Dr. Jacob Teitelbaum's Column
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Monday, April 7th, 2008:
Can testosterone be good for you?
Bio-Identical Testosterone Treatment for Both Men and Women
by Jacob Teitelbaum MD
Many anti-aging specialists are finding that natural bio-identical testosterone creams (not to be confused with high dose synthetics injected illegally by some athletes) keep those over 50 years old younger and healthier—and this is for both men and women! A rapidly expanding collection of research is showing that optimizing testosterone in men:
1. Decreases the risk of heart disease, including angina, and helps reverse heart disease when present—while lowering cholesterol levels .
2. Improves insulin sensitivity, thus improving blood sugar control in diabetics as well as decreasing a major cause of heart disease and diabetes called "metabolic syndrome."
3. Improves muscle mass.
4. Improves libido and sexual function.
5. Decreases depression.
In women, optimizing testosterone along with using safe BIO-IDENTICAL estrogen and progesterone seems to work the best, helping energy, libido and overall well being. As is usually the case, be sure to use bio-identical hormones. When looking at the overall safety and effectiveness data, one finds that treating testosterone deficiency in men (called "Andropause") as well as in women can help you feel young and vital late into life!
Doctors at the Fibromyalgia and Fatigue Centers also specialize in bio-identical hormone replacement as do many Holistic physicians. Optimizing a low or low normal testosterone level can also have marked benefits for those with CFS and Fibromyalgia. For those of you who would like more details, let's look at the issue more closely.
The Reproductive Glands
Many people going through midlife develop fatigue, poor libido or depression.74 This includes men and women alike. Researchers have found that if the estrogen and testosterone levels in females or the testosterone level in males is low, a trial replacement of these hormones can bring about dramatic improvement and is therefore worth considering. An under active adrenal gland can aggravate this problem.
Low Testosterone—Not Only a Male Problem!
Low testosterone is associated with many problems, including fatigue, depression, poor stamina, osteoporosis, muscle wasting, diabetes, high cholesterol, weight gain and poor libido. Low testosterone, classified as being in the lowest 20 percent of the normal range, is a major problem in 70 percent of my male patients with CFS and Fibromyalgia. The severity of the problem has worsened, as men's average testosterone levels have dropped by 16 percent over the last 15 years.75 Although testosterone levels are normally much lower in females, deficiencies in women cause similar problems. Testosterone is critical in females as well as males, and I find low free testosterone levels in most female CFS/FMS patients as well. It is important, then, to check the free, or unbound, blood testosterone level in both men and women. This measures the active form of the hormone. A serum (or total) testosterone level measures mostly the inactive storage form of the hormone. Inactive (total) testosterone levels are often normal despite an inadequate level of the critical active (free) testosterone.
Optimizing testosterone levels can result in many benefits in people with CFS and Fibromyalgia. After six to eight weeks, the effect of treatment is often marked. Benefits include:
1. In women with Fibromyalgia, a study done by Professor Hilary White of Dartmouth University showed that giving natural testosterone decreased fatigue and pain.76
2. Fibromyalgia and CFS are associated with decreased red blood cell levels. Testosterone supplementation is a highly effective way of increasing the blood cell levels.
3. Testosterone can improve libido which is low in 73% of CFS and Fibromyalgia patients.77-79
4. Testosterone increases bone density, therefore decreasing the risk of osteoporosis.80
5. Testosterone improves mood and decreases depression.81
6. Testosterone increases muscle strength and decreases fat levels.
7. Research has shown that men who have low testosterone are at greater risk of premature death. For example, one study which followed men over 40 years old for five years found that the men with low testosterone levels were 88 percent more likely to die during that period.82, 83
8. Low testosterone is associated with an increased risk of high cholesterol, angina84, 85 and diabetes.86
9. Chronic fatigue syndrome has been associated with a possible decrease in the heart's ability to pump blood, and testosterone improves heart function.87
As is the case with most hormones, keeping testosterone levels optimal using bio-identical hormones seems to be very helpful in CFS and Fibromyalgia and also appears to be associated with increased health and longevity. However, it is important that we not confuse giving safe levels of bio-identical natural testosterone with the high dose, synthetic, and toxic testosterone that bodybuilders sometimes use.
Testing for Low Testosterone
Again, it is important to check the free (not just total) testosterone. Most laboratories can test free testosterone only if they also measure the total testosterone—this is a normal procedure. Be sure that the normal ranges for the lab results are broken down by ten-year age groups: thirty-one to forty years old, forty-one to fifty years old, and so on. It is meaningless to have a normal range that includes eighty year-olds if you're twenty-eight. Bizarrely, some labs even have a normal range for women's testosterone levels that begins at zero. This would be like having a normal range for women's heights that go from 0-72 inches! If your result is below normal, or even in the lowest 25 percent of the normal range, I would consider a trial of natural, bio-identical testosterone therapy. Some researchers find that checking the levels of proteins that "bind or carry" testosterone (SHBG—Sex Hormone Binding Globulin) and a total testosterone level and then calculating the free testosterone level is more reliable. For now, keeping the "free testosterone" in the upper one third of the normal range should suffice.
