less testosterone than they had when young. This causes muscle weakness, reduced libido, depression and loss of mental acuity. These symptoms are reversible with testosterone therapy and millions of men over age 50 are now using testosterone for this reason.

Testosterone Levels Decline with Age:

Testosterone Therapy is Increasing

About 2 million prescriptions for testosterone were written in 2002. This represents a 30% increase from 2001 and a 170% increase from 1999. There has also been a 500% increase in prescription sales in the past 10 years. The rise in prescriptions may be in part due to the increasing recognition low testosterone in ageing males (or andropause).

Medical studies suggest an association of low testosterone with increased morbidity and mortality. For example, there is a higher prevalence of depression, coronary heart disease, osteoporosis, fracture rates, frailty and even dementia with low testosterone states. (1A)

You might ask the question: Why isn’t testosterone therapy accepted by my doctor and the conventional medical system? Of course, there are many reasons for this.

Fake Testosterone in The 1940s and 1950s

A major reason is the debacle in the 1940s and 1950s, when patent medicine companies sold a synthetic "hormone" called methyltestosterone, pawning it off as the real thing. After a few years of taking this chemical form, which does not exist in the human body, many of the men developed liver cancer and heart disease. The experts proclaimed that "testosterone therapy" was dangerous, so testosterone research died and didn’t wake up until the late 1980s with the use of safer, bio-identical testosterone.

BioIdentical Testosterone

Bad Reputation from Abuse in Sports

Testosterone has a terrible reputation. After all, it is an anabolic steroid. We all know about overambitious athletes taking illegal steroids to gain a competitive edge. Following their example, 7 percent of male high school seniors have taken anabolic steroids. This is an example of tragic self induced hormone overdose, but it has nothing to do with the subject of testosterone therapy for the decline associated with aging which has important health benefits. In response to the sports abuse issue, Congress, in its ultimate wisdom, made Testosterone a Controlled Substance just like cocaine and morphine. Illegal use penalties are severe, with 5 years imprisonment for any doctor who prescribes testosterone improperly. No wonder doctors are reluctant to prescribe it.

Institutional Medicine is Opposed to the Idea

In November 2002, the Institute of Medicine declared that "existing scientific evidence does not justify claims that testosterone treatments can relieve or prevent certain age-related problems in men." I disagree with this statement. There are literally dozens of studies in the medical literature showing health benefits and safety of testosterone therapy. I believe that a normal level of testosterone, sustained for a lifetime, is one of the most important ways for men to maintain good health.

Safety Regarding the Prostate:

Does Testosterone Therapy cause Prostate Cancer? The answer is NO and is clearly found in the medical literature. Dr. Rhoden, in the January 2004 issue of the New England Journal of Medicine, reviewed 72 medical studies and found no evidence that testosterone therapy causes prostate cancer. (1) In fact, they note that prostate cancer becomes more prevalent exactly at the time of a man’s life when testosterone levels decline.

Does Testosterone cause Prostate Trouble?

Dr. Perchersky published a study in the International Journal of Andrology (2002), which examined men with low testosterone levels (2). He looked at multiple parameters, including prostate volume, PSA, and lower urinary tract symptoms like frequency and urgency. Of the 207 men studied, 187 responded favorably to testosterone treatment. These 187 all showed improvement in every parameter measured: Their prostate glands all decreased in size, their PSA numbers went lower, and frequency, urgency, dribbling, and getting up at night all improved. This study indicates that, far from causing prostate trouble, testosterone is actually beneficial for the prostate gland in the vast majority of cases.

A recent study by Leonard Marks, MD in JAMA again shows safety of testosterone therapy. "No treatment-related change was observed in prostate histology, tissue biomarkers, gene expression, or cancer incidence or severity. Treatment-related changes in prostate volume, serum prostate-specific antigen, voiding symptoms, and urinary flow were slight." (2A)(2B)

Benefits of Testosterone Therapy:

Benefits include positive effects on mood, energy levels, verbal fluency, strength, increased muscle size, decreased body fat and increased bone density. There is also an anti-depressant effect.

Benefits: Testosterone is Good for the Heart and Circulation

Dr. S. Dobrzycki studied men with known coronary artery disease and showed they had significantly lower levels of testosterone (J Med Invest 2003).(3) He also showed that lower testosterone levels was associated with reduced pumping ability of the heart.

Dr. C.J. Malkin showed that testosterone therapy reduced the risk of death from abnormal heart rhythms (arrhythmias). This was published in the American Journal of Cardiology in 2003 (4). Dr Malkin also reported that Testosterone acts a protective factor against atherosclerosis and plaque formation in arteries (J Endocrin 2003).

