Hormone therapy for men - health and longevity

After the age of 40, men experience hormonal changes that significantly suppress physical and sexual activity and mental abilities. Outwardly, this is manifested by obesity in the abdominal region, a decrease in muscle mass, a deterioration in general well-being, and sometimes depressive syndrome develops. For treatment, HRT for men is prescribed - testosterone replacement therapy. Preparations based on hormonal components help restore testosterone levels in the blood, which helps avoid harmful consequences. Let's consider what hormone therapy is, who is it recommended for, and what are its contraindications?

Why is there a need for hormonal (hormone replacement) therapy?

The content of the article

Hormones are biologically active substances secreted by cells located on the surface of the endocrine glands. Hormones themselves are not active until they meet target cells. The interaction of substances occurs due to blood flow.

Hormones interact with each other, their concentrations are interrelated, so problems in the production of some hormones lead to disruptions in the production of others. Thus, with diseases of the pituitary gland, there is a failure in the production of stimulating hormones, resulting in insufficient production of sex hormones. The entire hormonal system is in homeostasis, a state of self-regulation to maintain hormonal balance.

With age, for various reasons, some hormones begin to be released beyond normal limits, which leads to a significant deterioration in well-being and a decrease in quality of life. Both low and high levels of hormones are dangerous for men.

For men, the situation is aggravated by the fact that 60-65% of them are smokers, while 20% started smoking in adolescence. 19-26% of the population abuses alcohol. Smoking and alcohol have a direct effect on hormonal levels because they inhibit the functioning of the pituitary gland, which produces vital hormones.

Based on the fact that men are more prone to drinking alcohol and smoking tobacco, age-related hormonal disorders occur earlier in them and are more severe than in women. The first symptoms of androgen deficiency (lack of male sex hormones) are observed already at the age of 35 and even earlier, and already at the age of 40, against the background of hormonal imbalance, chronic diseases develop (atherosclerosis, arterial hypertension, type 2 diabetes mellitus).

The only way to normalize the balance of hormones is hormone replacement therapy, carried out strictly under the supervision of an endocrinologist. Self-medication poses a deadly threat because excess androgens lead to the development of malignant prostate tumors. Hormone therapy is prescribed solely on the basis of blood tests for hormones in accordance with the patient’s well-being.

At first, the patient is regularly observed by an endocrinologist and undergoes tests. Only if the prescribed medications have a positive effect - normalization of hormonal levels and improvement of well-being - will the doctor prescribe medications that the man can take for a long time.

The effectiveness of hormone therapy depends on the patient's age. The sooner a man seeks help, the more effective the treatment will be. A 60-year-old man with obvious androgynous changes will have a much longer and harder recovery than a 42-year-old patient who experienced the first signs of hormone deficiency.

Timely prescribed hormone therapy improves the quality and length of life, preventing the most common dangers of androgen deficiency - myocardial infarction, stroke, coronary heart disease, angina pectoris, tachycardia, diabetes mellitus, prostate tumors.

Testosterone therapy: a brief historical excursion

Testosterone therapy in men has been carried out since the dawn of the last century. But its positive results were confirmed only 40 years later. Moreover, the side effects of such therapy were much worse than its positive effect. Synthetic testosterone of those times had only tablet form. After taking them, androgen metabolism occurred in the liver, where the main part of it was destroyed. This led to severe exposure of the liver to carcinogens and toxins. The organ was irreversibly destroyed, which became the reason for the ban on such treatment in many countries. But with the advent of analogues of the drug, but without such terrible side effects, this ban was lifted. Often these drugs are used by athletes, which is prohibited by a number of prestigious competitions, and this is what causes public scandals and showdowns.

How to determine when hormone therapy is needed

40 years is a landmark age for both men and women. Although in representatives of the stronger sex the first signs of aging (internal) may appear much earlier, it all depends on the sexual constitution and lifestyle.

Signs of noticeable hormonal imbalance in a man:

• obesity of the abdominal type (the stomach grows with relative thinness of the legs, arms and torso) with a decrease in the percentage of muscle mass;
• depressive state (dissatisfaction with life, irritability, feeling of missed happiness, insolvency, unfulfillment in life for no apparent reason);
• decreased libido, decreased sexual appetite, reluctance to have sexual intercourse;
• loss of strength, desire to sleep and do nothing;
• erectile disfunction;
• high blood sugar;
• high cholesterol;
• swelling of the mammary glands.

Contraindications for replacement therapy

Relative:

• Sleep apnea;
• Polycythemia;
• Gynecomastia;
• Fluid retention;
• Edema;
• Increased prostate size;
• Impaired spermatogenesis.

Relative contraindications mean that HRT with androgens may worsen the condition.

1. Primary and secondary hypogonadism.
2. Cryptorchidism.
3. Decreased libido and erectile dysfunction due to androgen deficiency.
4. Age-related androgen deficiency.
5. Gynecomastia.
6. Obesity, difficult to treat.

How testosterone replacement drugs work

Testosterone is the main male hormone. It is also found in the body of representatives of the fair half of humanity, but in much smaller doses.