Treating Low Testosterone
For men under 50, it is often best to simply stimulate your body's own production of testosterone using a low dose of a medication called clomiphene (a "Clomiphene Stimulation Test" will tell you if this will work for you). In men over 50, I recommend using topical testosterone creams or gels, applying 25-100 mg to the skin each morning. This is available from regular pharmacies (Androgel or Testim 1 percent gel), but the form made by compounding pharmacies is much less expensive if you do not have prescription insurance. Be aware that if the skin where it is applied comes in contact with a woman's skin (e.g. after a hug or if you do not wash your hands after applying the cream), this can result in very high, undesirable and unsafe levels in that woman's body. Always be sure to wash your hands after applying the cream.
I do not recommend taking testosterone by mouth in males as it can dramatically worsen cholesterol levels since testosterone goes to the liver first when taken by mouth, which is where cholesterol is made. I also do not recommend injections because this results in very high levels for the first few days after the injection and in very low levels a week later. Testosterone pellets that are injected under the abdominal fat each 4-6 months may well be the best approach, but it is difficult to find physicians trained in this technique. There are newer injections that can slow release testosterone over several months that also hold promise.
For women, testosterone treatment is easier. I recommended the natural testosterone creams made by compounding pharmacies. The usual dose is 1-5 milligrams a day (1-2 mg is optimal for most women). If you also need estrogen or progesterone, all three of the hormones can be combined in the same cream, resulting in increased simplicity and a lower cost. With this dosing, most women feel more energy and have thicker hair, younger skin and improved libido.
Adjust the testosterone level to the dose that feels best, checking blood levels to make sure they do not go above the upper limit of normal. Most people feel best with a blood level around the 70th percentile of the normal range. Although testosterone treatment helps male diabetics, if the dose goes too high in women it can promote diabetes. So keep the testosterone blood level in the normal range.
Potential Side Effects
In men, acne suggests the dose is too high. It is important to monitor levels because, as in body builders who abuse testosterone by taking many times the recommended dose, elevated levels can cause elevated blood counts, liver inflammation, a decreased sperm count with resulting infertility (usually reversible), and elevated cholesterols with increased risk of heart disease. Because of this, in men, a testosterone level, PSA, complete blood count (CBC), cholesterol test, and liver enzymes test should be done occasionally. Testosterone supplementation can also cause elevated thyroid hormone levels in men taking thyroid supplements. In men who are on thyroid supplements, consider rechecking thyroid hormone levels after six weeks if you get a racing heart or anxious/hyper feelings.
It is important to note that testosterone can be converted to two other hormones—estrogen and DHT (dihydrotestosterone). If the estrogen level rises too high in males, breast size may increase and erections may decrease. Because of this, it may be reasonable to also check total estrogen levels while on testosterone and, if they are elevated, to add a medication called Arimidex (1/2 mg every other day), which blocks the conversion to estrogen. DHT level can also become elevated, resulting in a higher risk of prostate enlargement.88
As noted above, in men, most studies show that bringing low testosterone up to the normal level is very healthy. Testosterone decreases angina and leg artery blockages, improves cholesterol, and helps improve insulin function in diabetics. In a small percent of men, problems with slowing urination and a worsening of male pattern baldness is seen. If this occurs, these side effects can usually be blocked by taking the herb saw Palmetto (160 mg twice daily) along with the testosterone. Fortunately, both of these problems have been fairly uncommon.
Treatment with testosterone in men has NOT been shown to increase prostate size or the blood test marker for prostate cancer (PSA).89 In addition, a review of 18 studies showed that testosterone treatment does not increase the risk of prostate cancer.
In women, if acne, intense dreams, or darkening of facial hair occurs, the dose is too high and should be decreased. These effects, which can also occur with DHEA supplementation, are usually reversible. These side effects can also be caused by an estrogen level that is too low relative to testosterone, and may be avoided by supplementing both together. If you choose to take testosterone and estrogen separately, it may be best to use estrogen for four to eight weeks before starting testosterone. This often decreases side effects.
For many patients with CFS and Fibromyalgia, improvements in stamina, energy, and overall sense of wellness have been dramatic, and treating low testosterone levels has been an important part of treatment. For healthy men and women entering Andropause and Menopause that have suboptimal testosterone levels, bio-identical, natural testosterone can help keep you very young, very late into your life!
1. Finding a physician: Doctors at the Fibromyalgia and Fatigue Centers also specialize in bio-identical hormone replacement (www.FibroandFatigue.com) as do many Holistic physicians (see www.HolisticBoard.org).
2. Finding a compounding pharmacy. Quality control is critical, so find a compounding pharmacy that pays attention to detail. Two of my favorites are ITC Pharmacy (303-663-4224 ) and Cape Apothecary (410-757-3522). The pharmacists at both of these are superb, and will be happy to guide your physician on the best dose and form to prescribe for you (they can mail it to you after your physician calls in the prescription).
3. For more information on bio-identical hormone replacement, or the research studies referenced in the footnotes, see my book “From Fatigued to Fantastic!”
Used with permission from Dr Jacob Teitelbaum's free newsletters-available at www.Vitality101.com
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