Testosterone Testosterone is a steroid hormone. Popular use of the term steroid leads people to believe that it signifies a drug that s illegal and abused by some body builders and other athletes. While some steroids are abused, the term steroid simply refers to the chemical structure of a hormone made from cholesterol. Estrogen, progesterone and cortisol are other examples of steroid hormones. Not just for men While testosterone is a male hormone and functions in men to produce and enhance male secondary sex characteristics, it also serves very important functions in women. We ve therefore separated our discussion of testosterone by gender. Testosterone for Women Testosterone for Men Testosterone For Women Testosterone is generally considered a male hormone, and it is. Nonetheless, testosterone is a very important component of normal female physiology. Indeed, testosterone levels rise in young girls during puberty to a blood level about 10% that of adult men. In women, testosterone is produced by the adrenal gland and the ovary. There appears to be a slight decline through young adulthood with a more rapid drop at menopause. The physiologic effect of testosterone in women is not different from that in men. In women, testosterone appears to contribute the same of benefits that it offers men. These include: Strength Muscle mass Feeling of well-being Bone density Cognitive performance Fat reduction Libido Sexual performance Copyright 2004 Leonardi Executive Health Institute. All Rights Reserved. 1
Given this attractive list of benefits, it s easy to see how hormone replacement, when managed skillfully, contributes to quality of life. At LEHI, we measure testosterone levels in women and offer them the option of supplementing testosterone to raise their level to the middle or upper aspect of the normal female range. Women who supplement testosterone may experience substantial benefit for the following issues, corresponding to the list of benefits above: Low bone density (osteopenia or osteoporosis) Depression Excess body fat Reduced muscle mass Decreased libido Difficulty with sexual arousal and/or achieving orgasm Memory loss and mental fatigue The great majority of studies demonstrating the benefits of testosterone have been done in men. Women looking for evidence of testosterone benefits are encouraged to read the abstracts of studies done on both women and men. Mode of administration For women, testosterone is administered as a skin cream or gel, applied to the specific areas of the body where absorption has been shown to be best (anterior neck, inside of upper arms, crease behind the knee or opposite the elbow). Each dose must be measured and blood levels must be evaluated regularly to assure they are in the appropriate normal range. Prescription Only Like Growth Hormone, testosterone is available only by prescription, and rightfully so. If used incorrectly or by the wrong candidate, like any prescription item, harm can result. Side effects This is an important section for women. The last thing any woman wants or needs is facial hair, acne or to appear muscular. Not to worry. The goal here is to maximize the benefit (energy, cognition, strength, fat loss, physical endurance, bone density, libido and sexual performance) with zero tolerance for error. Almost all women can take Copyright 2004 Leonardi Executive Health Institute. All Rights Reserved. 2
testosterone without any of the above side effects. What varies is the dose each can tolerate. Some women can have a blood level of testosterone at the top of the normal female range without growing a whisker. Others are not so lucky. To accommodate everyone, at LEHI we begin very slowly with a small dose and increase very gradually, keeping a close eye on the blood level and being very vigilant for side effects. At the first sign of a hair or blemish, we stop the testosterone for a short time until the perpetrator is eliminated, then resume at a reduced, side effect-free dose. Once again, our goal is maximal benefit with zero tolerance for the uninvited. Risks To first clarify terms, a side effect is an unpleasant symptom or physical problem that is known to result from a medication and occurs in a small percentage of those taking it. A risk is the chance of developing a disease or other physical problem that is not known to occur. The only known risk of testosterone therapy in women is the reduction of HDL (good) cholesterol. This problem is rare unless the blood level rises above the normal range. Since cholesterol monitoring is an extremely important aspect of the LEHI program, we also have zero tolerance for lowering HDL. We monitor the cholesterol and testosterone levels as part of our ongoing program. If HDL does decline at even normal testosterone levels, there are several possible approaches. Stopping the testosterone brings the HDL immediately back to baseline. Other options are discussed with each patient to find the one best suited to the individual. Once again, it is very unusual and easily remedied. Testosterone For Men It s really a toss up as to which hormone makes men feel and perform better in all aspects of life Growth Hormone or testosterone. The truth is they re very synergistic. While there is significant overlap in the benefits of the two, our view is that, relatively speaking, Growth Hormone gives more punch in the area of aerobic capacity, and body fat reduction. Testosterone excels in enhancing one s ability to add muscle mass and strength while increasing libido. Both testosterone and Growth Hormone provide mood elevation, especially when used together. In some, but not all men, testosterone also improves erectile function and sexual performance. More than just machismo Benefits of testosterone have been shown to reach far beyond those mentioned above. A number of studies have demonstrated that raising testosterone levels in men contributes to improvements in brain power, cholesterol, blood pressure, coronary Copyright 2004 Leonardi Executive Health Institute. All Rights Reserved. 3
