Before I launch into this discussion, I want to make a couple of points. I do not condone nor condemn the use of hormone replacement therapy. I am motivated to submit this article to the readers of the Performance Menu based upon some recent interactions I have had with a couple of my clients.

As their trainer, coach, mentor and friend, I encouraged them both to look deeper into the causation. One gentleman is in his late 40s, the other in his early 50s (Client X). Both guys are in what has been called the grey zone. It’s in the grey zone that men slow or stop production of testosterone http://en.wikipedia.org/wiki/Testosterone. The medical term for this condition is known as hypogonadal. The conditions and symptoms surrounding it have been label Andropause or androgen deficiency of the aging men (ADAM). I instructed both of these guys to return to their physicians for additional blood work. I also instructed them to seek additional information from what a hormone blood panel might reveal.

My instinct proved to be correct. Both guys were sub clinical on the testosterone levels. Their Free Testosterone readings were well below the reference range. Both men have since started hormone replacement therapy (HRT) and both are feeling and performing much better.

In 1998, a progressive practitioner, Dr. Eugene Shippen, published a book entitled THE TESTOSTERONE SYNDROME. In his practice Shippen was able to demonstrate that Testosterone was more than simply a sex hormone. The changes seen in aging, such as the loss of lean body mass, the decline in energy, strength, and stamina, unexplained depression, and decrease in sexual sensation and performance, are all directly related to testosterone deficiency. Degenerative diseases such as heart disease, stroke, diabetes, arthritis, osteoporosis, and hypertension are all directly or indirectly linked to testosterone decline. Secondly, testosterone also functions as a pro-hormone. Local tissue conversion to estrogens, dihydrotestosterone (DHT), or other active metabolites plays an important part in cellular physiology.

Shippen was able to demonstrate in his practice that if he could add back or replace testosterone to appropriate levels that his patient’s health improved from both a subjective and objective standpoint.

I was able to sit down with one of my clients to discuss his experiences. Client X wishes to remain anonymous for this writing. I was also able to secure a visit with a progressive physician in town. Dr. Z does not advertise as an anti-aging physician but has an estimated 25% of his male patients on a HRT regime.


WHAT SYMPTOMS DO YOU LOOK FOR IN A MALE WHO MIGHT BE LOW ON TESTOSTERONE?

Dr. Z: Here are some of the classic symptoms:

· Erectile dysfunction
· Decreased libido
· Mood disturbances, including depression, irritability and feeling tired
· Loss of muscle size and strength
· Osteoporosis
· Increased body fat
· Difficulty with concentration and memory loss
· Sleep difficulties

Most of the males I work with are highly successful. They have built or been leaders of companies. They are bulletproof and can tough their way through almost anything. It’s a compromise to admit that they might be breaking down. We will not know for sure until we get them into the lab.

Client X: For me it was really a mood disturbance. I had no drive or motivation. My business was healthy but I was on auto pilot. I thought I was depressed and my initial visit to the doctor I left was a prescription for anti-depressants. Thank God I never filled it. I started to look for more answers.

I was also very sore when I exercised. I had been active my whole life. It just didn’t make sense that I had all this muscle soreness from exercising.

It wasn’t that my sex life was completely shutdown, but I did not have the same drive.
Within four weeks or four treatments I could feel a difference. It was not subjective or placebo.


DR. Z, WHAT LAB TESTS DO YOU ORDER TO DETERMINE AN OVERALL HORMONE PROFILE?

The only way to clinically demonstrate a deficiency is via the label. I now instruct all my male clients interested in learning more to select for the following lab tests. Most practices have no idea how to deal with these types of tests. Our practice looks at these things so frequently that we are prepared to deal with them.

Basic
· Red cell/white cell
· Fasting blood sugars & Insulin
· Kidney, liver
· Lipids
· PSA

CV Panel
· Homocysteine
· Lipoprotein (a)
· Fibrinogen
· C-reactive protein (high sensitivity)

Hormone Panel
· Estradiol
· Prolactin
· FSH
· LH
· Cortisol
· IGF-1
· Thyroid
· Testosterone (total and free)
· DHT
· DHEAS

It’s critical that the doctor involved have a reading on hormones beyond measuring testosterone levels. Simply introducing testosterone without regard for blood lipids or prostate specific antigens is roulette. You must have all this information.

Client X: My former physician would not entertain the idea of testing my hormones. He was more interested is debating my cholesterol levels. I found an independent label to test my blood. I believe it’s critical to be proactive with this situation.


HOW BAD WAS YOUR TESTOSTERONE?

Client X: If my memory serves me right, my free testosterone I believe was around 225 ng/dl. The bottom range is 300 and the top of the range is 1200. So you can see that I had a problem.

