Healthcast 656 - Vast Difference Between the Benefits of Different Types of Testosterone Replacement

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The Problem: I see women and men every day who are deficient in their own production of testosterone because of age, testicular trauma, removal of their ovaries, chemotherapy, chronic illness, and medications.  The cause of testosterone deficiency is as varied as the side effects and benefits of every different type of testosterone. This means that when you hear or read a headline like the one that came out last week:

“Testosterone Treatment Fails to Offer Protection Against Fractures in Men with Hypogonadism, Research Indicates”

You cannot take It at face value.   This headline should read Testosterone replacement in the form of testosterone cream given at a low dose given at a low dose to men who already had osteoporosis doesn’t offer protection against osteoporosis.

The headlines that read the way this one is an example of the reality that everyone loves to hate testosterone. This makes informed decision making by a patient very difficult because of the jaundiced view by physicians and drug companies about replacement of one to the hormones that men and women both make when they are young, but which becomes deficient in most of my patient population as they age.

Why is there all this subterfuge and confusion about testosterone replacement? I believe it is the fact that allowing American’s to age out of jobs and make room for the younger workers; many people cannot afford testosterone on their own so they are jealous of those people who can and do afford it; The insurance companies don’t want to pay for anything they don’t have to; keeping people youthful and healthy is not a priority for American medicine based on acute care in the ER and operating room;

The group of naturalists who think aging is great, are people who either are out of touch or are very young; the use of testosterone by both sexes often makes the use of other medications unnecessary (anti-hypertensives, statins, autoimmune medications, etc, and also prevents patients from getting communicable diseases so the largest industry in the US, pharamaceutical companies cannot make more and more drugs to treat each symptom and disease individually; and lastly the government has made a very safe and natural hormone scheduled like amphetamines and pain killers by the DEA.

Now why are these tests misleading?  All research studied are manipulated to have a desired outcome.  You can do a lot with statistics…you can make a blue sky look black!

By given too little of a medication or vitamin, or by treating a disease for too short a time, or by picking the age group such that they won’t respond you can make any drug look ineffective!

So when you look at the studies on testosterone, you must look for the type of testosterone: is it a cream (which turns into estrogen as it passes through the skin? Or is it an injection of testosterone cyprionate which is not equivalent to natural testosterone and lasts 2 weeks because it keeps circulating through the liver and making more and more of the byproduct DHT than pellets or pure T injection?

Simply if the type of T is not the type that you are taking or are contemplating taking then you should ignore the studies conclusions because each type of T and each delivery system of T has a variety of effects, each different from one another.

“One testosterone is not equal to another form of testosterone. Therefore, a study that tests one type of testosterone does not apply to other forms of testosterone.” Dr Kathy Maupin MD

The factors that matter as to how much improvement you will get when you choose a form of T replacement are:

• Testosterone chemical structure (the best is pure testosterone like in sub dermal T pellets)
• Testosterone delivery systems (subdermal pellet, cream, vaginal tablet, oral, patches)
• The dose/day or week or month
• Duration of use
• What tissue or organ system you are studying (e.g., bone takes many years to show improvement, while muscle increases relatively quickly with T pellets)
• The age and condition of the patients studied
• The starting blood level of testosterone Total and Free testosterone.
• The resultant blood level of free T
• The length of time a man or woman has been without testosterone before treatment

I see research articles every day in the many journals I read that are shared with the public, that denigrate testosterone replacement in general, while in my practice, with the most effective form of T I have found, that T pellets literally transform  men and women who have T deficiency, most of whom are recently menopausal or over 55.

The successful studies that recommend testosterone seem never to make the front of journals, but this recent study about bone density made all the title pages of the digital version of journals. The result will be that doctors and patients everywhere who should treat their osteoporosis with the safest treatment available, testosterone, will be the victims of VERY expensive drugs that have more side effects and less effectiveness. Research trials no longer look for the truth.  They look for “how do we get the answer we want to , so our drug that is not testosterone, will sell?”.

These headlines deceive patients and scares them from asking for testosterone treatment, which can relieve their symptoms with one hormone, Testosterone, instead of many drugs. An even greater benefit of testosterone given at the dose that relieves testosterone deficiency symptoms, this one hormone gives my patients back their quality of life.

In 2002 the WHI study scared menopausal women from taking their menopausal hormone therapy (ERT and HRT) which caused these women to develop anxiety, depression, frailty, osteoporosis, dementia, poor critical thinking, fatigue and many other symptoms that required treated multiple drugs to relieve just a portion of them. Women also developed marital problems because sex was so painful that they stopped having sex with their life partners.  An unproven fear of breast cancer led to the loss of these women’s quality of life!

An example of one of my most severely affected patients went off her ERT (estrogen only hormone replacement) that she had been on for decades since her hysterectomy because her doctor refused to prescribe it for her.  By the time she came to me she had developed depression, suicidal thoughts, agoraphobia, frailty and osteoporosis and she refused to leave her home.  It took her months for her son, a doctor friend of mine, was able to bring her to my office to restart her treatment. Today she is still traveling all over the globe and fully enjoying her well-deserved retirement!

It has been estimated that in the 5 years after the WHI demonized estrogen replacement, more than 100,000 women died of diseases related to a lack of estrogen, and more experienced a loss of quality of life.   Even now over 20 years later, many doctors have not restarted giving estrogen to their women patients.

Medical Thinking and rapidly changing standards of medical care when it comes to sex hormones has affected how we live, if we live, and how many drugs and diseases we get in our lifetime.  We have effective inexpensive treatments for loss of hormones, why are we always looking for expensive and non-hormonal answers to the symptoms of menopause.  In the last year pharmaceutical companies have developed a new drug with many side effects to treat hot flashes (fezolinetant/ Veozah, another new drug for osteoporosis (Tymlos 1pen, 1 injection/day = $2,134) and even a new drug for waning sex drive (Vylessi injection 2 times a week prn 1 month is $3,066/month) , also exorbitantly expensive!  Instead of recommending replacement of relatively inexpensive hormone replacement with estradiol and testosterone (with pellets for women approximately $140/month, and for men $200/month), the Big Pharma companies try to strike it rich with multiple piece meal treatments for the symptoms of menopause and low T.   I did not even mention medication for insomnia, migraine headaches, Viagra for men, lubricants for women and many other symptoms and treatments that T and E2 completely resolve.

Back to the research article in question about testosterone for men, which employed testosterone as a transdermal gel, at a low dose, and determined testosterone (over-generalization) was not effective, for building bone in osteoporotic elderly men!  This was a defective study in every way, but the most important way was that it used T gel which turns most of the T into estrogen, so the effects are really from E2, E1 in men who do not respond well to E2.  The abstract is at the bottom of this page for your reading pleasure.

I hope you are more selective in the future about what you believe and question the research that criticizes testosterone treatment, estradiol treatment especially the safest delivery system, pellets, when the research is short term, and generalizes the results from one form of Testosterone or estrogen to all forms.

Testosterone Treatment Fails to Offer Protection Against Fractures In Men With Hypogonadism, Research Indicates

MedPage Today (1/17, Monaco) reports “testosterone treatment didn’t offer protection against fractures in men with hypogonadism, a” subtrial indicated. The research found that “compared with placebo, men who were on a testosterone gel actually had a significantly higher risk for fracture.” The findings were published in the New England Journal of Medicine.

HCPlive (1/17, Iapoce) reports “the findings showed the 3-year cumulative incidence of all clinical fractures was nearly 4% among those treated with testosterone, compared with 2.8% in the placebo group.” Additional “data revealed the fracture incidence was also numerically greater in the testosterone group for all other fracture endpoints.”