Hormone restoration

Testosterone is essential for maintaining muscle strength, bone density, stamina, libido, and sexual function in both men and women. Optimal levels of testosterone are essential for optimal health and quality of life. Testosterone levels decline with age in both sexes. Men lose their testosterone gradually after age 25, causing fatigue, depression, decreased strength, loss of libido, and "getting old", so they don't grasp the hormone connection and the need for hormone replacement. In men, testosterone restoration to higher levels with the reference ranges improves mood, energy, strength, muscle mass, and stamina. Studies show that higher levels of testosterone within the reference range protect against cardiovascular disease, diabetes, dementia, hypertension, abdominal obesity and arthritis. Several studies have shown that testosterone replacement by injection helps reverse metabolic syndrome in men. Nearly every study of testosterone and heart attacks shows that men with lower levels of testosterone have higher risk. Indeed, when men with prostate cancer are treated with androgen deprivation therapy--where their testosterone level is lowered to that of a woman and their estradiol levels become extremely low--they develop heart disease, diabetes, and metabolic syndrome.

Women's testosterone levels are 20 times lower than men's, but testosterone is essential to their health and quality of
life too. Testosterone brings the same benefits to women as it does to men, only on a smaller scale. It not only restores their libido, but also improves sleep, mood, mental function, bone mass and muscle strength. Women have higher free testosterone in the follicular phase of their menstrual cycle than free estradiol! Women's testosterone levels drop by 50% between the ages of 20 and 40. The majority of women in their 40s and 50s are suffering from low testosterone levels. Unfortunately lab reports state that the "normal" free testosterone for a woman is 0-2.2pg/ml, or a total of 2 to 45ng/dL. So a physician practicing Reference Range Endocrinology will tell her that she's "normal" even if there is no detectable testosterone in her blood! Optimal levels for most women are in the middle to upper part of the ranges.

The loss of libido with loss of testosterone can have a devastating effect upon relationships. The partner whose libido is
low may think that they are just no longer attracted to their spouse. They may still be excited by other persons because they are new, unknown, or have other qualities their spouse lacks (i.e. a super-stimulus). On the other hand, the partner who has not lost their libido will think that the other partner is no longer attracted to him/her. Dr. Lindner has seen relationships improve when testosterone and libido are restored in one or both partners. For certain, if the libido is healthy, one is happy to "love the one you're with"! When couples enjoy sex with each other again, all aspects of the relationship improve. Postmenopausal women require estradiol supplementation to restore youthful vaginal/genital health and lubrication. Estradiol also plays a role in normal libido.

The conventional population reference ranges cannot be used to diagnose testosterone deficiency in men as levels decline with age, and the reported range includes almost all men in that age group. Therefore the lower limits are far too low for both health and quality of life. For instance, a typical range for free testosterone for a middle-aged man is 6 to 18 pg/ml. That's a three-fold difference from bottom-to-top! Surely a man will feel very different with 1/3 his previous levels or 3 times his current low levels! For younger men, the upper limit is not 18 but 26.5 pg/ml. In Dr. Lindner's experience, men feel and function much better with free testosterone levels of around 20 pg/ml.

Contrary to popular opinion, scientific studies show that higher levels of testosterone Do Not cause prostate
enlargement or prostate cancer. Studies of men on testosterone replacement have consistently shown there is no increased risk of prostate cancer. In fact, the evidence is clear: It is LOW testosterone levels that increase the risk of prostate cancer! (See Testosterone for Life by Dr. Abraham Morgentaler.) The misconception that higher testosterone levels cause prostate cancer is due to the fact that an existing prostate cancer will grow more slowly if testosterone levels are brought very low by castration or drugs. This is an issue of cancer management, not of cancer prevention.

As with other hormones, conventional medical opinion about testosterone is lagging way behind the scientific evidence. Here again, as with the female hormones, lay persons and most medical professionals think that the problems caused by artificial hormone substitutes also occur with natural, physiological hormone restoration. "Roid rage" and liver disease are caused by non-bioidentical anabolic steroids and oral 17-alkylated testosterone substitutes. Contrary to popular misconceptions, testosterone restoration does not cause aggression or anger. It makes men more patient, more sociable, and less prone to anger. They have more affection for, and patience with, half of the human race! They feel more energetic and vital.

For men, Dr. Lindner prescribes weekly testosterone cypionate injections. These are self-administered subcutaneously, not
intramuscularly. Most men require 0.5 to 0.6ml weekly of a 200mg/ml testosterone cypionate solution to produce high-in-range free testosterone levels at 4 full days after the weekly injection. This is the best way to restore optimal testosterone levels/effects. It is bioidentical as the small natural cypionate molecule is cleaved off by esterase enzymes leaving bioidentical testosterone. This method best mimics normal testicular production. Testosterone-containing creams and gels are more expensive, difficult to monitor, produce abnormal DHT/testosterone/estradiol ratios, and can result in transfer to other persons.

Update:
Much concern has been caused (and a lawyer feeding-frenzy started) by a few recent retrospective studies claiming that men's heart attack incidence was increased after they were prescribed testosterone. These studies were low-quality evidence--not even close to the gold standard of randomized, placebo-controlled trials. Almost all other studies, and reviews of studies over the past decades have indicated that higher natural testosterone levels are protective against heart disease and heart attacks, and that testosterone supplementation does not increase heart attack risk. This issue was discussed in a recent review article. A careful review of one of the recent studies (Vigen et al.) revealed that errors were made both with gathering evidence and with the statistical treatment. The authors have already made two corrections. The rate of heart attacks in men taking testosterone was actually half the rate of those not given testosterone, whereas the study reported the opposite.

Dr. Lindner knows of only one possible cause for concern with testosterone supplementation and thrombotic events--and that is related to the way in which testosterone is delivered. Most men in these recent studies were given testosterone by transdermal gels or by injections. Injections are typically given as 1ml every two weeks. This produces very high, double/triple the reference range, testosterone and estradiol levels for a week, then low levels in the second week. Transdermal testosterone gels can cause unnatural elevations levels of DHT and estradiol. Higher estradiol levels do slightly increase blood clotting tendency. So sudden and/or superphysiological increases in estradiol with these delivery methods may promote clot formation in those men who have an increased tendency to blood clots and also already have advanced atherosclerosis. These men are basically heart attacks waiting to happen. Men with low testosterone levels are also more likely to have atherosclerosis. Estradiol is not bad for men, it is very good for men in the long-term, as it is for women. It offers protection against atherosclerosis and heart attacks, diabetes, dementia, and other health problems. For this and other reasons, Dr. Lindner decided years ago to prescribe testosterone only by weekly, self-administered subcutaneous injections. This method produces the full benefits of testosterone restoration, more stable testosterone and estradiol levels, and a more natural testosterone/estradiol/DHT ratio. Testosterone patches also provide physiological replacement, but are usually too weak to produce optimal testosterone levels. Given these recent studies, he also recommends that for older men with or men with very low testosterone levels and possible atherosclerosis, rapid rises in estradiol levels be avoided. He recommends starting testosterone injections at just 0.1ml weekly and raising the dose gradually by 0.1ml/week
up to 0.4 or 0.5ml depending on the man's weight. Dr. Lindner also recommends that all patients take fish oil (2500mg/day of EPA+DHA) which corrects our nearly-universal Omega-3 fatty acid deficiency and reduces the blood's clotting tendency.