Dr. Z: We are more interested in the free than with the total. This gives us a better idea of your functional status. For someone his age I would try and push him back towards 700 ng/dl. Of course, we would do this gradually and monitor other variable.


DOCTOR, WHAT IS YOUR FIRST STEP ONCE YOU FIND ONE OF YOUR PATIENCE IN THIS QUANDRY?

Dr.Z: We don’t immediately send them to a pharmacy for creames or injections. Our approach is very comprehensive.

I have two related stories. One involved a patient who tested very low. We were able to dig deeper into his lifestyle practice and discovered that he was a borderline alcoholic. His consumption had gotten out of control after the passing of a parent. We got his alcohol consumption reduced and his numbers improved so much that we did not need to begin treatment. The second involved a wealthy couple. They showed up in my office demanding hormones. They didn’t want the testing just the testosterone. I discovered that they were using recreational drugs quite heavily. Needless to say I sent them home.

I guess in summary, I would tell you that we don’t take lifestyle practice lightly. We see this as a critical part of our treatment.

Client X: Coach you know my story. I’m a model citizen. I go to bed early and only drink socially. I workout hard. I’m just suffering sub-optimal output and it made me feel horrible.


WHAT LIFESTYLE PRACTICES MAY CONTRIBUTE TO POOR TESTOSTERONE PRODUCTION?

Dr.Z: We look at lots of elements but we do believe that these are a definite:

· Chronic sleep deprivation.
· Excess body fat.
· Low caloric intake and low fat intake
· Alcohol and cannabis consumption
· Using Statins
· Overtraining and chronic stress.

The good report is that testosterone can be optimized by reversing the above practices. It doesn’t take a rocket scientist or a doctor to tell you that going to bed earlier, limiting your alcohol, maintaining optimal body fat levels and intelligent exercise will improve your health. Better hormones equal better health.

We are slightly interested in looking at environmental estrogens. We are seeing younger males with lower levels of testosterone and higher estrogen levels. They are consuming these somehow from the environment.


WHAT ARE THE TREATMENT OPTIONS?

Dr. Z: Should you want or need to replace your testosterone to normal here are some things to consider.

First, this is what is known as a scheduled medicine. Once you start this practice you are pretty much locked into it for the rest of your life. You will apply or inject testosterone on a scheduled interval. It’s not like taking an ADVIL for the times when inflammation is at its peak. Your natural production will go from medium low to essentially nothing. Your body will become reliant on this weekly treatment.

You will have options. The most popular forms of treatment are creams and gels. These will generally be applied weekly in 5-10% concentrations. These are commonly known as TESTIM and ANDROGEL.

The other option is injections. These are done from weekly to biweekly. These are typically oil based and can be painful. Years ago I knew an old man who was part of a clinical trial at the KU Medical Center. He didn’t know what they were injecting him with but he knew three things. He was getting $50.00 per week to show up for the injections, they hurt for days after the fact and he was experiencing erections like he was 20 again. He discovered after the fact that he was part of a testosterone study.

We prefer injections. These are working better in our practice but they can be intimidating. They stay in the system longer (peaking 3-8 days later) than creams or gels. The potential for aromatization http://en.wikipedia.org/wiki/Aromatase is minimized since you miss the skin and subcutaneous fat. Creams and gels must pass through these layers to be absorbed.


IS THERE ANYTHING ELSE THAT WILL NATURALLY ELEVATE TESTOSTERONE?

Dr. Z: We do not see anything that is effective. I’ve worked with some professional athletes. They are taking all kinds of natural boosters. We know that Dehydroepiandrosterone (DHEA) is banned by the USOC and the NFL. DHEA is a pre-hormone. It’s necessary to make other hormones. Most of these natural herbs and minerals are not cost effective.

Client X: I have never used them but I’m hearing good things about supplementing Zinc and going to sleep with 3-6 grams of the amino acid Arginine.

Dr. Z: I know that Zinc defiency especially in heavy drinkers can lower testosterone.


FINALLY, ON A 10 POINT SCALE, HOW WOULD YOU RATE THE RISKS OF HRT?

Dr. Z: I hate to assign a number but it would be below three in a healthy male. All treatment certainly has risk. We work hard to screen out the individuals who are higher risk. It would be akin to you looking at smoking, high blood pressure or family history before you let them start exercising with you. We don’t want the guy with elevated PSA, cholesterol, or sleep apnea to start using hormones.

With that being said, they offer a lot for the healthy male who is clinically low on the stuff. We are giving life back to these guys.

We are not jacking them up to super human levels. We are not building freaks. We are adding back some stuff that nature has reduces prematurely. To all our critics I say, Show me the bodies.

Client X: Based on my twelve week experience I can not see the downside. I don’t have a crystal ball but I certainly find this better than were some of my peers are heading. My blood lipids were actually better in my recent lab result. None of my friends can say that.