testosterone therapy

A Great Alternative for Men with Low T Levels

By Thomas Rohde, MD, Renew Total Body Wellness Center
have written about the more traditional medical manner of testosterone replacement therapy, consistent with current TV advertising for Low T. I would like to present a more thoughtful discussion about an option that is healthier and safer, yet will still achieve the goal of normal T levels. When we speak about low T, everyone immediately thinks of sex. But Testosterone has numerous vital health functions in the body that are so much more important for longevity and health. Better sex should really be viewed merely as icing on the cake! Low testosterone levels (hypogonadism) are not healthy and yes, are not fun whether you are a 30, 50 or 80-year-old man. The symptoms of low T in men range from lack of energy, depressed mood, loss of vitality, muscle atrophy (sarcopenia), muscle aches, low libido, erectile dysfunction and weight gain to abnormal cholesterol, premature heart disease, bone loss (osteopenia), osteoporosis, mild anemia, increased risk of Alzheimers, increased risk of high-grade prostate cancer, and ultimately increased risk of death due to all causes. Low testosterone in men has two main categories. It may be caused by problems in the testes, brought on by the mumps, testicular trauma, testicular cancer, etc. This is called primary hypogonadism and can only be treated with testosterone replacement therapy. However, the more common cause of low T results from problems in the pituitary gland and/or hypothalamus in a mans brain. Low T levels caused by central problems are known as secondary hypogonadism. This secondary category may result from a wide variety of causes such as environmental toxins like pesticides, heavy metals like lead or mercury, depression, anxiety, head trauma, iron overload, anabolic steroid overdosing, diabetes, sleep deprivation, or some medications. In our traditional western model of treatment, if low testosterone is diagnosed, then testosterone replacement therapy is prescribed. This most commonly comes in the form of a cream, gel, pellet, patch, or an injection. Although these types of therapy are effective, they all have some significant side effects such as testicular shrinkage, breast enlargement, low sperm count/sterility, and overproduction of red blood cells. For many, these side-effects are mostly treatable or considered worth it by the patient. However, specifically due to the sterility side-effect, traditional testosterone treatments arent a good option for younger men, especially those men who want to have children. In these younger men, Clomid (clomiphene citrate) and/or HCG (human chorionic gonadotropin) have been used for decades to increase testosterone production, increase sperm production, and increase fertility. Both these therapies effectively help signal the testes to produce testosterone and thereby increase testosterone levels (assuming the cause of the initial problem is not in the testes ability to make testosterone). In a healthy male with low levels of testosterone, the hypothalamus releases gonadotropin releasing hormone (GnRH) which causes the pituitary gland in the brain to release luteinizing
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hormone (LH) into the blood stream, which signals the testes to go and produce testosterone. After testosterone has been produced it naturally converts to some estrogen (yes, theres estrogen in men too) and this estrogen acts as a stop signal to the pituitary to stop making LH. It is a delicate system of checks and balances. Clomid works by blocking estrogen at the pituitary and hypothalamus. Thus, the usual estrogen message to stop production of LH is silenced, the pituitary makes more LH, and there is an increased go signal to produce testosterone in the testes. HCG works differently by mimicking LH, which also increases the go signal to produce more testosterone in the testes. Traditional prescribed testosterone replacement therapy does the opposite of what Clomid and HCG do. The brain gets the message that there is plenty of testosterone being made in the testes, so much so that it doesnt need to make anymore. Subsequently, the pituitary stops producing LH, and the natural production of testosterone (and sperm) in the testes ceases. This is why traditional testosterone replacement results in testicular shrinkage and low sperm count...a mans testosterone and sperm manufacturing plant is essentially shut off. Clomid and/or HCG do not turn off the testosterone manufacturing plant but rather turn it back on or reboot it. While some men with low T require continuous use of Clomid, for others it can be used for a 3-6 month time period and then discontinued. Furthermore, the checks and balances feedback system is not interrupted, so there arent the testosterone replacement side effects. Most interestingly, although it used to be thought that Clomid and/ or HCG only worked on young men, in the past decade or so it has been used effectively in older men too.

So, since Clomid stimulates the body to produce more testosterone, is an inexpensive generic medication taken orally, doesnt interfere with the bodys regulatory mechanisms, and has few side effects, why isnt it prescribed by more physicians? One reason is that many physicians simply dont know about Clomid as it was marketed as a female fertility medication. Now that Clomid is available as an inexpensive generic, drug companies do not educate physicians about it. If doctors dont know that it is safe and effective, they also have to use it off label, meaning it is not approved by the FDA for the purpose of increasing low T. There are multiple other medications that are commonly prescribed off label as well, such as HCG, but it involves daily injections and is much more expensive. There are two possible side effects. One is a rare occurrence of visual changes that goes away if Clomid is stopped, and the second is a rare instance of non-infectious, increased white blood cells in the sperm without any known problem. Other considerations are that it may not work, especially in older men or if the problem is both in the brain and in the testes ability to make testosterone when signaled to do so. There is no good way to test for this so it becomes a trial and error process to see if it will work. Clomid may be an excellent alternative to both short- and longterm testosterone replacement therapy that health-conscious men should consider. If you would like more information about hormones, anti-aging medicine, and improved health, please visit www.DrRohde.com or call 217-864-2700 to schedule a consultation to review your health history.

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July 2013 Bloomington Healthy Cells Magazine Page 49