In men, testosterone is produced by the testes under the influence of hormones produced by the pituitary gland, and in smaller quantities by the adrenal glands. The normal testosterone level is 12.5-40.6 nmol/l. This level is sufficient for the normal functioning of the prostate gland, ovaries, maintaining and increasing muscle mass, lowering cholesterol levels, maintaining an erection, etc.

Due to illness or age-related changes, the amount of testosterone in the blood decreases. This leads to a deterioration in health and the development of various diseases.

The first synthetic analogues of testosterone went on sale in the USSR countries in the 80s of the 20th century. The drugs were used not only for therapeutic purposes, but also in the sports world. It was during this period that bodybuilding flourished, because artificial androgens led to rapid growth of muscle mass and an increase in physical strength. But testosterone synthesis did not occur in the testicles, but in the liver, as a result of which toxins and carcinogens accumulated there. The liver was destroyed, and synthetic testosterone analogues were banned for some time until the invention of a new generation of drugs.

Testosterone itself is not active; it requires the enzyme 5-alpha reductase to activate it. It is he who converts the hormone into dihydrotestosterone, the active form of androgen. Only a doctor can determine what exactly the patient needs: a synthetic testosterone analogue itself or a 5-alpha reductase inhibitor. The result of treatment depends on this. Self-medication is strictly contraindicated because it leads to testicular cancer.

The endocrinologist prescribes blood tests for the patient several times a day: morning, afternoon and evening. Based on the dynamics of hormone production, it is determined whether the main problem is a lack of the hormone itself or its inhibitor. Then the doctor prescribes the drug itself.

There are several forms of release of the drug:

• The oral form (tablets) is the most convenient. The advantages include: different dosages, the possibility of independent use, ease of use. Among the disadvantages of tablets are a high percentage of counterfeits, a cumulative effect, strict adherence to dosage and frequency of administration.
• The injection form (injection) is more often used in replacement therapy. Advantages: the effect occurs immediately and lasts a long time, the active substance enters the blood immediately and is in a stable concentration, no control over daily intake is required. For some men, injections are contraindicated; they are performed under the skin, but this requires certain skills.
• The transdermal form (plasters, creams) is used extremely rarely, because the percentage of the active substance entering the skin is quite small. In addition to keeping your skin clean, you should avoid exercising in the pool and gym. However, some men fell in love with this form of androgen administration. It does not affect the liver and ensures a smooth flow of testosterone into the blood.
• Subcutaneous form (implants). In Russia, this form of androgen administration is prohibited. Its essence is this: an implant is inserted under the skin with a hormone applied to the surface of a certain dosage, designed for six months. The implant is then removed and a new one is inserted in its place.

The benefit of hormone replacement therapy under the supervision of an endocrinologist is the fact that some men do not need an artificial testosterone analogue. They just need to take a course of stimulants, which will force the testicles to independently produce the required dose of testosterone.

This applies mainly to young men whose gonadal activity is suppressed due to physical and psychological stress. Based on blood tests, the doctor draws conclusions and prescribes treatment appropriate to the individual characteristics of the body. At the same time, a drug course with synthetic androgens can lead to the development of oncology if used by a healthy man.

Pitfalls of testosterone therapy

26.04.2018

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In the next episode of the program “An Hour with a Leading Urologist” Stepan Sergeevich Krasnyak, employee of the Department of Andrology and Human Reproduction of the Research Institute of Urology and Interventional Radiology named after. N.A. Lopatkina of the Russian Ministry of Health, spoke about the problems associated with prescribing hormonal replacement therapy with testosterone drugs in men.

As Stepan Sergeevich noted at the beginning of his speech, the topic of testosterone therapy is extremely controversial and raises many questions among both doctors and patients. The prevalence of testosterone therapy today is growing rapidly, but the negative aspects of such treatment, according to the guest of the program, are often forgotten.

S.S. Krasnyak recalled the main areas of influence of testosterone on the male body. In particular, this hormone provokes the growth of body hair, is involved in the synthesis of whey proteins in the liver, causes enlargement of the penis and triggers spermatogenesis, affects thinking and mood, helps to increase strength and muscle mass, and from the kidneys is involved in the synthesis of erythropoietin, as well as supports bone growth in length and increase in their density. Accordingly, the less testosterone in the body, the less pronounced male sexual characteristics. Fortunately, according to Stepan Sergeevich, the decrease in the amount of this hormone is usually reversible.

Boundary between normality and pathology

It's no secret that testosterone levels tend to decline with age. However, is this process normal or pathological, and where is the line that allows us to distinguish between these two conditions? Most often, problems with testosterone occur in men over the age of 45–50 years. There are a number of criteria for identifying age-related hypogonadism. These include a decrease in serum testosterone (total <11 nmol/l, free <220 pmol/l), erectile dysfunction, decreased libido and decreased frequency of morning erections (EMAS data). The doctor emphasized that testosterone drugs are prescribed to treat not sexual dysfunction or obesity, but hypogonadism as such. The testosterone level threshold for prescribing hormone replacement therapy is 9.7–10.4 and 6.9 nmol/l.

