Hormone replacement therapy for men with the administration of exogenous testosterone. The Complete Guide to Testosterone Replacement Therapy for Men Testosterone Replacement Therapy for Women What

Testosterone is produced by the testes in a percentage of more than 90%, the remaining small amount is produced by the adrenal glands. The flow of androgen into the blood can be disrupted under the influence of external and internal factors.

Conditions for reducing testosterone:

Drinking beer containing phytoestrogen, as well as smoking, which poisons the body, has a negative effect. With prolonged exposure to testosterone deficiency syndrome, a decrease in body hair and a change in the timbre of the voice are possible.

FACT. Irregular sex life suppresses sexual reflexes - testosterone in the blood decreases.

What to do in such a situation? Medicines or folk remedies?

Herbs and other components of natural origin are used if a decrease in testosterone is observed for a short period of time. The easiest way to correct hormonal levels is after eliminating destabilizing factors, especially alcohol abuse, exposure to nervous tension and poor nutrition.

However, there are also prerequisites for the need for drug treatment if significant physiological disorders are diagnosed.

Rationality of therapy for:

1. mechanical damage to the genital organs;
2. genetic diseases;
3. pituitary tumors;
4. orchitis and cryptorchidism;
5. varicocele, spermatocele and hydrocele.

Infectious inflammation of the scrotal organs, which often occurs when infected with sexually transmitted diseases, is also dangerous. Against the background of emerging skin lesions, balanoposthitis and epididymitis occur.

When infected with mycoplasmosis and trichomoniasis in men, testosterone levels also decrease along with a deterioration in spermatogenesis.

Chlamydia provokes inflammation of the appendages, bladder and impaired potency.

The destruction of foreign pathogens is carried out mainly by taking powerful antibiotics, and only then is therapy carried out to restore the balance of testosterone in the blood.

With diagnosed asthenospermia (the number of motile sperm is less than half of their total number) and azoospermia (active germ cells are completely absent), the help of natural components will no longer be enough.

Congenital forms of male hormone deficiency are called Kallmann syndrome and Klinefelter syndrome.. In the latter case, there is not only a deficiency of testosterone, but also poorly developed genitals.

In such situations, andrologists prescribe medications that force the return of healthy hormonal levels. In old age, you need to be prepared for the appearance of andropause: after 50 years, a significant decrease in androgen is a natural process that can only be corrected with medication.

WARNING. In men with prostate cancer or other prostate diseases, increasing the concentration of testosterone in the blood is contraindicated.

Treatment tactics for testosterone deficiency in men: exercises, recommendations, medications

Herbal products are used as conservative methods of restoring healthy hormone levels. Tinctures of ginseng, eleutherococcus, Schisandra chinensis and leaves of the ginkgo tree have a strong tonic effect.

The use of multicomplexes provides tangible help(Vitrum, Alphabet, Multitabs), containing vitamins from which testosterone is built (B, C, E, D), and trace elements (zinc and selenium). Among the foods, andrologists advise to “lean on” nuts, ginger, dried fruits, garlic, eggs and seafood.

Physical activity is similarly included in the list of what is called a must-have for androgen deficiency syndrome.

Useful exercises to enhance testosterone production:

• warm-up (5 to 10 minutes);
• exercises with lifting a barbell (from 10 to 40 minutes);
• strength training for large muscles (legs, chest, back);
• abdominal exercises (10–20 min).

Rivalry between males is a traditional source of increased testosterone. Since ancient times, dominance has made men feel euphoric after victories in wars or hunting.

In modern conditions, these methods may be considered barbaric and unethical by some men, so it is rational to choose more civilized methods of raising the spirit.

Participation in sports - from running to boxing- can be a help for treating insufficient amounts of androgen in the blood using the most natural methods possible.

Career success is also seen as an element of social dominance that restores a man's natural strength. The peak rise in testosterone is observed during the period of promotion, with active self-development and career achievements.

The production of the hormone also occurs when contemplating a female naked body, therefore, to strengthen the sexual constitution, the number of sexual contacts should be increased.

A smaller amount of androgen is formed during verbal communication with the opposite sex without erotic contacts.

Along with the above recommendations, you should increase physical activity - the best option is to sign up for a gym. Muscle tension automatically activates the male reflex, which causes the body to produce more testosterone.