disease risk and blood sugar control. Reduction in body fat has also been demonstrated, particularly in regard to visceral body fat. That s the brown fat surrounding the abdominal organs that promotes insulin resistance (risk for diabetes) and coronary heart disease. Low testosterone levels are associated with greater obesity and diabetes risk, higher blood pressure and coronary risk. Prescription Only Like Growth Hormone, testosterone is available only by prescription, and rightfully so. If used incorrectly or by the wrong candidate, like any prescription item, harm can result. Mode of administration For men, testosterone can be given as a cream or gel daily, as in women. Most men, however, prefer weekly injections for several reasons. First, while blood levels achieved are the same, most men feel better on the injections. The effect seems more profound. Second, the injection requires only once-weekly dosing, while the cream must be applied once or twice a day. Finally, because it s absorbed through the skin, testosterone cream preferentially raises the level of another hormone called DHT (dihydrotestosterone). DHT is the hormone related to male pattern baldness and prostate enlargement. The injectable testosterone, by bypassing the skin, doesn t raise DHT significantly. Benefits The physiologic benefits of testosterone in men are many and substantial. These include: Strength Muscle mass Feeling of well-being Bone density Cognitive performance Fat reduction Libido Sexual performance Given this attractive list of benefits, it s easy to see how hormone replacement, when managed skillfully, contributes to quality of life. Copyright 2004 Leonardi Executive Health Institute. All Rights Reserved. 4
At LEHI, we measure testosterone levels in men and offer them the option of supplementing testosterone to raise their level to the middle or upper aspect of the normal male range. Men who supplement testosterone may experience substantial benefit for the following issues, corresponding to the list of benefits above: Low bone density (osteopenia or osteoporosis) Depression Excess body fat Reduced muscle mass Decreased libido Erectile dysfunction Memory loss and mental fatigue Click here for abstracts of studies of testosterone for men. Side Effects Testicular atrophy (shrinkage of the testicles) is one potential side effect of testosterone therapy. In Dr. Leonardi s experience, it seems to be limited to men under 55 years old, but should be considered a potential side effect for older men as well. Since you are taking the hormone your testicle normally makes, the testicle more or less turns off during testosterone administration and may shrink by 10 to 25%. It also stops making testosterone. If your level was quite low prior to using testosterone, nothing is lost. If your testicles are strong producers of testosterone, you don t need testosterone to begin with. At LEHI, we limit testosterone use to those who need it. Testicular atrophy can be reversed with the use of HCG, a hormone that stimulates the testicle to make testosterone. If testicular atrophy occurs, it is very useful to cycle between using testosterone and HCG. This is a commonly used technique at LEHI. If you re a candidate for raising your testosterone level, the various options will be discussed in detail at your MEDSTART. Irritability is another potential side effect that is generally not seen unless the testosterone level is directed above the normal range. Since that is not an option at LEHI, Dr. Leonardi has seen only one patient develop irritability in over 700 treated with testosterone. Raising testosterone to the upper normal range usually results in mood elevation. Copyright 2004 Leonardi Executive Health Institute. All Rights Reserved. 5
Risks To first clarify terms, a side effect is an unpleasant symptom or physical problem that can result from a medication and occurs in a small percentage of those taking the medication. A risk is the chance of developing a disease or other physical problem that is not known to occur. The only known risk of testosterone use in men is to potentially fuel an existing prostate cancer. No doctor, however, would treat a prostate cancer patient with testosterone so the risk is limited to an occult cancer that could not be detected by either the physical exam or PSA test. Since he began practicing Vitality and Longevity Medicine in 1997, Dr. Leonardi has not seen a single case of prostate cancer. Is there any increase in risk of developing a new prostate cancer when taking testosterone? We don t think so. In the medical literature there are about 5 published studies that indicate a possible connection between testosterone levels and risk of developing prostate cancer. However, there are over 35 published studies that refute such a risk. Urologists (prostate cancer specialists) have been treating men with testosterone for decades without evidence of increased risk of prostate cancer. HCG (Human Chorionic Gonadotropin) Many men at LEHI use HCG instead of testosterone. HCG promotes increased production of testosterone naturally by the testicle. This is a somewhat more physiologic (natural) way to raise the testosterone level and eliminates the risk of testicular atrophy (shrinkage). Its success is predicated on the continued ability of the testicle to produce testosterone. The testicle becomes less responsive to HCG with increasing age. If the testicle has completely lost the capacity to make testosterone, the HCG will not be effective. The initial blood test at your MEDSTART will help to determine your likelihood of responding to HCG. If a patient doesn t respond well to the HCG, Dr. Leonardi will recommend testosterone instead. HCG is given by subcutaneous injection twice a week. At LEHI, we do not, never have and never will use HCG for weight loss. It has been unequivocally proven to be ineffective for that purpose. Summary Testosterone use in men offers many health and vitality benefits with few potential pitfalls. The pitfalls are avoided by limiting testosterone use to men who really need it and by skillful administration and ongoing monitoring. HCG is an excellent alternative to testosterone for men whose testicles continue to function. Copyright 2004 Leonardi Executive Health Institute. All Rights Reserved. 6