Bioidentical Hormone Therapy for Men in Atlanta

Why Men Need Testosterone Therapy

It is estimated that over 45% of men aged 45 or older have low testosterone levels. Low testosterone (Low T) has been found to be more common in men with Type 2 diabetes or those on chronic opioid pain medications.

Low testosterone is usually defined in the medical community as a total testosterone level less than 300 mg/dl. In reality, an OPTIMAL testosterone level in men varies but is anywhere from 600 to 1000 mg/dL.

The enhancement of male testosterone levels is supported in the clinical literature, but there is still a lack of understanding in the medical community about when and how to test men and more importantly, how to treat and monitor them.

The result is many men who have these symptoms are being told “you are just getting older, it’s normal aging” or not being tested or treated appropriately.

At VLH we feel this is a serious medical issue that needs to be corrected. Men are being needlessly treated for depression, sleeplessness and anxiety when in many cases the real problem is an undiagnosed hormone deficiency.

How Bioidentical Testosterone Works

Bioidentical testosterone is a synthetic, laboratory-created hormone that is chemically and molecularly identical to the testosterone naturally produced by the body.

Because of this, the body can recognize, utilize, and metabolize bioidentical testosterone effectively. This allows us to treat the symptoms of Low T in men, while safely managing and delivering the best results for each individual HRT patient.

The bioidentical testosterone can be administered via multiple methods, including:

• Patches
• Topical gels
• Injections
• Implanted Hormone Pellets

HRT treatment for men boosts testosterone levels to an optimal state with the expected benefit of resolution of symptoms of low testosterone within 4-6 weeks. BHRT treatment options range from:

• Testosterone injections
• Topical testosterone preparations (placed on the skin daily)
• Testosterone or “Pellet” Implants
• Troches (lozenges absorbed on the tongue)

Treatment Options for Male HRT

Clomid Pill

A popular treatment option for our patients is the endocrine stimulator, Clomid. Clomid is an oral medication that increases the hormone signal in the body (called LH) that increases testosterone production. With the use of this medication taken as a half or whole pill daily many men can increase their testosterone levels into the optimal range without utilizing testosterone therapy.

The advantages of this type of treatment are easy compliance and retained fertility. We know that treatment with testosterone will actually lower our sperm counts and will shut down the body’s testosterone production in most men. We will know within 6 weeks if Clomid therapy is successful for HRT with most patients.

Human Chorionic Gondatrophin (hCG) Injections

Human Chorionic Gonadotropin (hCG) is injected intramuscularly, usually 3 times weekly and is another endocrine stimulator. It works by mimicking the natural Luteinizing Hormone (LH). Like Clomid, hCG helps promote natural testosterone production in men, helps prevent testicular shrinkage that can result from prolonged bioidentical testosterone use, and preserves fertility by boosting sperm production.

Testosterone Injections

Bioidentical Testosterone Cypionate shots are administered intramuscularly — typically in the buttocks, thigh, or upper arm region — every 6-10 days depending on the patients’ hormone metabolism. Most men do great with weekly injections on the same day of the week.

Since this testosterone preparation is a “depot” preparation, it can support the body for up to a week at a time, delivering a slow, steady rate of absorption over 3-5 days to maintain optimal testosterone levels. When used subcutaneously (under the skin), it is absorbed more rapidly and requires twice weekly injections in most patients. The payoff is that SQ injections are generally easier to do for patients.

Topical Hormone Gels

Hormones delivered topically are commercially prepared transdermal gels or solutions, including:

• Axiron
• Fortesta
• Androgel
• Compound Gels or Suspension from a Compound Pharmacy

Topical hormone gels are typically applied directly to clean, dry skin in the upper arm, abdomen, thighs, or shoulder region on a daily basis. They need 3-5 minutes to dry and will absorb through the skin into the bloodstream over several hours.

Swimming or sweating can severely limit their effectiveness, and there is some risk of localized allergic reaction or acne to the application area (usually the shoulder or bicep area). Women should not contact the areas applied for several hours or the testosterone can be transferred to them and upset their hormonal balance.

There are some patients that do not have absorption through the skin or absorption may be compromised by hair on the application area. For these patients other methods are advised. Additionally this method creates the highest levels of DHT, a powerful testosterone metabolite that can negatively affect hair growth on the top of the scalp leading to thinning hair and balding.

Testosterone Pellet Implants

Testosterone Pellets are a long-lasting, convenient method of alleviating symptoms through bioidentical hormone replacement therapy for men. Bioidentical testosterone hormone pellets are implanted underneath the skin — in the buttocks or hip area — via a small incision.

Once implanted, the compounded hormone pellets are slowly degraded over a 5-6 month time window in which the levels are very stable, providing long lasting testosterone support. This allows the patient to maintain more stable hormone levels while avoiding major fluctuations that can occur with other forms of HRT for men such as testosterone injections.

*Note that we do NOT use the TESTOPEL implants that are commercially available and last up to 3 months on average.

Risks & Side Effects of HRT for Men

While male HRT is safe under experienced medical supervision, some potential side effects include:

• Increased Red Blood Cell Count
• Fluid Retention
• Acne and Hair Loss on the Top of the Head

For these reasons we monitor our patients closely and check labs every 3.5 months with follow up visits to discuss labs and changes to therapy (if needed) every 4 months. If indicated, we do refer patients with elevated red blood cell count to LifeSouth for a therapeutic blood draw to remove the excess red blood cells.

Dosage adjustment can also decrease this side effect in many patients. Those with untreated or undiagnosed sleep apnea (which can lead to low testosterone levels) may need further sleep evaluation and monitoring.

Potential Long-Term Risks & Side Effects

Prolonged testosterone replacement therapy can sometimes include:

• Shrinking of the Testicles and Infertility: to prevent testicular shrinkage, Clomid or hCG may be used in concert with testosterone therapy.
• Hair loss on the Crown, Top and Forehead Area: this is a genetic condition called androgenic alopecia and affects both men and women. There are medications that can be either oral or topical to decrease this side effect if needed.
• Formation of Acne: it is more likely in men who had acne as teens and usually occurs on the chest or back area. Often, adjusting hormone levels and topical medications combined with good skin care can eliminate acne.

The HRT experts at Vital Living Healthcare closely monitor every patient’s hormone levels and health to ensure optimal, safe results, adjusting dosages and methods as needed.

What Male Patients Can Expect From HRT

Initial Consultation

Your HRT journey with Vital Living Healthcare starts with an initial complimentary meet and greet with Dr. Cox or Jordan Carney, CRNP where you will discuss your symptoms and goals for treatment.

If you choose to move forward with treatment the next steps are a blood draw to assess your hormone levels and an hour consultation where you will learn the science behind HRT, the efficacy and safety of treatment and the options available to you to begin your journey.

After beginning treatment we will check your labs 6 weeks later to determine how the therapy is working and meet with you to discuss the labs, get your feedback and make adjustments to the plan if needed.

Getting HRT Treatments

Vital Living Health provides patients access to a supportive, expert HRT team committed to your overall wellness. Our approach for HRT for men includes:

• Personalized Check-Ins and Adjustments: These help you achieve your treatment goals, providing the guidance you need every step of the way. It’s important to remember that HRT is not one size fits all treatment. Your treatment is customized to meet your individualized needs.

Many of our male HRT patients come to us from other facilities who specialize in “one size fits all” approaches due to referrals from friends and family. We believe that if hormones are worth doing, they should be done to the best of our ability for each individual patient.