In addition to TRT, certain therapies for LOH syndrome often include counseling, antidepressants, PDE5i, and herbal medicines (Kampo). A number of herbal medicines have been used to treat LOH syndrome (1.Tsujimura and others (20) recently reported on herbal medicine as a possible treatment option. Low testosterone levels can negatively affect male fertility and general well-being. While testosterone replacement therapy (TRT) effectively increases testosterone levels, it can compromise sperm production and fertility. Clomiphene citrate (Clomid) offers a promising alternative that can increase testosterone levels while preserving fertility.
Clomid, traditionally used to treat female infertility, works differently than direct testosterone supplementation. It stimulates the body's own production of testosterone by blocking estrogen receptors in the hypothalamus and pituitary gland. This leads to increased secretion of luteinizing hormone (LH) and follicle stimulating hormone (FSH), which in turn, it stimulates the testicles to produce more testosterone and sperm. Yes, they can be taken together; it is highly recommended because of the impact that peptides have on their growth.
To better understand this, let's discuss some of the benefits of this combination. Men produce “male” and “female” hormones important for normal male physiology. The male hormone par excellence is testosterone and testosterone is by far the most important androgen of the body. Other androgens, such as androstenedione and DHEA, are not important players in the field of hormone therapy.
Testosterone production is mediated by Leydig cells in the testicle. Leydig cells are under the control of the pituitary gland, the “master gland” at the base of the brain. The pituitary produces a hormone called LH or luteinizing hormone that travels to the testes and acts on Leydig cells to stimulate testosterone production. The pituitary also produces another hormone called FSH or follicle-stimulating hormone.
FSH acts on Sertoli cells in the testicle to promote healthy sperm production and quality. Testosterone production in the testicle is also very important for normal sperm production, a process called spermatogenesis. As Leydig cells increase testosterone production, androgen can enter the blood stream. Some of the testosterone is bound to proteins, while some of the testosterone remains free or free.
Only about 2% of total testosterone is free, but some of the protein-bound testosterone weakly binds to albumin, making it bioavailable. Bioavailable testosterone is the portion of total testosterone that is available to tissues and consists of free testosterone plus testosterone weakly bound to blood proteins. Both total testosterone levels and free testosterone levels can be measured in the blood. Testosterone must leave the bloodstream and enter organs and tissues to exert its powerful effects.
If testosterone binds tightly to a protein called sex hormone binding globulin (SHBG), it is trapped in the blood stream, where it cannot alter physiology. Aromatase, an enzyme found in fat cells, converts a small amount of testosterone to estradiol. Estradiol also travels through the bloodstream and needs to bind to estrogen receptors to exert its hormonal effects. A small percentage of testosterone is also converted to another hormone called DHT or dihydrotestosterone.
DHT is a very potent androgen but it exerts its effects primarily on the prostate and hair follicles. Increased levels of DHT can accelerate male pattern baldness in men who take testosterone and can also stimulate prostate growth. The drugs finasteride and dutasteride can inhibit this enzyme. When testosterone levels decrease in men, they can develop symptoms such as low sexual desire, poor sexual function, fatigue, insomnia, depression, weight gain, and difficulty building muscle mass.
Testosterone therapy involves correcting low testosterone levels in men by administering testosterone. Exogenous testosterone can be administered in different forms, including topical gels, oral pills, injections, and implantable testosterone granules. Sometimes, other drugs called selective estrogen receptor modulators are used to treat low testosterone levels. The most common of the selective estrogen receptor modulators used to treat low testosterone levels is clomiphene citrate.
Selective estrogen receptor modulators, such as clomiphene citrate, block the estrogen receptor at the level of the pituitary gland. This blocks the negative feedback that estradiol exerts on the pituitary gland, resulting in increased production of LH, FSH, and testosterone. Correcting testosterone deficiency with testosterone replacement therapy can improve sexual function, energy, mood, concentration, sleep, bone mineral density and body composition. It can also help promote healthy weight loss.
Testosterone replacement therapy can also cause side effects, such as acne, fluid retention, high blood pressure, male infertility, worsening sleep apnea, blood clots, erythrocytosis, and gynecomastia. Testosterone therapy is generally contraindicated in men with prostate cancer or breast cancer. Prostate and breast cancer cells can be stimulated by increasing testosterone. Men who receive testosterone therapy should be closely monitored by a knowledgeable doctor. Monitoring should include a physical exam every 6-12 months.
The exam should include the testicles, breast, and prostate. It is necessary to monitor blood pressure, and laboratory tests are usually performed every 3-4 months. Laboratory tests should include testosterone, estradiol, PSA, and hematocrit. I also like to monitor metabolic health and lipid profiles annually. When testosterone is prescribed, elevated estrogen levels can develop due to a process called aromatization.
This is expected due to the presence of aromatase, an enzyme that converts testosterone to estradiol, the main estrogen in men. The aromatase enzyme is found primarily in adipose tissue, also known as adipose tissue. Obese men tend to have greater aromatase activity and may be more likely to have high estrogen levels when being treated for low testosterone levels. Slightly elevated estrogen levels are expected when testosterone replacement therapy begins.