Stepan Sergeevich noted the importance of a personalized approach to the patient: there are people with high receptor sensitivity in whom even low testosterone levels do not cause clear clinical manifestations. Accordingly, the question arises as to whether hormonal therapy is needed in such patients. Current clinical recommendations today indicate that, as a rule, it is not necessary. In practice, according to the lecturer, one must proceed from a combination of clinical symptoms, probably associated with low testosterone levels, and its laboratory confirmation. At the same time, it is important to avoid uncontrolled and excessive prescription/reception of testosterone.

In general, cases of symptom discrepancy (20–40% of the general population) and low circulating testosterone levels (20% of men > 70 years) are quite common. According to these criteria, only 2% of people aged 40 to 80 years have age-related hypogonadism and actually need testosterone therapy.

Hormone replacement therapy – billions of dollars

Today, testosterone replacement therapy is widely used throughout the world to treat hypogonadism and associated isolated symptoms. The alarming aspect of this trend, however, is that it has emerged without any serious scientific evidence regarding the benefits and risks of this type of therapy.

Today, injectable and gel testosterone preparations are mainly used. In the United States, sales of testosterone preparations between 2005 and 2010 has doubled and continues to grow. Similar trends can be seen all over the world. From 2000 to 2011, total sales of testosterone in the world increased 12 times to $1.8 billion. According to forecasts, in 2020 sales of testosterone preparations in the United States alone will amount to $3.8 billion. Involuntarily, as Stepan Sergeevich noted, the question arises: is it really Have men become so much more likely to suffer from hypogonadism lately? It is possible that large scale overtreatment is occurring.

The doctor also spoke about the presence of scattered but numerous data indicating an increasing trend in the number of patients suffering from obesity associated with taking testosterone.

Replacement therapy, Stepan Sergeevich emphasized, should be offered to the patient only after a conversation that in the long term the beneficial and unfavorable consequences of this treatment for him are unknown. Thus, in 2020, at the Congress of the American Urological Association, a so-called urological “trial” was held, where, with the participation of practicing lawyers, a case of prescribing testosterone drugs to a patient with a high risk of cardiovascular diseases was examined, which ultimately led to his death. Interestingly, virtually no somatic diseases are contraindications to hormonal therapy. However, the doctor emphasized, this does not mean that it should be prescribed to everyone, including the most severely ill patients. Patients with a high risk of concomitant diseases must undergo specialized studies.

It is also noteworthy that many of the studies available on the topic today included men without symptoms of hypogonadism, while various testosterone thresholds, drugs, and dosage regimens were used for evaluation. Thus, it is very difficult to bring together data that would allow an objective assessment of the safety of testosterone therapy.

About pitfalls

At the very least, there are absolute contraindications for prescribing HRT. These include prostate and breast cancer, as well as liver tumors. Relative contraindications include prostate-specific antigen (PSA) level >4 ng/ml (or 3 ng/ml in men at high risk of developing prostate cancer); hematocrit >50%; severe lower urinary tract symptoms caused by benign prostatic hyperplasia (above 19 points on the IPSS scale); and poorly controlled congestive heart failure and sleep apnea.

There is some evidence that testosterone supplements increase prostate volume, ultimately causing a modest increase in PSA levels in older men. In 2005, the Journal of Gerontology published a report showing that the total number of prostate-related adverse events (prostate biopsies, cancer, serum PSA levels greater than 4 ng/mL, increased IPSS scores) was significantly higher in the group of patients those receiving testosterone than those receiving placebo (odds ratio 1.90; 95% CI 1.11–3.24; p<0.05). There are also data showing the results of testosterone supplementation in patients with locally advanced and metastatic prostate cancer (PCa). According to these data, in patients with aggressive and non-aggressive forms of the disease, the levels of total testosterone and sex hormone binding globulin were significantly different: in patients with an aggressive form of prostate cancer, testosterone levels were significantly higher. It is unclear whether we can talk about a cause-and-effect relationship here, but the fact of correlation has been revealed.

Another significant factor is hepatotoxicity. It is because of this that oral forms of testosterone preparations are prohibited in most countries today. Their use has been associated with the development of liver failure, benign and malignant liver neoplasms, intrahepatic cholestasis, hepatic purpura, hepatocellular adenoma and carcinoma.

In addition, a factor such as polycythemia was noted. A very common complication of taking testosterone drugs is erythrocytosis (hematocrit greater than 50%). Two meta-analyses performed in recent years have shown significant negative effects of testosterone therapy compared with placebo in this regard. There is a correlation between high testosterone levels and high hemoglobin levels. Erythrocytosis is more often dose-dependent and develops in older men during therapy with injectable forms of testosterone. The risk of such complications is especially high in the presence of other chronic diseases, for example, chronic obstructive pulmonary disease. Therefore, when prescribing testosterone drugs, control blood tests should be performed.

As for the effect of testosterone drugs on the cardiovascular system, this issue remains controversial. Due to the steady increase in cardiovascular mortality rates, it becomes especially acute. There is, in particular, evidence that testosterone intake correlates with the progression of heart failure, but the cause-and-effect relationship remains a matter of debate. The use of testosterone in coronary artery disease is thought to have a stimulatory atherogenic effect due to its negative effect on the lipid profile. However, normal physiological levels of testosterone have been shown to be beneficial for the male heart, and low levels are associated with an adverse risk of coronary disease outcomes. But, as S.S. Krasnyak emphasized, it is impossible to guarantee that a particular patient will achieve exactly the physiological level of testosterone without serious fluctuations.