If conservative methods are ineffective, then the doctor has the right to prescribe androgenic drugs. Common injection options: Sustanon 250, Nebido, Testosterone propionate, Omnadren. Andriol can be prescribed as tablets, and Androgel as ointments.

Duration of taking testosterone products:

1. ampoules - within 7–10 days;
2. tablets are taken for up to 1 month;
3. gel - 1–3 months.

These drugs introduce artificially created testosterone into the blood, but there are also medications that force the reproductive system to resuscitate the production of its own hormone.

Medicines in this group: Arimatest, Evo-Test, Vitrix, Tribulus, Animal Test. By suppressing aromatase, a testosterone antagonist, anabolic substances lead to a sharp increase in the male hormone, but their use is recommended in conjunction with a trip to fitness clubs or sports complexes.

WARNING. Lifelong administration of injections is possible only in cases of congenital insufficient development of the testicles - hypogonadism - or the loss of testicular functions during life.

Conclusion

Treatment of patients with low testosterone is necessary: ​​the long-term presence of weak hormonal levels leads to obesity, impotence and even premature aging of a man.

Maintaining the production of sufficient concentrations of androgen helps to prolong good health and permanently consolidate the behavioral and physiological qualities truly inherent in the stronger sex.

In conclusion, watch the video about drugs to increase testosterone in men based on tribulus:

In the treatment of age-related androgen deficiency, the basis is therapy aimed at normalizing the content of testosterone in the blood plasma!!!
There are two ways to increase testosterone levels:
. carrying out androgen replacement therapy
. stimulation of the androgen-producing function of the testicles with chorionic gonadotropin preparations.
Currently, the generally accepted standard for prescribing androgen replacement therapy for age-related androgen deficiency is the prescription of testosterone preparations. Indications for prescribing certain androgenic drugs are discussed in the relevant chapters of this review, but let’s briefly talk about our own experience of this therapy.
Considering the presence of significant risk factors for hormone replacement therapy in men over 45 years of age (risks of prostate cancer and cardiovascular diseases), despite the thoroughness of the preliminary examination, at the beginning of treatment we prefer testosterone preparations with a short period of elimination from the body. Further, in the absence of negative dynamics in the clinical condition and laboratory data, we recommend that patients switch to depot forms of testosterone.
The criteria for the effectiveness of treatment of age-related androgen deficiency will be:
. reduction of symptoms of androgen deficiency: increased libido, improved overall sexual satisfaction, decreased severity or disappearance of vegetative-vascular and mental disorders;
. with treatment for more than 1 year - increased bone mass density, decreased severity of visceral obesity, increased muscle mass;
. normalization of laboratory parameters: an increase in hemoglobin level or the number of red blood cells, a decrease in the level of low and very low density lipoproteins with an unchanged level of high density lipoproteins.

Testosterone therapy has a beneficial effect on sexual function.

Testosterone therapy results in increased muscle strength.

Testosterone therapy reduces risk factors for cardiovascular disease

The effectiveness of testosterone therapy.

Despite the obvious successes of androgen replacement therapy for age-related androgen deficiency, treatment with gonadotropic drugs has very authoritative supporters with very serious arguments.
Here are their arguments:
1. Hormone replacement therapy has a number of serious disadvantages.
Intramuscular forms of testosterone preparations lead to significant fluctuations in the concentration of testosterone in the blood serum, often not physiological.
Oral forms of testosterone preparations are unable to maintain the physiological concentration of testosterone in the blood for a long time.
Implantation of testosterone preparations creates a non-physiological distribution of testosterone concentration over time.
Transcutaneous forms are expensive and cause local reactions.
Carefully selected therapy with gonadotropic drugs does not have all these disadvantages.
2. Under physiological conditions, Leydig cells synthesize not only testosterone, but also many other sex steroids - estrogens and progestins. The administration of androgen replacement therapy leads to a blockade of luteinizing hormone synthesis, and a decrease in the concentration of luteinizing hormone inhibits the synthesis of all other sex steroids in the testes.
Stimulation of the androgen-producing apparatus of the testicles (Leydig cells) with chorionic gonadotropin preparations seems to be more physiological, since the synthesis of not only endogenous testosterone, but also all other necessary steroids is stimulated.
3. It is indisputable that endogenous testosterone produced by Leydig cells is better than any synthetic analogue. Therefore, in cases with hypogonadotropic hypogonadism, as well as in cases with age-related androgen deficiency, when it is necessary to preserve the sperm-forming function of the testicles, preference should be given to chorionic gonadotropin preparations, which stimulate the secretion of their own testosterone by Leydig cells.
4. It should also be noted that there is a persistence of the effect of using chorionic gonadotropin drugs in patients for 1-6 months after cessation of therapy, which is a positive additional aspect of the use of this therapy.
In conclusion, it should also be noted the disadvantages of stimulating therapy with human chorionic gonadotropin drugs for age-related androgen deficiency.
1. Treatment with this drug is possible only after a test with human chorionic gonadotropin. If this test is negative, then there is no point in carrying out this type of treatment - there are no reserve capabilities of Leydig cells, there is no substrate for stimulation.
2. The need for weekly intramuscular injections for a long time.
3. Since human chorionic gonadotropin stimulates the production of not only testosterone, but also estradiol, this type of therapy increases the risk of hyperestrogenemia and gynecomastia
4. Long-term treatment with human chorionic gonadotropin drugs can lead to the appearance of antibodies to human chorionic gonadotropin and the development of resistance to this type of treatment.