Dr. Gerald Philips at Columbia University, and Dr. Joyce Tenover of the University of Washington also showed that low testosterone correlates with increased heart disease. These are only a few of the many recent articles. Dr. Eugene Shippen presented an impressive study at a recent meeting I attended, in which testosterone therapy was used to successfully reverse diabetic gangrene of the lower legs and avoid amputation in many cases.

Testosterone Improves Cognitive Abilities:

Dr. Cherrier has an impressive array of studies which show testosterone improves cognitive and verbal abilities in men. (5)(6)(7)(8)

Adverse Side Effects of Excess Testosterone.

Adverse side effects from excess Testosterone administration listed in the medical literature are: sleep apnea, breast enlargement, testicular atrophy, excess blood count (polycythemia), and acne. Prostate issues such as possible stimulation of benign growth of the prostate (BPH) and worsening of urinary symptoms and stimulation of pre-existing prostate cancer growth are also included in this list. With careful monitoring of clinical and laboratory parameters, and keeping Testosterone levels within the normal range, these side effects can be avoided or minimized.

Monitoring of Testosterone Therapy:

Initially, a careful history and physical examination is required, as well as a testing panel which includes not only free testosterone levels, but also many other important parameters. As usual, it is important to work closely with a knowledgeable physician who is readily accessible and who can monitor adverse side effects and adjust treatment.

Recommended Reading:

The Testosterone Syndrome by Eugene Shippen, M.D.

Maximize Your Vitality and Potency for Men Over 40, Wright Jonathan V, Lenard L., Smart Publications,Petaluma, California, 1999

Testosterone and Andropause: the feasibility of testosterone replacement therapy in elderly men.
Lund BC, Bever-Stille KA, Perry PJ.
Pharmacotherapy. 1999 Aug;19(8):951-6. link

Case Scenarios in Androgen Deficiency. McCullough, Andrew MD, Rev Urol. 2003; 5 (Suppl 1): S41–S48. Link

References:

(1A) Salazar, J, Risks of testosterone replacement therapy in ageing men. Summary Expert Opinion on Drug Safety. November 2004, Vol. 3, No. 6, Pages 599-606

(1) Rhoden, E.L, Risks of Testosterone-Replacement Therapy and Recommendations for Monitoring Ernani Luis Rhoden, M.D., and Abraham Morgentaler, M.D. NEJM Volume 350:482-492 Jan 29, 2004.

(2) Perchersky AV et al. "Androgen administration in middle-aged and aging men: effects of oral testosterone undecanoate on di-hydrotestosterone, oestradiol, and prostate volume." International J Androl 2002; 25(2): 119

(2A) Marks, Leonard S., Effect of Testosterone Replacement Therapy on Prostate Tissue in Men With Late-Onset Hypogonadism A Randomized Controlled Trial. , MD JAMA. 2006;296:2351-2361.
(2B) Press Release for JAMA , Leonard Marks MD article

(3) Dobrzycki S et al. "An assessment of correlations between endogenous sex hormone levels and the extensiveness of coronary heart disease and the ejection fraction of the left ventricle in males." J Med Invest 2003; 50(3-4):162-169.

(4) Malkin CJ et al. "Effect of testosterone therapy on QT dispersion in men with heart failure." Am J Cardiol 2003; 92(10): 1,241-1,243

(5) Cherrier MM et al. "Testosterone supplementation improves spatial and verbal memory in healthy older men." Neurology 2001; 57(1): 80-88.

(6) Cherrier MM et al. "Cognitive effects of short-term manipulation of serum sex steroids in healthy young men." J Clin Endocrinol Metab 2002; 87(7): 3,090-3,096.

(7) Cherrier MM, Craft S, Matsumoto AH. "Cognitive changes associated with supplementation of testosterone or dihydrotestosterone in mildly hypogonadal men: a preliminary report." J Androl 2003; 24(4): 568-576.

(8) Cherrier MM et al. "Relationship between testosterone supplementation and insulin-like growth factor-I levels and cognition in healthy older men." Psychoneuroendocrinology 2004; 29(1): 65-82.

Continued …… Symptoms of Low Testosterone

Here’s a quick update on my dad. The endocrinologist ordered a fasting testosterone test. The results were:

Total T: 403 ng/dl (Range 280-800)
Free T: 3.8 pg/ml (Range 6.6-18.1)

He concluded that Dad’s free T couldn’t possibly be that low, so he repeated the test 2 weeks later. The new results were:

Total T: 438 ng/dl (Range 280-800)
Free T: 6.6 pg/ml (Range 6.6-18.1)

Notice that the Free T was profoundly low in the first test and extremely low in the second.

Based on these results, the endo hand-wrote the message “All normal. Levels good!” on the test results he sent to my father.

We’ve made an appointment with a new doctor.

Also, my dad fell again last night. Six stitches in the back of his head.

