by Dr. Gary Bellman
For many years we were concerned about giving men testosterone. The basis of this concern was that testosterone contributed to the development of prostate cancer.
One piece of ‘evidence’ that testosterone causes prostate cancer was from the fact that eunuchs never developed prostate cancer. Eunuchs are boys who were castrated before the age of puberty. It was felt these men would be more strutted advisers to the powers in charge in some cultures, as well as more trusted to be alone with women. The fact that these men never developed prostate cancer was felt to be on the basis that they had their testicles removed and lost the body’s main source of testosterone.
The other piece of evidence was from the experience with a medication called Lupron. This medication has been used to treat metastatic or advanced spread of prostate cancer. The drug causes testosterone levels to go down significantly by shutting off the messages from the brain to the testicles to tell the testicles to produce testosterone. This drug caused, in many cases, for the prostate cancer deposits to shrink down.
These two pieces of evidence are not the whole story and in fact testosterone does not cause prostate cancer. A basic amount of testosterone is necessary for prostate cancer to develop. A Dr. Morgentaler, a urologist, popularized a theory called the saturation theory where the receptors for testosterone get bound up at a low level of testosterone and more testosterone does not cause any more effect on the receptors and does not contribute to a greater risk of prostate cancer.
In the 20 years of being a urologist specializing in prostate cancer, I have never seen a bodybuilder with prostate cancer. Therefore, I believe that while all men above the age of 40 should get an annual PSA (prostatic specific antigen), a blood test to check for prostate cancer and a prostate exam, the administration of testosterone does not increase the risk of developing prostate cancer.
A man’s testosterone is the highest after puberty until the early 20s. This very important hormone leads to muscle strength, boundless energy, sense of well being, high libido and good erections. It is the hormone that makes a man feel like a man. Unfortunately, for some reason, this important hormone declines as men age. For some, it starts in one’s 30s or 40s, for others, not until later. This decline causes a whole host of problems ranging from poor energy to depression, weight gain, poor libido, erectile dysfunction, osteoporosis, lipid problems, sleep problems as well as other issues. It is unclear why this occurs. Either the messages from the brain (pituitary) that go to the testicles to produce testosterone are insufficient or the testicles themselves can no longer keep up with the production. Regardless of the specific cause, the end result is that many men suffer from hypogonadism, a condition where their body has insufficient male hormone.
The remedy is testosterone replacement, where testosterone is added to erase the negative effects mentioned above. Testosterone can be given orally or in the forms of patches, gels,creams, injections or pellets. This can make a tremendous difference in how a man feels. One should be aware that testosterone is not good long term for a man’s fertility and can cause a decrease in sperm production. For a man with low testosterone who wants to maintain good sperm quality, drugs like clomid or HCG can accomplish this. Some awareness is necessary with oral testosterone as it can cause liver issues. Creams and gels can be messy or have an unusual smell and sometimes not be effective as the absorption may be suboptimal in some men. The cost of gels can be significant as well. Testosterone injections are a very effective method of replacing testosterone. This is generally given once a week through a very small needle into a muscle (buttock or thigh) or even subcutaneously in the belly. Pellets are small devices placed under the skin by a physician and can maintain good testosterone levels for 3 or 4 months. This would require 3 or 4 pellet placements for an entire year making it a good convenient option for many men.
In my practice, I see men who come in for a vasectomy or a kidney stone, they are often in their 30s and 40s, and I ask them to complete an ADAM questionnaire which asks questions about mood and energy as well as erections. Many men have issues in these areas and are extremely grateful when they are properly diagnosed and treated. I had one patient tell me after testosterone replacement that he now he feels like he has enough energy to run after his kids and keep up with them. Another man shared that he can now perform well in the bedroom without the use of Viagra , Levitra or Cialis after testosterone replacement.
So testosterone replacement is generally very safe. It should be done under the care of an experienced physician who will monitor blood tests a few times a year to make sure levels are appropriate, monitor the CBC (complete blood count) to make sure the blood doesn’t get too thick, monitor estradiol levels as well as PSA. When done properly, testosterone replacement should be safe and make a huge difference in the quality of a man’s life.
Dr. Gary Bellman, M.D., is a Board Certified Urologist, interested in Testosterone replacement and men’s heath. He went to medical school and urology residency at McGill University, did a fellowship at Long Island Jewish Medical Center and has taught at UCLA for many years. He is currently is private practice in the San Fernando Valley, a suburb of Los Angeles.
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