In 2006, the New England Journal of Medicine published a study of 106 older men with a mean age of 74 years with low total testosterone, limited mobility, a high prevalence of hypertension, obesity, diabetes, pre-existing heart disease, and hyperlipidemia. For 6 months, patients underwent testosterone therapy in daily doses of 5 to 15 g. A placebo group was also allocated. The incidence of cardiovascular events was significantly higher in patients taking testosterone drugs (23% vs. 5%). Thus, Stepan Sergeevich summed up, it is impossible to assert the safety of such therapy, especially long-term therapy, in patients with existing diseases.

Testosterone and Fertility

Another serious issue is the effect of testosterone drugs on male fertility. There is evidence of a decrease in the volume of patients' testicles and a decrease in the number of sperm up to their complete absence (azoospermia) while taking testosterone drugs. In this case, the sperm count most often returns to its original level within 6 months after stopping therapy, but this does not always happen. This is especially important for young men, some of whom take hormonal medications to achieve rapid improvements in physical and athletic performance. Today there are even developments in the use of testosterone drugs as a means of male contraception.

Other factors

An important factor is also changes in the psyche: psychotic symptoms, excessive libido and aggression, in addition to physical and psychological dependence with withdrawal syndrome, quite rarely, but still noted by attending physicians in patients taking testosterone. In this sense, as the doctor noted, the hormone, like many things in the world, has dark and light sides. Taking testosterone may increase the patient's level of entrepreneurship and courage, but may also lead to aggression and suspiciousness. Here a lot depends on the innate qualities of the man himself.

A known side effect of testosterone drugs is gynecomastia. It is associated with the aromatization of testosterone to estradiol in peripheral adipose and muscle tissue. In this case, the ratio of estradiol to testosterone, as a rule, remains normal.

In addition, testosterone replacement therapy is associated with worsening sleep apnea. Its severe forms are a relative contraindication for therapy. In case of occurrence or exacerbation of obstructive apnea, a reduction in the dosage of the drug or discontinuation of therapy is required.

Like any anabolic steroids, testosterone preparations can cause nitrogen, sodium and water retention - the mineralocorticoid effect. Edema in such cases can worsen the condition of patients with heart, liver and kidney diseases.

The use of cutaneous forms of testosterone is associated with the phenomenon of hyperandrogenism in sexual partners of patients. Transdermal formulations may be associated with a range of skin reactions, mainly erythema and pruritus, which are also common with patch use. Intramuscular injections of testosterone, in turn, can cause local soreness and bruising.

Non-drug ways to increase testosterone

In addition to hormone replacement therapy, physical exercise, proper nutrition and regular visits to a urologist help maintain and increase testosterone levels at any age. Stress control also plays an important role. Many patients benefit from, for example, reducing their working hours. If there is a large volume of overtime work, the working day should be reduced to 10 hours. It is useful to spend at least 2 hours a day doing something you love that is not related to work: for example, reading or listening to music.

Regarding physical activity, there is a recent Japanese study (Kumagawa et al., 2015), which showed that after 12 weeks of high physical activity there was a significant increase in testosterone levels without hormone replacement therapy. Another study of 83 men (Trumble, Benjamin C. et al.) found that one hour of chopping wood increased testosterone levels by 48% (P < 0.001). Another work was carried out with the participation of 30 young men aged 18–27 years (Devi S. et al., 2014). They exercised on an exercise bike for 15 minutes a day with a heart rate of 125–150 beats per minute. After 12 weeks of such exercises, an increase in testosterone levels of up to 20% was observed.

There is also evidence that testosterone levels correlate well with waist circumference. Thus, getting rid of excess fat mass will in any case lead to an adjustment in the level of this hormone. It is weight loss that can be considered as a first-line therapeutic measure in patients with hypogonadism caused by obesity. There is a possibility that if weight loss is successful, the man will not need hormone replacement therapy in the future.

In the 21st century, prolonging life and maintaining its quality come to the fore among the tasks of medicine. Accordingly, patients should be given a number of simple recommendations that will help reduce the risk of developing metabolic syndrome and problems with testosterone levels. First of all, a man should change his diet and stop drinking excessively, and approach this systematically, and not as a temporary measure. However, the doctor emphasized, the patient does not need to be severely limited in the consumption of fats, including saturated fats: they are involved in the production of sex steroids, including testosterone. There is evidence of a strong correlation between high-density lipoprotein (HDL) levels and free testosterone levels (Heller, R.).

There are also a number of herbal remedies that have an evidence base for increasing testosterone levels. For example, 14-day consumption of Eurycoma longifolia extract has been shown to increase circulating testosterone levels by 30.2%. Another study found that the same extract increased the number of men with normal testosterone levels from 35.5 to 90.8%. In addition, 6-week consumption of Peruvian maca extract showed an increase in testosterone production by Leydig cells (Ohta Y. et al., 2016).