Your dad’s free TT CAN be that low. Your doctor was correct in requiring a second sample and might even ask for a third. However, both results, I reckon, are BLOODY LOW. Being at the bottom on the "normal" range is NOT good enough. You want to see him at least one third of the way up if now half way. That’s what I reckon anyway.

The problem often is (and that’s not to say this is the case with your dad) that as we get older, whatever TT we make quickly gets bound up by other substances and, particularly, what is known as sex hormone binding globulin. Have a look at Sex hormone-binding globulin - Wikipedia or Google sex hormone binding globulin and look for yourself. Worse, it can be aromatised and converted into estrogen, but I don’t think that is the case with your dad.

Lack of adequate free TT means your dad’s fat muscle ratio has gone right out of whack. Lack of muscle means loss of strength and falls.

Whatever you do, the first thing to find out is why his free TT is OK, but his bound is not. You need to find a doctor who understands all this and most don’t (in Australia anyway).

As I’ve said many times, supplementing with Divanal (95% nettle root ligans) will significantly increase free T without changing total T (it would probably get you’re father level to about 10 pg/ml within 4 weeks). It binds to the Sex Hormone Binding Globulin that can cause low free T levels. Older men in particular have high SHBG levels; so your father would be a great candidate for this. He should take I3C along with it (extracted from broccoli) to lower his “bad” estrogen.

RichM: I totally agree with you. My dad’s current endo really dropped the ball, in my opinion.

Man-of-10: This is a great tip, and something I might look into for myself. If subjective impressions can be trusted, I feel like my own T levels are dipping. They’re not terrible, but they’re not what they used to be, either. I’m not averse to a do-it-yourself approach for minor tweaking of my own system.

But I’m more cautious about my dad, and frankly he’s a lot more cautious than I am. He wants a doctor to tell him what to do. It’s funny. I’ve been calling my parents almost every day, pushing this idea about T treatment. They’ve been very slow to come around. They’re from the old generation that trusts their doctors. They think I’m opinionated and eccentric about all this. Maybe they think I’m falling for a fad. In any case, it’s only in the last few days that I’ve gotten them to line up with my own thinking on this subject. Today, I’m going in to visit them to give them a major brain dump. I hope they can take it. ;)

I googled divanil and haven’t found anything that positive about it. If it was any good at all, I think there would be lots of positive news, but I haven’t run across that. Too 50/50 for me.

Hey ModestoMan, there are some things about andropause that are well established and others that aren’t (that is not to say they are not true, though). You seem to have found a doctor who might know what he’s talking about. Arm yourself with whatever you can glean from here and your own web searches. However, remember, some of this could be bullshit. Split your knowledge into two groups — that you can be fairly sure about and that which you can’t. Listen to your new doctor, weigh it all up. Make sure your doctor backs up whatever he does with regular blood tests and these should be for life and at least at 3-monthly intervals.

One good thing you’ve said though, is that your dad’s total TT is OK — that means his balls are still working reasonably well (wish I could say the same about my own — I’ve posted heaps on where I’m at elsewhere on this site). It’s just that whatever he does make gets screwed up for some reason. For what it’s worth, I would not push for TT therapy (adding extra TT to his system). However, I might help his own TT production along a bit with hCG for as long as his total TT looks OK. It’s addressing sex hormone binding globulin or similar crap in his system that I’d be worrying about. If you add extra TT to his system, you’ll cause his own production to shut down and that’s not desirable in my opinion. Help him to help himself rather than taking it over if you follow my drift.

Good advice, Rick. I have a tendency to take over, especially with my folks getting older and being a little less quick on the uptake. I’ll make sure this is their decision. But that’s not to say I won’t guide them toward what I think is right ;) .

I’ll also try not to set their expectations too high. The goal should be for my dad to feel a little bit better, to get stronger, and to get more stable on his feet. Anything beyond that is gravy.

I’ll ask the new doc about hCG, aromatase inhibitors, SERMs, and SHBG inhibitors. Not only is my dad’s total T not so bad, his LH is actually low. THis suggests his testes may be up for much more than they’re currently producing. He might be able to get by without direct T supplementation. However, I read in Morgentaler’s book that many men can correct their serum levels through hCG, SERMs, and the rest, but still not feel that well. For some reason, direct T supplementation is generally associated with a more positive subjective response.

ModestoMan, I can understand your feelings here. You love your dad and hurt for him when things go a tad wrong. That’s a really good way to be (caring, that is). You must love him very much. Well done!

Can I add one other thing to what I said above, though. Very little is absolutely certain here, no matter who the person is, even Harvard educated folk. I am the principal author of several well respected, applied science texts in my country (very few can stand beside me and only one or two might be ahead in my field. That’s because I’ve retired and am not out there leading the pack anymore). I know there is stuff that I wrote only ten years ago that I wish I hadn’t. The problem is that our knowledge base is constantly changing. All you can do here is to hope that the decisions your dad makes are the best ones given what we know now. HRT for men is a relatively new science and our knowledge base on this topic is still growing rapidly.