There's NO reason to automatically prescribe men an aromatase inhibitor when they start hormone therapy. Any doctor who suggests doing so lacks training and experience in the field of andrology. And just for the record, the only medical specialists who consider themselves experts in andrology are urologists and endocrinologists. Urologists are also experts in sexual medicine.
In fact, some of the benefits of testosterone replacement therapy are due to the increase in estrogen levels seen during therapy. So it's not just about increasing testosterone levels in men who are deficient in testosterone, estrogens are also important as men age. To be clear, we want to see an increase in both serum testosterone and estradiol levels after starting testosterone therapy. However, we like that an adequate balance of these two sex hormones is maintained or that adverse effects occur.
Aromatase is an enzyme found predominantly in adipose tissue or in the body's fat stores. Men with more adiposity tend to have more estrogen production due to greater aromatase activity, but this isn't always the case. There may also be individual differences in enzyme activity that can cause differences in estradiol levels in men receiving testosterone therapy. In general, men with more belly fat tend to have higher levels of estradiol while being treated with testosterone, but there are exceptions to this general rule.
Weight loss can lower estradiol levels. It is important to monitor estradiol levels in men after starting testosterone treatment to recognize excess estradiol and low testosterone to estradiol ratios that may cause adverse effects or poor clinical outcomes. When estrogen levels become a problem, aromatase inhibition is often the solution. When estradiol levels are markedly elevated or the ratio between testosterone and estradiol falls below 10, some men may experience a higher risk of side effects, such as mood disorders, erectile dysfunction, edema, weight gain, difficulty losing body fat, and breast enlargement.
If high estradiol levels are not controlled in a male patient who complains of breast tenderness or pain, he may develop an enlarged male breast, a condition called gynecomastia. Gynecomastia is a serious problem because, once it develops breast tissue, it is necessary to remove it surgically. In some cases, men will experience great results after starting testosterone replacement therapy only to see those results dissipate 4 to 6 months later. Sometimes this is due to increased levels of estradiol, which simply develops over time.
These patients may not complain of specific estradiol-related side effects, such as breast tenderness, but simply may not see the clinical benefits they experienced at the beginning of treatment. Restoring the balance between testosterone and estradiol with medication can easily eliminate the side effects of excess estradiol and prevent devastating complications such as gynecomastia. Therefore, a person does not need to start taking an aromatase inhibitor when starting testosterone therapy, but they should carefully monitor their estradiol levels and ask them periodically about potential estrogen-related side effects. If the male body produces too little testosterone, we will try to find the underlying cause.
Medical problems such as thyroid dysfunction, pituitary tumors, and iron storage diseases can cause reduced testosterone levels. Some medications can affect testosterone production. When men complain about poor results of testosterone therapy or specific side effects indicative of high estradiol levels, a thoughtful conversation should be initiated. Estrogen and testosterone levels should be carefully evaluated.
If testosterone and estrogen levels are elevated, a simple dose reduction in testosterone treatment can resolve the problem and restore the proper balance between these two essential hormones. Encouraging men to lose body fat will also help lower estradiol levels by reducing aromatase activity in the body. Most commonly, an aromatase inhibitor is prescribed to restore the balance between testosterone and estrogen levels. Aromatase inhibitors are oral medications that block the aromatase enzyme.
They were developed and are still being used to treat estrogen receptor-positive breast cancer. But they can also be used to block aromatase in men who take testosterone. This essentially interrupts the conversion of testosterone to estradiol. Estradiol levels should decrease and testosterone levels should increase.
Too often, men treated by non-expert doctors for low testosterone levels automatically start taking an aromatase inhibitor when they start testosterone treatment. This usually causes your estradiol levels to drop to normal or even very low levels. If estrogen is important to men, why would they? Because they just don't understand andrology or hormone replacement therapy. In one case, I saw a 55-year-old man with osteoporosis who had been receiving high doses of aromatase inhibition for years prescribed by an online testosterone clinic.
They reduced his estradiol levels to practically zero and told him that it would help him burn more fat. Fortunately, we discontinued aromatase inhibitors to allow estrogen production again. The improvement in estrogen levels eventually improved their bone density, which reversed osteoporosis. In short and in simple terms, I tell my patients that when estrogen levels are too high, they can be harmful.
But when they're too low, it can be very serious. The same logic applies to testosterone levels. The most common treatment for low testosterone levels is exogenous testosterone injections. While there are other treatment options that men should consider, testosterone injections come first. Testosterone replacement therapy with injectable testosterone can be performed with testosterone cypionate or testosterone enanthate.
Intramuscular and subcutaneous injections are acceptable methods. Men who want to have children should not be treated with exogenous testosterone. Drugs such as clomiphene citrate or human chorionic gonadotropin (HCG) can be used to treat low testosterone levels in men who want to preserve their fertility potential. After careful monitoring of hormone levels, a clinical evaluation of adverse effects and clinical benefits will be performed. I usually test my testosterone and estradiol levels about a month after I start taking aromatase inhibitors.
