When we talk about hormone replacement therapy (HRT), in general it is assumed we are referring to the treatment of menopausal symptoms in women. However men also experience a decline in hormones with age that can be treated with HRT. In men, this hormone decline is sometimes referred to as “andropause” although it may also just be referred to as testosterone deficiency. Testosterone is the essential male sex hormone and affects many aspects of a man’s health and well-being. Testosterone replacement can improve multiple symptoms of low hormone levels.

Andropause vs. Menopause

While it is called andropause to draw a parallel to menopause, the male version is a completely different kind of hormone decline. Menopause occurs as a woman stops menstruating and the decline in hormones happens relatively quickly. For men the decline in testosterone happens gradually over time, starting as early as age 30 and decreasing on average 1% each year after that.  Because this hormone decline occurs gradually not all men will experience symptoms.

There are other possible causes of low testosterone besides aging, however. The condition is called hypogonadism when there is a problem with the testicles or pituitary gland resulting in low testosterone levels. Besides coming from normal aging, hypogonadism can be present from birth or it can develop from an injury or infection.

Detecting Testosterone Deficiency

Levels of testosterone are determined with a blood test but the “normal” range may not always be an accurate goal. Each man’s normal level of testosterone can vary and even changes throughout the day. The change from an individual’s normal level to a lower one is more important. Since a man usually will only seek help once levels of testosterone are already low and he is experiencing symptoms, it is difficult to determine an individual normal range. In many cases, prescribing hormone replacement therapy is based on relief of symptoms and not an attempt to hit a targeted level of hormones.

Symptoms Associated With Low Testosterone

Low levels of testosterone can result in a number of symptoms and health concerns including:

• Decrease in lean body mass with an increase in fat mass
• Decrease in energy and muscle strength
• Decreased libido and erections
• Increased risk of osteoporosis
• Mood changes
• Reduction in cognitive function

Testosterone replacement therapy can relieve symptoms of andropause and lead to several health benefits. Sexual functioning, mood, and energy can all be improved by restoring levels of testosterone. The potential benefits to sexual activity and physical activity are reasons many men seek HRT. Testosterone replacement can also reduce the risk of osteoporosis through improving bone health and can reduce the risk of cardiovascular disease.

Methods of Testosterone Replacement Therapy

There are different methods of administration for testosterone replacement therapy that have varying levels of effectiveness. Oral administration of testosterone often leads to low absorption and inconsistent levels with each dose so it is not usually recommended. Injections produce increased levels of testosterone but can lead to an inconsistent effect. Levels are very high after the injection and then taper off to levels that are low again, which causes symptoms to return. Transdermal application of testosterone with a cream or gel is likely the most popular and most effective method. It is easy to use and consistently improves testosterone levels.  Troches are available that are dissolved in the mouth, which also avoids the gastrointestinal tract and the variability that can come from oral capsules.

Other Hormones and Supplements for Treating Andropause

DHEA is a hormone that leads to the production of testosterone. It has been shown to enhance libido, cognitive functioning, and the immune system. It is most often administered in a sublingual tablet or in an oral capsule.

Anastrozole is an aromatase inhibitor that can lead to increased production of testosterone. Aromatase inhibitors reduce levels of estrogen by inhibiting aromatase enzyme, which leads to an improved ratio of testosterone to estrogen.

Chrysin is a bioflavonoid that is an aromatase inhibitor. It also has antioxidant effects and can reduce inflammation in the body.

Compounded Testosterone Therapy

A compounding pharmacy specializes in providing medications that are not commercially available. There are many customized formulations for testosterone available from a compounding pharmacy including creams, gels, and troches in multiple strengths. A doctor can work together with a compounding pharmacy to get the optimal delivery method and dosage for each patient.