Sorry to bug you again ModestMan, but further to your post above, please remember that if your dad does increase his total TT by whatever means, you’ll probably find that more of it is converted to estrogen. That means he must include a test for that each three months. I reckon that he should keep it in the lower third of the normal range for men. Arimidex can control it — I take half a tablet three times a week. My experience is that you can have TT way above the normal range, yet still feel crap — that’s the effect of estrogen.

But, on the topic of the thread, I sympathize strongly and hope that hormonal therapy might help your father. With luck, maybe some of the falls have been due to muscle weakness, and T might help him to rebuild some muscle. Just be cautious and be mindful of the doc “experimenting” too much with your father as his guinea pig. It’s great you’re talking to your parents in detail about this.

Thanks, guys! I’m heading out soon and can’t reply in detail right now. But I’ll try to log on tonight.

Thanks for the support. Have you read Eugene Shippen’s book, “The Testosterone Syndrome?” He dedicates and entire chapter to the dangers of estrogen in men—his points are very much in line with yours. For some reason, Morgentaler didn’t talk much about estrogen in his book. I’m not sure why not. Perhaps he thought that information about testosterone supplementation was enough to subject the average man to and didn’t want to further confuse the matter with talk about estrogen. Many people have a very low tolerance for technical jargon—especially guys with testosterone deprived brains!

As for you other cautions, I will take those to heart and not assume anything about the doctor’s positions. In other words, I’ll accompany my dad to his appointment and arrive with books and studies in hand—including material about estrogen.

I know that a Harvard degree doesn’t confer magic powers (Morgentaler is actually an associate professor at Harvard Med School), but it is an indication of rigor. There’s a doctor 10 minutes from my house who specializes in HRT for men, but I chose not to bring my father to him because I wanted my dad to get the opinion of the most highly educated and respected guy available. I realize T therapy is somewhat experimental, so I want my dad to be in the best possible hands.

In your personal experience with HRT, have you had any scares or really unpleasant effects that you think an older man shouldn’t be subjected to?

Dinoiii Gets Re-ActivaTed: This Time Divanil has brought some Xtreme Friends! - Bodybuilding.com Forums

All the blood work is there. That guy is a Dr.. It lowered his estrogen and increased his free T by 50%.

No, not at all. All my experiences are now quite positive. However, my doctor really didn’t understand the issues as they related to me and it took SOME 2 OR 3 YEARS for him to get it right. My hope for your dad is that he won’t have to go through what I did time-wise. It could be that he throws the towel in if it doesn’t work first time around and he sees instant results. I remember my dad who passed away in 2005 — he had a VERY low tolerance to mistakes or things not going as he’d like as he got older. That’s a function of an old age mindset which you cannot predict. Whatever, I have no idea where your dad is at right now.

I should explain a bit more — my doctor was VERY cautious. He took things in VERY small steps and backed each change in my regimen with a blood test. Each blood test was three months apart from the previous one. At the time, I was in my mid 50s and, while I’d have liked everything to be sorted out right now, had a bit more patience than an 83-year old and accepted the need to take things in small steps. The problem here is that there is no one single solution to the problem — we’re all different and respond best only to a particular regimen. What worked for me will be different for your dad. For a start, his balls still seem to be working and he’s making his own TT in reasonable quantities. Mine had failed. Your dad’s problem seems to be that what he makes is bound (SHBG) fairly quickly. Mine wasn’t, but it did become an issue when I went onto HRT — estrogen became a problem then too. Sorry buddy, but you’re going to have to take one step at a time, encourage your dad as much as you can (he could loose heart) and see what happens.

Despite what I have said above, I reckon nothing could be worse that where he’s at right now — it’s crap. While things might not get better as fast as he’d like, I really don’t believe they’ll get worse either. I believe HRT will improve things out of sight. It’s how quickly that’s the issue and, along with that, your dad’s patience or lack of it.

Incidentally, I wouldn’t go to the doctor with books or printouts from the Internet under your arms. That’ll put him off big time. Sorry buddy, but you have to have it all in your head and be able to discuss it with him rationally. Outwardly, you should present a submissive demeanour (he’ll reckon he’s the expert), but still someone who, maybe, understand many of the issues at hand — don’t be seen as an expert who knows it all. Please, don’t be aggressive.

Last, yes I have read Eugine Shippen’s book. However, I’m in the US at present and can’t check, but I think he wrote his book more than 10 years ago. There have been tremendous technical advances in those years and, now, expect that some of what he wrote is out-of-date. I strongly suspect that he’d write a quite different book were he to do it today. It was a very good book in its day, but we’ve moved on.