Stepan Sergeevich, however, noted that he understands the skepticism of some doctors regarding methods other than hormone replacement therapy. But, as he recalled, many of the active ingredients of the drugs synthesized today were initially obtained from plant materials. Therefore, the use of herbal remedies in addition to changing the amount of physical activity, adjusting diet and reducing daily stress levels may well bring results.

Stepan Sergeevich Krasnyak, employee of the Department of Andrology and Human Reproduction, Research Institute of Urology and Interventional Radiology named after. N. A. Lopatkina, Ministry of Health of Russia

The article was published in the journal “Urology Digest” No. 2/2018, pp. 26-34

Topics and tags

Testosterone

Comments

Oreshkov Vasily Sergeevich - 06.13.2018 - 17:42:36

Thank you very much for the informative report

Kiselev Evgeniy Alekseevich - 04/30/2018 - 11:14:14

I came across a statement that a new type of treatment undergoes damped fluctuations in assessment from “panacea” to “ineffective and harmful.” Over time, as application experience accumulates, a balanced position is formed. In the case of testosterone, these fluctuations are apparently far from dying out. Despite the fact that it has been used for about 80 years. Maybe non-medical factors intervene, artificially maintaining disputes?

Chernega Sergey Vasilievich - 04/26/2018 - 18:00:31

Thanks for the informative report

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Changes in the proportions of follicle-stimulating and luteinizing hormones in men

First of all, you need to find out the reason for the decrease in testosterone, because age-related androgen deficiency is only one tenth of the probable factors.

Testosterone is synthesized by Leydig cells in the testicles from dietary cholesterol. Gonadotropins, hormones produced by the hypothalamus, are responsible for the synthesis. These include the luteinizing hormone LH (it supports the functioning of Leydig cells) and the follicle-stimulating hormone FSH (it controls spermatogenesis). Functioning is controlled by the hypothalamus.

Homeostasis is when there is insufficient testosterone production in the testicles, a signal is sent to the hypothalamus and it signals the pituitary gland to release more LH or FSH. The norm for follicle-stimulating hormone in a man is 1.5-12.0 mU/l, and for luteinizing hormone - 0.5-10 mU/l.

Unlike women, these hormones in representatives of the stronger half of humanity do not fluctuate throughout the month, but maintain a stable level. The ratio of proportions is also important. WASH should always prevail over LH, and a change in the opposite direction leads to a number of health problems.

Follicle-stimulating hormone affects Sertoli cells located on the seminiferous tubules. The cells contribute to the production of substances that support sperm activity. If there is a lack of FSH, little nutrient fluid will be produced, which will cause male infertility.

Diabetes mellitus, excess weight, tumors of the adrenal glands and brain lead to decreased production of FSH. Low FSH levels also occur with problems with the small intestine. Only a doctor can determine the true cause of the disease.

What is menopausal syndrome

The onset of menopause is associated with the gradual decline of reproductive function. A woman stops getting her period. She becomes unable to bear any more children. Such complex changes in the female body occur due to a decrease in the amount of sex hormones produced by the ovaries.

The onset of menopause is characterized by hormonal imbalance - the amount of hormones either decreases or increases. Unstable hormonal levels, as well as natural changes in the functioning of the systems of the female body, lead to the development of “menopausal syndrome” - a set of specific symptoms.

This is the first time a woman encounters neurovegetative symptoms of menopause in her life:

1. Hot flashes - for a short period of time (about a few minutes), the body temperature rises sharply due to a rush of blood to the head and upper body. This causes the lady’s face, neck, chest and hands to quickly turn red, and after a short time they return to normal. Some representatives of the fair half of humanity experience dizziness from such a lightning-fast flow of blood.
2. The profuse sweating is so intense that women have to completely change their clothes several times a day. Most ladies experience this phenomenon during sleep.
3. Vaginal dryness, which is accompanied by itching or burning.

In addition, women very often encounter such unpleasant symptoms as involuntary urination or urinary incontinence, dry skin, chills, and surges in blood pressure.

Menopausal syndrome includes the following psychoemotional disorders:

• increased irritability;
• insomnia;
• impaired concentration;
• high fatigue even with minor loads;
• loss of appetite.

Thus, the lady’s performance decreases, and her psycho-emotional state also worsens.

Hormonal imbalance leads to menstrual irregularities. Menstruation comes irregularly, becoming either scanty or heavy. The number of days of menstrual bleeding decreases. Gradually, a woman approaches menopause - her last independent period.

Everything in the body is interconnected and under the influence of female sex hormones, metabolism occurs before the onset of menopause. A gradual decrease in the amount of hormones, and then a complete cessation of their synthesis, provokes metabolic and endocrine changes.

In women, the genital organs atrophy and dangerous diseases such as osteoporosis, osteochondrosis, obesity, diabetes mellitus and various joint diseases develop.

Tests and ultrasound to identify hormonal problems in men

Luteinizing hormone also does not decrease or increase on its own. An endocrinologist takes several blood tests, from which he draws conclusions about the level of the hormone. Its value can be influenced by stress, so the psychological aspect is also taken into account.

If all tests show a consistently low level of LH, the patient undergoes an ultrasound examination of the thyroid gland and adrenal glands. Additionally, the doctor takes a blood test for thyroid hormones, and also conducts a biochemical blood test to determine the condition of the kidneys and liver. At the same time, the quality of sperm is checked, because LH affects the maintenance of their viability.

