Health and Hormone Therapy – Men

Testosterone Deficient Men

Counseling And Decision Making

If a therapy is chosen, the patient and physician should agree on goals, whether they are short-term, long-term, or both. Routine follow-up is essential to achieving therapeutic goals, as some men may experience side effects or not achieve their desired benefits.

A Step-Wise Treatment Strategy

At OC Sports and Wellness, hormone balance is essential to overall wellness. We can determine whether you have testosterone deficiency and adequately replace testosterone under medical supervision.

At OC Sports and Wellness, we have men come in for a physical exam and complete a Men’s Health Questionnaire. We will review your past medical history, family history, and social history, and review your current medications and supplements. Next, we obtain morning fasting blood work to look for nutritional and hormonal imbalances.

Testosterone is the main androgen in the body. Androgen deficiency is defined as a total testosterone < 300 ng/dl. If it’s clinically warranted, a therapeutic trial of testosterone cream or gel will be initiated. Repeat questionnaires and lab work are done after 6-7 weeks.

Commonly Observed Benefits Of Testosterone Replacement

• Increased libido
• Increase in muscle mass
• Decreased body fat
• Increase in bone density
• Improvement in cognition and mood
• Increases in energy and decreases in fatigue
• Possible favorable effect on cardiovascular disease

Facts About Testosterone Deficiency

• Testosterone deficiency affects 2-4 million men in the U.S.
• Low levels of testosterone have been associated with high-grade prostate cancer, higher stage at presentation, and worse prognosis.

Possible Risks

• Transfer of cream or gel to a spouse or child. We recommend you avoid contact with others for several hours after application.
• Increases in aggressiveness, irritability, and impulsiveness. This is not typically seen with physiologic (standard) levels of testosterone replacement.
• Testicular atrophy and/or infertility. This is usually reversible with cessation of treatment.

Health and Hormone Therapy – Women

Evidence-Based Treatment Options

Our Goals

Our purpose is to provide personalized hormone counseling (before and during menopause), as well as developing a partnership that provides a comprehensive review of a woman’s past medical and family history. We review the results of a recent physical examination and current use of medications and supplements to provide personalized treatment options and enhance a woman’s confidence in the decision-making process of hormone replacement.

Counseling And Decision Making

If therapy is chosen, the patient and physician should agree on goals, whether they are short-term (menopause symptom relief), long-term (primary or secondary relief of diseases associated with aging), or both. Routine follow-up is essential to achieving therapeutic goals, as some women may experience side effects or not achieve their desired benefits.

Menopause, The Facts

• The average age of a woman at menopause is 51 (>90% by age 55)
• Most women begin “perimenopause” around the age of 47
• Perimenopause usually lasts 4-5 years (sometimes it’s as short as 2 years)
• Perimenopause includes changes in the amount or duration of menstrual flow and the length of a cycle
• There is a risk of unintended pregnancy during perimenopause
• Symptoms most commonly associated with estrogen and progesterone deficiency in menopause are:
  – Hot flashes, day sweats, and/or night sweats
  – Vaginal dryness/painful intercourse

The Benefits Of Hormone Therapy

• Improved sleep quality (i.e., increased duration of REM sleep)
• Reduction of the time it takes to fall asleep
• Prevention of osteoporosis
• Epidemiological studies consistently find that women using ERT/HRT have a 40-50% lower risk of dying of coronary heart disease than women who do not take ERT/HRT.

Treatment Options – Hot Flashes

• Non-pharmacologic
  – Dress in layers
  – Identify and avoid triggers (e.g., hot rooms)
  – Exercise (aerobically)
• Pharmacologic
  – ERT/HRT
  – Clonidine
  – Low dose oral contraceptives (20 mcg estrogen)
  – Herbal preparations/dietary supplements

Coronary Artery Disease

Treatment Options

• Assessment of and counseling on risk factors
• Smoking cessation
• Healthful diet (fat, cholesterol, salt, high fiber)
• Weight loss if overweight, and exercise
• Stress management
• Control of blood pressure, if elevated
• Control of diabetes, if present
• Total cholesterol, LDL, HDL, and triglycerides
• ERT/HRT
• Antioxidants (e.g., vitamins C and E)
• Adequate folic acid

Osteoporosis

Lifestyle Changes As Treatment Options

• Assessment of and counseling on risk factors
• Dietary calcium (1,500 mg daily)
• Vitamin D (5,000 units daily)
• Exercise
• Fall prevention
• Smoking cessation
• Limiting alcohol
• Bone mineral density (BMD) testing for:
  – postmenopausal women with fractures
  – postmenopausal women under 65 with more than one risk factor

Consider Treatment For The Following

• All postmenopausal women who present with vertebral or hip fractures, or have a BMD T-score < -2 (or < -1.5 if they have additional risk factors)
• Prevention and treatment of postmenopausal osteoporosis
• ERT/HRT prevents bone loss in women in early and late postmenopause, and is effective for the duration during which it is used
• Epidemiologic studies of ERT/HRT indicate a 50-80% decrease in vertebral fractures and a 25% decrease in nonvertebral fractures with five years or more of use

Other Treatments

• Alendronate
• Risedronate
• Raloxifene
• Calcitonin
  – Soy/phytoestrogens
  – Calcium and Vitamin D (these should be considered supplemental as they are not sufficient by themselves)

Bio Identical Hormones

• The studies reviewed suggest bioidentical progesterone does not have the negative effect on blood lipids or vasculature that many synthetic progestins do, and may carry less risk with respect to breast cancer incidence. Studies of both bioidentical estrogens and progesterone suggest a reduced risk of blood clots compared to non-bioidentical preparations. Bioidentical hormone preparations have demonstrated effectiveness in addressing menopausal symptoms. – Altern Med Rev. 2006 Sep;11(3):208-23
• Patients report greater satisfaction with HRTs that contain progesterone compared with those that contain a synthetic progestin. Bioidentical hormones have some distinctly different, potentially opposite, physiological effects compared with their synthetic counterparts, which have different chemical structures. Both physiological and clinical data have indicated progesterone is associated with a diminished risk for breast cancer, compared with the increased risk associated with synthetic progestins. Estriol has some unique physiological effects, which differentiate it from estradiol, estrone, and CEE. Synthetic progestins also have a variety of negative cardiovascular effects.
• Physiological data and clinical outcomes demonstrate that bioidentical hormones are associated with lower risks, including the risk of breast cancer and cardiovascular disease, and are more efficacious than their synthetic and animal-derived counterparts. Until evidence is found to the contrary, bioidentical hormones remain the preferred method of HRT. Further randomized controlled trials are needed to delineate these differences more clearly. – Postgrad Med. 2009 Jul;121(4):172
• Early evidence suggests ERT/HRT may prove beneficial for the prevention and/or treatment of the following conditions, but more research is needed:
  – Alzheimer’s Disease
  – Colon Cancer
  – Macular Degeneration