Representatives of the following associations took part in developing the recommendations: the International Association of Andrology (ISA), the International Association of Aging Men (ISSAM) and the European Association of Urology. Authors: E. Nieschlag, K. Swerdlof, H.M. Behre, L.T. Gooren, T.M. Kaufman, T.T. Legros, B. Lunenfeld, T.E. Morley, C. Schulman, C. Wang, W. Weidner, and F. C. W. Wu.

Recommendation 1.
Definition of age-related hypogonadism.
(Late onset hypogonadism, LOH). A clinical and biochemical syndrome associated with advanced age and characterized by typical clinical symptoms and a deficiency of circulating testosterone. This can lead to a significant deterioration in the quality of life and have an adverse effect on the function of a number of body systems.

Recommendation 2.
Age-related hypogonadism as a syndrome is characterized by the following:
. Easily recognizable signs are decreased libido, deterioration in the quality and frequency of erections, especially nocturnal erections.
. Changes in mood with a concomitant decrease in intellectual activity and cognitive function.
. Sleep disturbance.
. A decrease in muscle mass associated with a decrease in its volume and strength.
. Increase in visceral adipose tissue.
. Reduction of hair growth and changes in skin turgor.
. A decrease in bone mineral density with the development of osteopenia, osteoporosis and an increased risk of fractures.

Recommendation 3.
Patients with suspected hypogonadism should undergo clinical and biochemical examination. Special biochemical studies must be performed to the following extent:
1. Determination of the concentration of total testosterone in the blood serum and sex steroid binding globulin (SHBG), which requires taking venous blood between 07.00 and 11.00 hours. To confirm the presence of hypogonadism, the most appropriate parameter is to determine the level of total testosterone and determine the concentration of free testosterone, using a mathematical calculation or its determination by a reliable method of equilibrium dialysis.
2. Currently, there is no generally acceptable lower limit of normal for total testosterone. However, there is general agreement that total testosterone levels above 12 nmol/L or free testosterone levels above 250 pmol/L do not require replacement therapy. Finally, based on data from young adult men, there is consensus that testosterone replacement therapy is necessary when total testosterone levels are below 8 nmol/L or free testosterone levels are below 180 pmol/L. Since symptoms of testosterone deficiency begin to appear at testosterone concentrations in the range of 8-12 nmol/l, the decision to prescribe therapy should be made for those specific patients in whom other causes of symptoms of hypogonadism have been excluded.
3. Determining the concentration of free testosterone in saliva is a fairly reliable approach. However, this methodology requires further standardization. Standards for adult men are not yet available in most clinics and reference laboratories.
4. In cases where testosterone levels are below or below the lower limit of acceptable normal testosterone levels typical for men, it is recommended to conduct a secondary determination of testosterone, as well as study the serum levels of luteinizing hormone and prolactin.

Recommendation 4.
1. It is well known that changes in the function of other endocrine systems are associated with age, but the true significance of these changes is still poorly understood. In principle, the determination of thyroid hormones, cortisol, dihydroepiandrosterone and its sulfate form, melatonin, growth hormone and insulin-like growth factor-1 is not required when determining age-related hypogonadism. However, in cases where there are clinical symptoms of corresponding endocrine disorders, the determination of the above hormones, as well as a number of others, is required.
2. Type 2 diabetes mellitus is common in older men. It is currently unclear what effect testosterone has on blood glucose levels and insulin sensitivity; therefore, treatment, first of all, should be aimed at compensating for diabetes, while it is also possible to prescribe testosterone drugs if the patient has a deficiency.
3. In aging men with complaints of erectile dysfunction, it is necessary to examine the serum lipid spectrum and the state of the cardiovascular system.

