As of February 2016, there are thousands of men walking into doctors offices complaining of plow sex drive, declining energy levels, weight gain, erectile dysfunction and declining workouts due to loss of muscle mass. These symptoms are collectively referred to as andropause and can start as early as 30 years old. We treat these men using testosterone, human growth hormone boosters, DHEA, thyroid and pregnenolone in addition to optimizing nutrition, hydration and sleep. In this blog I am going to cover the most common bioidentical hormone side effects seen in men using bioidentical hormone replacement therapy.
1. What are the side effects of testosterone?
To understand the side effects of testosterone you need to understand what happens to it when it enters the body. Testosterone gets metabolized into two things, dihydrotestosterone (DHT) by and enzyme called 5-alpha reductase and estradiol by an enzyme called aromatase. It is DHT and estradiol that are responsible for the majority of side effects of using testosterone. The first thing is that testosterone can cause is an increase in male pattern baldness. However this only occurs in 2% men who are using testosterone (1/50) and they are typically susceptible to it genetically. This is because DHT stimulated the hair follicle to undergo an accelerated life cycle. This however can be easily treated using something called propecia or avodart given twice per week. In men with excess body fat, if too much testosterone is converted to estradiol and your estradiol levels get really high, men can experience some breast tenderness or nipple sensitivity. If left unchecked this can progress to gynecomastia which is essentially an increase in breast tissue. In these cases we simply ease off the dose of testosterone and/or ad a medication called arimidex which slows the conversion of testosterone to estradiol. We typically only need to use arimidex for 2-3 months and then patients can come off. Some men will report and increase in acne but it’s usually very mild and tolerable.
2. Can testosterone affect your sperm counts?
Here is a link to an entire video I did dedicated to testosterone and its effects on your sperm. http://www.doctorbreen.com/portfolio-archive/how-does-testosterone-impacts-your-sperm-count/
In a nutshell, long term testosterone can negatively effect your sperm counts. So for men who would still like to have children, we recommend on of three different protocols for boosting testosterone and maintaining your fertility
3. I hear testosterone can increase my risk of blood clots and heart attacks. Is this true?
Based on the most up to date medical evidence the answer is no to both of these questions. Testosterone can cause an increase in red blood cell production which is called erythrocytosis. This is physiologic and results in having an increased ability to transport oxygen throughout your body which is a good thing. Erythrocytosis is often confused with something called polycythemia vera which is an increase in red blood cell production, but also an increase in platelet counts which is what can lead to blood clots. There has not been one medical study that shows testosterone increases your risks of blood clots which is extremely important for you to understand. As far a heart attack risk, there were two very flawed studies published in the last two years which showed that there was an increase in risk of heart attack in the first few months after starting testosterone. I HIGHLY encourage you to watch this YouTube video of Dr. Mogentaler, who is a Harvard trained urologist and world renowned expert on testosterone replacement, explain why these studies do not show an increased risk of heart attack and why using testosterone is actually beneficial to your heart. https://www.youtube.com/watch?v=NPx2dRG1zRQ
The reality is that using bio-identical hormones, specifically testosterone, DHEA and thyroid has been show to reduce or eliminate symptoms of andropause and also reduce your risk of dying from all causes by 25-50% (Journal of Circulation, 2013). There are some mild and infrequent side effects that are easily managed, but most men do fantastic and report no side effects if the doses used are physiologic. I highly encourage all med aged 35 and oder to have their hormone levels checked and optimized prior to developing disease and symptoms. If you want to get started, simply pick up the phone and call one of my patient coordinators and they will get your labs ordered.