With a mild LH imbalance, the patient is advised to give up fast food, play sports and have regular sex life. If the hormone concentration is low, the doctor prescribes replacement therapy.

Transdermal patches

They have their disadvantages and positive aspects, on the basis of which a choice is made. The benefits of using patches include:

• rapid achievement of the required level of hormones;
• easy to use, no need to constantly visit health care facilities, as is the case with injectable forms;
• painless, non-invasive;
• testosterone is released at regular intervals in precise quantities;
• does not affect the liver, has high bioavailability, without being destroyed in it;
• prompt completion of treatment if necessary.

Disadvantages of the transdermal route of drug administration:

• frequent use;
• irritation or allergic manifestations at the site of attachment;
• inconvenience when going to the beach, going to the pool, bathhouse, sauna.

Scrotal patches are attached only to the scrotal area. They involve frequent shaving of the area. Skin forms that are attached to the back, abdomen, thigh do not cause discomfort when worn and do not require special conditions.

A well-known representative is Androderm, which is widely used today. A skin patch that needs to be applied before going to bed. Its action lasts for a day.

What are the stages of hormone replacement therapy in men?

Hormone replacement therapy is a set of measures aimed at restoring unbalanced body functions. The set of measures can be divided into several stages:

• Restoring optimal testosterone levels;
• Restoration of other hormonal parameters;
• Normalization of weight, increase in muscle mass;
• Treatment of cardiovascular pathologies - normalization of cholesterol;
• Prevention of prostate cancer;
• Restoring libido.

Types of drugs for menopause

3 main dosage regimens for hormone replacement therapy have been developed and are used:

• monotherapy with estrogens or gestagens;
• combination of estrogens with gestagens;
• combination of estrogens and androgens.

Estrogen pills

Hormone therapy medications that contain only estrogens can only be used in women who have had their uterus removed. This is due to the proliferative effect of the female hormone and an increased risk of developing endometrial cancer. Also, with fibroids or endometriosis, pure estrogens stimulate the progression of the pathology.

Estrofem tablets are used, which contain 2 mg estradiol. These menopause pills are prescribed to women over 50 every day from any day. But if the uterus and menstruation are preserved, they are drunk from the 5th day of the cycle.

Combined tablets for menopause

Tablets for severe hot flashes during menopause can be used continuously or cyclically. For patients under 50 years of age, gynecologists often prescribe combined oral contraceptives as a preparation for HRT. They help regulate cycle irregularities, protect against pregnancy, and improve overall well-being. The optimal drugs during this period are three-phase COCs Qlaira, Triregol.

From the age of 50, pills for menopause are replaced with combination products based on natural estrogen and supplemented with a gestagenic component. The following types of progestins are effective:

• Levonogrestrel;
• cyproterone acetate;
• norgestrel;
• medroxyprogesterone acetate;
• norethisterone acetate.

When using hormone replacement therapy for complicated menopause, the drug is selected individually. In the first phase of the cycle, the woman takes tablets containing only estradiol, and in the second, a combination of it with progestins. The combination of estrogens and androgens is rarely used due to the large number of side effects.

Herbal remedies for menopause

During menopause, herbal hormonal preparations, which include phytoestrogens, can be used. These are natural molecules that resemble female hormones in structure and effects in the body. The main classes of substances include:

• lignans – isolated from the shells of grain crops, found in rice, nuts, fruits, seeds, and plant fibers;
• isoflavonoids - found in soybeans, pomegranates, dates, sunflower seeds, red clover; through metabolism in the intestines they are converted into substances with estrogenic activity;
• coumestans – found in nuts, seeds and fiber-rich vegetables.

Doctors prescribe women's pills for menopause based on herbal components when the patient refuses to take hormones or there are a large number of absolute contraindications to HRT. The most commonly used drugs are in the form of tablets or drops Klimonorm, Qi-klim. It is made from extracts of black cohosh, melbosia and raponticin.

In the category of dietary supplements for menopause with a weak hormone-like effect, the following are used:

• Menoforse - contains B vitamins, ascorbic acid, iron, zinc, potassium, phosphorus, copper, flavonoids and camphor essential oil, the supplement has no estrogenic activity;
• Serelis is a patented drug with an unproven mechanism of action, does not contain phytoestrogens, but it contains pollen extract and vitamin E;
• Mense is a supplement based on a complex of vitamins E, C, group B and microelements with the addition of isoflavonoids.

Restoring optimal testosterone levels

Synthetic drugs have different dosages, so the type of drug is selected by a urologist, andrologist or endocrinologist.

Non-invasive products (gels, patches) are quite popular, but they have a low dosage, so they will not help everyone. Injections maintain testosterone levels for a long period, but cause a sharp jump in hormones, which is fraught with the development of oncological tumors. Tablets are the most popular drugs, however, they should not be taken without consulting an endocrinologist.

What to pay attention to when treating with hormones

Given the many serious side effects, it is necessary to monitor the functions of organs and systems:

• 
  Liver tests: before starting androgen replacement therapy, once every 3 months in the first year, then 2 times a year or immediately when specific complaints appear.

