Low T: The Male Disease 

by Fred Harvey, MD  

There is significant hype around testosterone replacement for men these days. We see clinics and advertisements hawking shots or creams to fix every ailment under the sun. Primarily sold as the answer for erectile dysfunction or low libido, testosterone replacement has become a real fad. However, it is a potent chemical which is so risky to use that the FDA made it a controlled substance like opiates and sedatives.  

            Misuse of it can cause metabolic changes in those who do not want a beard. It can close the bone growth centers in adolescents to stunt their physical development. It can also cause liver damage when taken in a high dose orally. Therefore, I recommend the use of this strong and useful hormone sparingly due to these risk factors. At the Harvey Center, we use science and laboratory testing instead to guide hormone replacement. 

         First, let’s define a term: Bioidentical. This means, the hormone replacement is exactly the same as what occurs naturally in a living organism. Androgen refers to the line of human hormones that produce masculinizing effects, so a Bioidentical hormone replacement therapy (HRT) would use testosterone, the principle human male hormone, rather than synthetic steroids that mimic human ones.  

            My preferred method is topical daily replacement with a cream gel because our human diurnal (day-night) physiologic cycle involves a daily morning spike in testosterone, which drops off steadily until night and results in less stimulation for restful, adequate sleep.  

          One drawback of HRT topical cream is the user must be diligent to wash hands and to keep the area of application covered when in intimate contact if the cream has not yet absorbed. linens and clothing should also be washed separately to keep the testosterone exposure away from others.  

         Weekly injections are another relatively convenient method of administering testosterone HRT. With this method, the testosterone only reaches a low once per week instead of daily. However, pellets are one method that I do not recommend because they artificially override the normal axis of control between the master glands in the brain and the testes. Male fertility is also in question with that method. It seems safe in testing, but I prefer a more natural rhythm to mimic life’s normal diurnal pattern, as we see with daily cream use. 

            DHEA is a bioidentical precursor hormone to testosterone, and it can support a lack of testicular production of testosterone. I always test DHEA when treating male hypogonadism (Low testosterone syndrome). Supplementation with DHEA can be helpful to support testosterone production.  

     Estradiol is metabolically created from testosterone. Alcohol increases metabolic conversion of testosterone to estrogen. Therefore, excess alcohol could decrease available testosterone supplies. We also monitor the estradiol level to make sure that men are not wasting their testosterone through conversion to estradiol. 

Call the Harvey Center to discuss whether science guided HRT is right for you. The Harvey Center is location at 3982 Bee Ridge Rd, Sarasota. Ph 941-929-9355. Telehealth and second opinion consultations are available upon request. We can help you to achieve hormone balance, feel stronger and achieve better results in mental and physical activities. For more information, call 941-929-9355 or email [email protected].