Male hormone replacement

Organic changes related to aging, such as andropause, a condition in which there is a decrease in testosterone levels and clinical changes, may stimulate the need for male hormone replacement.

Such treatment is indicated for patients with hypogonadism, which causes a decrease in testosterone production by the body. There are medical studies that indicate that 15% of men between 50 and 60 years old may have this diagnosis. 

Therefore, in this post, we will clarify what it is, When to take male hormone replacement and what are the benefits of this approach for patients. Check out! 

What is male hormone replacement?

The popular name andropause is clinically referred to as Androgenic Disorder of Male Aging. This condition refers to a decrease in testosterone levels in the male body. 

Testosterone, the main male sex hormone, plays a crucial role in both sexual vigor and the regulation of muscle mass, voice depth and other body and facial patterns characteristic of men. Testosterone levels peak in adolescence and early adulthood.

Using men aged 40 to 70 years as a base, followed by 7 to 10 years, there is a tendency for total testosterone to fall by 1,6% per year, bioavailable (active) testosterone by 2% to 3% per year and increase in sex hormone-binding globulin (protein that blocks the action of testosterone) by 1,3% per year.

It is important to note that the normalization of hormonal levels can be achieved in two ways:

• Stimulating the testicle to produce more testosterone;
• Offering exogenous testosterone, performing the famous TRT (testosterone replacement therapy).

These therapeutic approaches must always be supervised by a specialist doctor, in this case, a urologist or endocrinologist. 

Before long, patients taking male hormone replacement medication You will notice an improvement in your general condition, recovering your physical and mental disposition and sexual desire.

Using men aged 40 to 70 years as a base, followed by 7 to 10 years, there is a tendency for total testosterone to fall by 1,6% per year, bioavailable (active) testosterone by 2% to 3% per year and increase in sex hormone-binding globulin (protein that blocks the action of testosterone) by 1,3% per year.

Therefore, we are talking about a very common and underdiagnosed pathology.

What are the symptoms of andropause?

A low dosage of testosterone can cause several cognitive, physical and emotional changes. 

Thus, men in andropause may present signs and symptoms such as:

• Fatigue: constantly feeling tired and unmotivated; 
• Loss of Libido: it is one of the most common symptoms of andropause in men, because it is associated with a low level of testosterone hormone, which is responsible for activating sexual desire; 
• Decreased muscle and bone mass and increased fat: Many patients notice that their arms and legs are thinning, on the other hand, an accumulation of fat begins to occur in the abdominal region. The decrease in bone loss is practically not noticed by the patient in andropause, unless they are very old;
• Sleep disorders and irritability: patients realize that they are not sleeping well, consequently, they wake up more tired and irritated. Many even complain of a general lack of well-being in any respect and memory loss. So they can be in a very bad mood; 
• Decreased fertility; 
• Decreased testicles;
• Decreased body hair;
• Swollen nipples;
• Strength reduction; 
• Tiredness;
• Memory and concentration problems;
• Sadness;
• Depression; 
• Mood swings;
• Dry skin. 

How to diagnose andropause/low testosterone?

The diagnosis of andropause/low testosterone should be based on the symptoms described above and testosterone dosage below the level of young adults. Sometimes, a single sampling of testosterone dosage at 'normal' levels does not exclude the diagnosis due to cyclical variations of the hormone.

It is important to remember that the analysis of this hormonal profile must always be carried out by a doctor specialized in the field, as mentioned above. 

Laboratory reference values ​​will not always be sufficient to make the diagnosis and, therefore, many errors are made. Therefore, therapy is safe when carried out by a doctor who knows these conditions and symptoms well and understands these markers.

What is the treatment?

Treatment for andropause/low testosterone is individualized and should be started at any age, as long as it is after the diagnosis presented by the specialist. 

It is important to highlight that in patients with children, replacement is performed with bioidentical testosterone, which can be administered in different ways, the most common being the use of daily transdermal gel and periodic intramuscular injection.

In cases where men still want to have children, there is the option of using oral or injectable male hormone replacement medication to stimulate the testicle to produce more testosterone.

Currently, in addition to men's quest for longevity, everyone also values ​​quality of life and well-being, that is, modern man must mature while maintaining disposition, vigor, cognition and power.

How old can I take male hormone replacement therapy?

First of all, it is essential to warn that for men who still want to have children, male hormone replacement may not be the best solution because the treatment inhibits the endogenous production of testosterone and sperm.  

Therefore, this procedure in young people is not the most recommended, also due to the issue of fertility.. Therefore, Hormone replacement is most recommended for patients over 40 years of age, who already have children or no longer want to have children, but want to reverse the symptoms of andropause.

For these cases of proven low testosterone, but with the intention of preserving fertility, the best option is a natural male hormone replacement, creating ways for the body to resume testosterone production through testicular stimulation.