• Study of the lipid profile before treatment, if there were previously prerequisites for pathology - once every 3-4 months.
• TRUS, PSA blood, transrectal digital examination in men over 40 years old - once every 3 months in the first year, then after 6-12 months.
• ECG 2 times a year.
• Spermogram monitoring in patients planning parenthood (if there is no absolute infertility, for example, due to a genetic disease);
• General blood test, coagulogram.
• TAM, urea and creatinine.
• Ultrasound of the abdominal organs.
• Study of the hormonal profile of the thyroid gland.
• Blood sugar control.

Important

You may need consultations with an endocrinologist, hematologist, urologist, oncologist, therapist, neurologist, etc.

Hormone replacement therapy should be prescribed by a doctor, taking into account many factors . The expected effect of treatment must exceed the possible risks. Independent interference with hormonal levels will inevitably lead to negative consequences that are not always reversible.

Victoria Mishina, urologist, medical columnist

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Normalization of weight, reduction of adipose tissue and increase in muscle mass

Men after 30 live with the memories of their youth, when they could eat anything, and at the same time many people told them “why are you so thin.” Good metabolism and good hormonal levels did their job; most boys 16-25 years old can boast of a toned figure and lack of fat without any special diets or training.

After 25 years, to maintain definition, you need to visit the gym - a man quickly gains muscle and loses fat. After 31-35, the situation changes dramatically: muscles lose elasticity, a noticeable belly appears, any exercise becomes more difficult, and physical activity is accompanied by tachycardia and shortness of breath.

These are the first signs of androgen deficiency, and it is at this stage that measures should be taken. If you miss the moment, the recovery will take a long time, and the effectiveness of hormone replacement therapy will not be noticeable immediately.

Normalizing weight after 40 is impossible without a balanced diet. Testosterone increases not only with the help of hormones, but also with food. 20-30% of the diet should consist of foods rich in healthy fats - avocados, fish, olives, nuts. Protein foods should dominate carbohydrate foods.

Physical activity is of great importance. Without them, weight normalization is impossible. If a man has never played sports, it is difficult for him to regain optimal physical shape.

The process of normalizing weight will take more than one year, but in many ways this will allow you to achieve the required level of testosterone. In case of significant problems, hormonal therapy is prescribed to restore the balance of the male hormone.

Review and characteristics of medications

Conventionally, drugs for HRT can be divided into several groups:

• monohormonal ones contain only estrogen,
• complex ones consist of artificial analogues of estrogens and gestagens,
• phytohormones are natural analogues of estrogen.

All HRT products contain estrogens in different dosages. To reduce the risk of side effects, women over 50 years of age are recommended to use drugs with an estrogen dosage of up to 35 mcg. The forms of such drugs can be different (tablets, injections, vaginal suppositories, ointments, gels). For systemic exposure, it is recommended to take oral medications, injections, local suppositories, ointments.

A woman’s doctor may prescribe one of the following options for taking hormonal medications:

• monotherapy with estrogens and progestogens cyclically or continuously,
• combination treatment in cyclic or monophasic continuous mode.

Single drugs and combination drugs

Monopreparations that can be used after 50 years:

• Ovestin (cream, gel or suppositories),
• Divigel (gel of different concentrations),
• Estroferm (tablets),
• Estrogel (gel).

Combined products:

• Divina,
• Klimonorm,
• Triaklim,
• Angelique.

After removal of the uterus, a woman is often prescribed estrogen monotherapy cyclically or continuously. If a gel is used, it must be applied to the gluteal region and abdomen every day.

If the uterus is preserved and there are no pathologies on its part, combined hormonal drugs are prescribed in a cyclic or continuous mode:

• Klimonorm consists of estradiol and levonorgestrel. Effectively relieves menopausal symptoms. Do not take for ectopic bleeding.
• Cyclo-Proginova active substance estradiol valeriat and norgestrel progesterone derivative. They are produced in the form of white and light brown dragees, 21 pieces in a blister. Eliminates vegetative and psycho-emotional symptoms associated with menopause.
• Climen is an antimenopausal drug with antiandrogenic action. Active ingredients: estradiol, cyproterone acetate. The product helps to renew the thinned epithelium of the uterus, increases the hydration of the mucous membranes, and is a good prevention of osteoporosis.
• Femoston is available in tablets with different dosages of active ingredients. Contains estradiol and dydrogesterone. The drug is contraindicated in the presence of cancer.

Treatment of cardiovascular pathologies caused by excess “bad” cholesterol

Androgen deficiency is often accompanied by high cholesterol, which poses a health threat. In women, blood vessels are protected by the hormone estrogen, so they fall into the risk group after 50 years, and men much earlier - already at 35.

In Russia, 60% of cardiovascular disorders are caused by the “attack” of very low density lipoproteins. They settle on the walls of blood vessels, forming a plaque. It clogs the vessels, narrowing their lumen and impairing the blood supply to the organs. Even more dangerous is the tearing of the plaque by the bloodstream. The result will be stroke and death.

On the other hand, the lack of very high density lipoprotein also negatively affects hormonal levels. 50% of sex hormones consist of cholesterol, which is also responsible for maintaining the cell membrane. Smoking, alcohol, lack of physical activity, stress at work - all this contributes to an increase in “bad” cholesterol.

