Articles

Hot Flash Husbands? Is This Your Husband?

By Brock Smith, R.Ph.

With the recent release of Suzanne Somer's new book Ageless, she introduces a not so new concept that changes in hormones impact men as well as women. Many women probably suspect this and recognize the symptoms described in her book in their own spouse or significant other. Andropause or male menopause occurs when men's natural levels of testosterone fall below a normal range. The main male hormone is testosterone, which helps form personalities, male sexual characteristics including emotional and physical strength, body shape, deepness of voice, sex drive and performance during sex. The most common symptoms of lower testosterone can be:

- Fatigue, decreased energy
- Depression
- Irritability
- Decreased libido
- Erectile dysfunction
- Premature aging
- Loss of muscle and strength
- Change in hair growth and skin quality

Testosterone is primarily produced in the testicles of the male; a small amount is
also produced in the adrenal glands. To start testosterone production the hypothalamus will release gonadotropin releasing hormone (GnRH), a chemical messenger to the pituitary gland. The GnRH causes the pituitary gland to produce follicle stimulating hormone (FSH) and luteinizing hormone (LH), together known as gonadotropins. LH is released into the bloodstream and travels to the testes and starts the production of testosterone from cholesterol. Leydig cells change the cholesterol into a series of compounds until it becomes testosterone. The testosterone is released into the bloodstream and is carried to receptors by a protein called sex hormone binding globulin (SHBG). There is a wide array of conditions that may cause low testosterone:

- Aging
- Physical trauma to the testes
- Radiation or chemotherapy treatment
- Testicular or pituitary tumors
- Inadequate production of GnRH

Male hormones decline gradually over the course of their lifetime. The decline of testosterone is about 1% per year. By the age of 80 most men will have testosterone levels below that of a prepubescent male. The declining hormones include testosterone from the testes, human growth hormone (HGH) from the pituitary and DHEA and androstenedione from the adrenal gland.

Diagnosis generally involves a comprehensive medical exam including measuring total and free testosterone as well as DHEA, estradiol, DHT, and cortisol. Lab testing can be evaluated with serum testing or with salivary testing. Evaluation of results should be undertaken by an experienced health care professional who can provide recommendations for appropriate supplementation.

Patients should not use testosterone replacement if they have had breast cancer (male) or prostate cancer. In patients with liver, heart or blood vessel disease, edema, prostate or kidney problems or diabetes their doctor will help decide if replacement therapy is right for them. Treatment and therapy options are readily available in the market place, choosing one that is right for you will require some thought and trial. Testosterone supplementation is commercially available in oral, topical patches, and injectable forms. For patients who do not find a solution with commercial options, a compounding pharmacy offers other customized options for compounded bioidentical testosterone and other hormones not available at all pharmacies. A compounding pharmacy can prepare testosterone as a sublingual tablet (a rapid dissolve powder tablet), a cream, or a gel prepared to match the patient's needs. Patients may also opt for sub-dermal pellet therapy. Pellets are made by a compounding pharmacy and placed under the skin by a trochar device in the doctor's office. The pellets dissolve under the skin over the course of 3-4 months. This delivery method offers the convenience of 3-4 administrations per year compared to daily dosing of tablets or topical formulations as well as slow and steady release of testosterone into the system. These formulations offer great benefits by bypassing first pass metabolism in the liver. This is important as medications and hormones taken orally are subject to the first pass metabolism of the liver, which metabolizes a large chunk of the active hormone. This process leaves less hormone available to supply the needs of the body's receptors as well as metabolizes hormones into less desirable metabolites.

In conclusion, after starting testosterone replacement therapy patients can expect to see improved mood, energy and quality of sleep. Patients should also see improved libido and sexual performance, an increase in lean body mass and decrease in body fat. Most patients will generally see improvement within 4-6 weeks time. Other potential benefits may include increased bone density, and possibly a decrease in heart disease. Any treatment of andropause should also include healthy lifestyle changes including diet and exercise. Bellevue Pharmacy Solutions has a staff of consultant pharmacists trained in andropause therapy and ready to assist you in evaluating your situation. To schedule a consultation time with one of our pharmacists, please call 800-728-0288 or click on the following link and complete and submit the Men's Online Patient History form. One of our pharmacists will review the information and call you to schedule a consultation time.

References
- Caruthers, Malcolm MD. "The Testosterone Revolution"
- Segal, Sheldon PhD. "Hormone use in Menopause&Male Andropause, A choice for women and men."
- Shippen, Eugene MD. "Testosterone Syndrome"
- Tan, Robert. "The Andropause Mystery"