How to do male hormone replacement?

If you are wondering what the best male hormone replacement medication is, Know that each patient may adjust better to a certain type of medication.  

After adjusting the male hormone replacement dosage for each patient, the doctor may suggest 4 approaches: application of transdermal gel, injectables, subcutaneous implants (testosterone chip) or oral (capsules).

Injectable male hormone replacement

Such an approach may be medium or long term. In both cases, You need a prescription to purchase male hormone replacement medication. 

In the case of medium duration, it is Testosterone Cypionate, which can be injected every two weeks, or at variable intervals, according to what is most appropriate for the patient. This treatment is more cost-effective than long-term medication.

Long-acting male hormone replacement injections can be administered every 6 to 12 weeks, and have a higher cost.

Gel

A testosterone gel is the pure hormone dissolved in a hydroalcoholic base or in Pentravan. It can be used axillary or transdermally.

This form of replacement is very similar to the physiological process and is easy to apply, in addition to being safer in cases where use needs to be paused suddenly.

Those who choose this option should apply the gel daily in a small amount to areas of the body such as shoulders, abdomen or arms. Wait for the gel to dry for 5 minutes before getting dressed.

In these cases of using the gel, care is not to expose other people, such as women or children, to the gel while it is still fresh in the body.

implants

Male hormone replacement with bioidentical testosterone with pellet implants are ideal for those men who are not willing to have to use medication daily, which is the case with the use of gels, or undergoing constant injections.

In these circumstances, 8 to 10 pellets are implanted at once, quickly, which will release the hormone into the body for around 4 to 6 months.

orally

The oral male hormone replacement medication can be prescribed in capsules. This method had been abandoned because the substance at that time was harmful to the liver. However, in 2019, a new substance was formulated and approved by the FDA, testosterone undecanoate.

In Brazil, The male hormone replacement pill can only be found in compounding pharmacies. However, it is worth remembering that, for this method or others, it is important that patients do not perform this replacement alone, constant medical monitoring is necessary.

The benefits of proper hormone replacement are:

• Increased desire to have sex;

• Improvement of the quality of the sexual act;

• Improved physical performance (increased strength, muscle and bone mass);

• Decreased abdominal fat;

• Improved self-esteem and a sense of well-being;

• Increases disposition for general activities;

• Improves cognition in general.

How long does male hormone replacement last?

Normally, patients who start hormone replacement therapy must undergo treatment for life, since when the individual is recommended for replacement, he or she already has a drop in natural production. However, this is far from being a rule. 

In summary, as the testicles stop endogenous testosterone production as the hormone is delivered exogenously, that patient will only benefit from continuing treatment. 

If the man stops treatment, the testicle may take around 6 months to produce the hormone naturally and when it resumes it will produce the same low level as before, then all the undesirable symptoms will invariably return.  

If the patient is going to stop hormone replacement, it is important to tell the doctor to make this transition, stimulating the testicle's natural production with specific medications. 

Read more:

Sex at 60

Male hormone replacement: most common side effects 

Hormone replacement can have some side effects, such as gynecomastia (breast enlargement) and skin problems such as acne, increased sweating, hair loss and increased body hair.

In cases of patients with prostate cancer, treatment should always be guided by a urologist/andrologist, when necessary. Side effects can be minimized as much as possible with frequent monitoring, dose adjustments and adding medications to counterbalance them. 

See also:

Treatment for erectile dysfunction

How much does male hormone replacement cost? 

When it comes to male hormone replacement, the approximate values ​​for each procedure can have many variables. Therefore, it is worth remembering that each type of replacement has its advantages and disadvantages for men. 

Looking for a doctor for male hormone replacement? Meet Dr. Marco Túlio Cavalcanti!

If you want to know which doctor does testosterone hormone replacement, remember that this treatment is carried out by a urologist/andrologist, a specialty also responsible for caring for male sexual issues.

Dr. Marco Túlio Cavalcanti is a specialist in hormone replacement treatments and other conditions related to male sexuality.  

Your case will be studied in detail and the best solution will be suggested. There are several options that can fit your needs, like the approaches mentioned in this post.

Therefore, if you want to ask questions in how to know if I need male hormone replacement, Instituto Cavalcanti has a personalized service to solve all your doubts.

In addition, it is worth remembering that a life with healthy habits can also prevent the early drop in testosterone in the male body. It's always worth taking care of yourself!

Schedule an appointment right now and learn about all the treatments available:

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Dr. Marco Túlio Cavalcanti Urologist and Andrologist. Erectile Dysfunction and Sexual Impotence: put an end to this torment. Penis Prosthesis: the resumption of your sex life. Peyronie's disease: correction of curvature, recovery of the size and caliber of the penis. Hormone Replacement: resume your performance.

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