The upper limit of “bad” cholesterol should not be higher than 3.5 mmol/l. Diabetes mellitus also contributes to a change in proportions in favor of “bad” lipoproteins. The only non-drug way to reduce cholesterol is to review your diet and give up bad habits. Even without changing your usual menu, but by replacing frying with boiling, you can reduce cholesterol levels by 20%.

If the patient cannot cope with the problem on his own, and he has a high risk of heart attack or stroke, the doctor prescribes cholesterol-lowering drugs. Self-medication in this case is prohibited, otherwise the hormonal imbalance may worsen.

Causes of androgen deficiency

The main cause of testosterone deficiency is age-related decline in sexual function . The level of the hormone begins to gradually decrease after 30 years (by 1% annually); when its level is critically low, andropause occurs. In men it usually occurs after 50, but some experience the first symptoms after 40.

Other causes of testosterone deficiency:

• Pathologies of the pituitary gland and hypothalamus (brain glands), which regulate the synthesis of androgens;
• Cryptorchidism (in a newborn boy, the testicles do not descend into the scrotum);
• Tumors of the adrenal glands and testicles, their inflammation, resulting in tissue deformation, as well as castration (the testicles produce 95% of testosterone);
• Pathologies of the thyroid gland;
• Liver dysfunction (cannot cope with testosterone metabolism);

• Heart failure;
• Obesity. Adipose tissue in men is an endocrine organ that transforms testosterone into female estrogens using the enzyme aromatase;
• Hormone-dependent tumors (prostate, testicles), the treatment of which requires a maximum reduction in testosterone levels;
• Medicines: beta blockers, steroids, antiepileptic drugs;
• HIV.

The reason for a slight decrease in testosterone levels may be lifestyle: smoking, alcoholism, lack of physical activity.

Prevention of prostate cancer with hormones

Prevention of prostate cancer is of great importance, because malignant neoplasms of the prostate gland are the 5th leading cause of death in men under 70 years of age. Cancer develops very slowly and is detected only when metastases spread to other organs - liver, kidneys, lungs.

Hormone replacement therapy is an important part of preventive work in the fight against prostate cancer, since androgens, or more precisely, androstenediones, are responsible for the functionality of this organ. These sex hormones are converted into estrogens (estradiol) in the prostate gland. Under unfavorable conditions (excess fat, smoking, alcohol), an imbalance of testosterone and estrogen occurs, leading to changes in cells.

One way to recognize a predisposition to prostate cancer is the PSA test. The technique detects antigen in the prostate epithelium. Through the fluid produced by the prostate gland, the antigen enters the blood serum. The norm is considered to be 4 ng/ml. Borderline indicators indicate hyperplasia - uncontrolled proliferation of adenoma cells.

Hormone replacement therapy requires regular examination of the prostate gland through the rectum.

Recipes with boron uterus for HRT

Effective recipes from boron uterus at home help reduce the severity of menopause symptoms.

1. Water infusion. You need to take 1 tbsp. dry boron uterus and pour hot water into a mug, wait until it cools down for about 20 minutes. Filter and take half a cup 3 times a day before snacks. Use no longer than 2 weeks.
2. Alcohol tincture. You need to chop 2 tbsp. boron uterus, add alcohol 40° 1 cup. Place everything in a container and close tightly. Leave in a dark place for 14 days. As time passes, drink 30 drops before a snack 3 times a day. Dilute the tincture with boiled water, slightly warm. The course of treatment is no more than 14 days.
3. Decoction. Add 2 tbsp to 300 ml of boiling water. dry raw materials. Boil for 5 minutes, turn off the heat, cover with a lid and leave for 0.5 hours. Drink half a glass 3 times a day before meals. You can also douche with this decoction at night, but only warm.

Libido restoration

Regular sex life is an excellent prevention of prostate cancer, but at the same time it is difficult with androgen deficiency.

The fluid secreted by the prostate is naturally released during sexual intercourse. When you refuse sexual activity, fluid stagnates in the ducts, causing hypoxia. This enhances proliferation - the growth of cells through their division. With prolonged abstinence, the risk of prostate development increases several times.

In women, libido is based on an emotional component, while in men it has a physiological basis. Without normal testosterone levels, it is impossible to bring male libido back to normal. However, taking synthetic drugs on your own is very dangerous; this must be done under the supervision of an endocrinologist, who will select the dosage based on the patient’s health and hormonal background.

To do this, the patient takes a testosterone test; based on the results, the dose will be calculated and the drug will be selected.

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Transcutaneous and implantation forms

These drugs are quite expensive to use, so they are not so common. In addition, gels often cause unwanted skin reactions. Representatives - Androgel, Androgel, Dihydrotestosterone Gel. Gels are applied to the skin of the shoulders, forearms or abdomen (not on the genital area!), leaving until completely dry.

Implants may become dislodged or pushed outward after implantation, and bruising or infection may occur. Injectable forms have completely replaced implantation methods of hormonal therapy.

The choice of management path is based on the general condition of the patient, his hormonal levels, and the severity of the clinical signs of andropause. Early initiation of treatment will ensure a favorable outcome of male menopause.