If dose adjustments are needed, I will repeat the lab tests every 4 to 6 weeks until the hormones are optimized. Once optimization is achieved, laboratory tests can be performed every 3-4 months to evaluate biomarkers, including PSA, an important screening test for prostate cancer. The dose of aromatase inhibitors may need to be adjusted depending on hormone levels. Testosterone replacement therapy may also require a dosage adjustment if testosterone levels rise too high. Men who started taking aromatase inhibitors should be closely monitored for side effects.
Testosterone can also increase the risk of blood clots, high blood pressure and increases in PSA. Hormone therapy requires an accurate diagnosis and very careful monitoring to mitigate the risks of side effects. Medical testosterone deficiency is a serious condition in men, where more testosterone is needed to maintain normal physiology. Men who are deficient in testosterone may have a variety of symptoms and are at greater risk of certain health conditions, such as diabetes and metabolic syndrome. The diagnosis of testosterone deficiency or hypogonadism requires careful evaluation by a skilled physician, preferably a urologist.
If there are no medical contraindications for hormone replacement therapy, testosterone may be prescribed. The most commonly used drug to treat hypogonadism in men is injectable testosterone, but there are other viable treatment solutions. Men who want to have children should not be treated with exogenous testosterone and will do better if they use drugs such as clomiphene and HCG, which increase endogenous production. of testosterone.
Regardless of the drug treatment chosen for low testosterone levels, men require close follow-up with a qualified physician. Follow-up should include a careful medical history and a review of possible side effects, as well as a complete physical exam. As part of that examination, breast and prostate masses should be excluded and blood pressure should also be monitored. Regular laboratory tests are needed to evaluate hormone levels, PSA, hematocrit, lipid profile and blood sugar.
Some men who receive testosterone therapy will see estrogen levels increase and this isn't necessarily a bad thing. Estrogen can be beneficial for men, and in fact, some of the benefits of testosterone therapy come from higher estrogen levels. However, excess estrogen or an imbalance between testosterone and estrogen can be harmful and lead to poor outcomes, side effects, and even adverse health outcomes. Careful evaluation of clinical outcomes and hormone levels using blood tests will identify men who could benefit from additional hormonal manipulation. When estrogens are too high, the most common solution is the administration of an aromatase inhibitor.
Aromatase inhibitors block the conversion of testosterone to estradiol and, when used correctly, restore the normal balance of these hormones. Alternative treatments, such as synthetic gonadotropins, selective estrogen receptor modulators (SERMs) and aromatase inhibitors, are used in an unauthorized manner to increase serum and intratesticular levels of testosterone and, at the same time, preserve fertility (39, 80). However, these can have unwanted side effects, such as a decrease in semen quality and consequences for bone mineral density and libido due to changes in estrogen levels (80). Therefore, there is a need to develop different approaches to restore testosterone levels in patients that can reduce negative side effects and preserve the HPG axis and fertility.
The future of TRT in men who want to preserve fertility involves stimulating endogenous testosterone production through the manipulation of LSCs. In this regard, novel therapeutic approaches have been shown to be very promising for the transplantation of LSC in several testicles from animal models (73, 7). More in vivo studies are needed to evaluate the efficacy, safety and clinical applicability of LSC transplantation in practice). Hormone therapy is often the first treatment option for advanced prostate cancer.
It's not usually used on its own to treat early-stage prostate cancer. Hormone therapy may be used in combination with other treatments. These treatments may include radiation therapy, freezing cancer cells with a very cold liquid, called cryotherapy, or a targeted therapy called a PARP inhibitor. A PARP inhibitor is another term for the poly (ADP-ribose) inhibitor.) polymerase.
Given the lack of long-term safety information, women who are interested in receiving testosterone treatment should understand the potential risks associated with the use of a potent hormone. The patient's clinical condition is the best way to check the effectiveness of testosterone treatment, since normal levels are not well established. Oral treatment in combination with estrogen is the most readily available treatment method for women, although some doctors prescribe the topical gel. Patients usually notice an improvement in libido and energy within days or weeks. A major benefit of increasing testosterone levels through TRT is that it helps you gain muscle mass and, ultimately, strength.
There are several formulations of exogenous testosterone replacement therapy, including oral, buccal, intramuscular, transdermal, subdermal, and nasal preparations. Treatments require a consultation with a healthcare provider, who will determine if treatment is appropriate. However, a decrease in testosterone due to various causes may be associated with the development of symptoms and with aging. Because treatments for both conditions include androgen suppression, the possibility of an increased risk of these conditions with testosterone supplementation is a matter of great concern. In general, hCG is an effective and safe alternative or adjunct to TRT in men who want both fertility and treatment for symptoms of hypogonadism.
Anabolic steroids are testosterone compounds used by male and female athletes to improve performance and by others to treat depression and increase feelings of well-being. We have analyzed in detail the undeniable benefits of testosterone replacement therapy (TRT) when combined with peptides, since it improves the effectiveness of Treatment. TRT is a therapy prescribed by your doctor or doctor; you undergo treatment to increase the required amount of testosterone levels in your body. There are currently several treatments available to restore testosterone levels and improve symptoms of Alzheimer's disease.