Recommendation 5.
Clear indications based on clinical symptoms in combination with biochemical confirmation of low circulating testosterone levels should be available to the physician before prescribing testosterone replacement therapy.

Recommendation 6.
1. Testosterone therapy is absolutely contraindicated in men who are suspected or have already been diagnosed with prostate and breast cancer.
2. Men with severe polycythemia, untreated sleep apnea, cardiac disease, and severe symptoms of lower urinary tract obstruction, especially due to benign prostatic hyperplasia, are contraindicated in testosterone replacement therapy. Minor obstruction is not an absolute contraindication for such therapy. After successful treatment of obstruction, contraindications are removed.
3. In the absence of certain contraindications, the patient’s age as such is not a contraindication for the prescription of testosterone replacement therapy.

Recommendation 7.
1. Natural testosterone preparations should be used for replacement therapy. All currently available testosterone preparations for intramuscular, subcutaneous, intradermal, oral and buccal administration are safe and effective. The attending physician must have sufficient knowledge and a specific understanding of pharmacokinetics, as well as be informed about the beneficial and side effects of each drug. The choice of drug should be made jointly by the doctor and the patient.
2. If contraindications arise during treatment (especially prostate carcinoma), prompt cessation of testosterone replacement therapy is required. Short-acting drugs (transdermal, oral, buccal) in patients with age-related hypogonadism should be preferred over long-acting drugs (intramuscular, subcutaneous).
3. There is insufficient data to determine at what level it is necessary to maintain circulating testosterone during replacement therapy, taking into account its effectiveness and safety. At the moment of our knowledge, it is necessary to strive to maintain the concentration of testosterone in the blood at a level characteristic of young men. It is important to avoid super physiological testosterone levels. Despite the desirability of maintaining a circadian rhythm of testosterone, this should not be achieved during replacement therapy.

Recommendation 8.
eleven . Alkyl-substituted testosterone preparations such as 17a-methyltestosterone are absolutely contraindicated as they have hepatotoxic effects and therefore should not be prescribed to patients.
2. There is insufficient evidence to date to recommend replacement therapy with dihydrotestosterone in older men, as well as other steroids such as dehydroepiandrosterone, dehydroepiandrosterone sulfate, androstenediol and androstenedione.
3. Human chorionic gonadotropin (hCG) stimulates the production of testosterone by Leydig cells, but this effect is weaker in aging men than in young men. Since there is insufficient information about the effectiveness and side effects of human chorionic gonadotropin treatment in elderly men, its use is not recommended for the treatment of age-related androgen deficiency.

Recommendation 9.
Improvement in signs and symptoms of testosterone deficiency should be carefully monitored and if there is no positive dynamics or the patient's condition worsens, testosterone therapy should be discontinued.

Recommendation 10.
Rectal palpation of the prostate gland and determination of serum prostate-specific antigen (PSA) are mandatory in men over 45 years of age, as well as determination of gland volume before testosterone therapy is prescribed. In the first 12 months of treatment, the condition of the prostate is examined quarterly, and then once a year. Transrectal ultrasound-guided prostate biopsy is indicated only if rectal palpation and serum PSA levels indicate possible prostate carcinoma.

Recommendation 11.
Testosterone therapy is usually accompanied by improved mood and overall well-being. The appearance of significant negative deviations in the patient’s behavior during treatment with testosterone dictates the need to modify the dose of the drug or discontinue therapy.

Recommendation 12.
Polycythemia develops periodically during testosterone treatment. Periodic hematological examination is necessary, for example, before prescribing therapy, every 3 months during the first year, and then once a year. The dose of the drug may need to be changed.

Recommendation 13.
Bone density increases during replacement therapy, and the incidence of fractures may decrease. Therefore, it is advisable to assess bone density at intervals of once every 2 years.

Recommendation 14.
Some patients with erectile dysfunction and low testosterone levels do not benefit from treatment with testosterone alone. In this case, phosphodiesterase-5 inhibitors can be additionally included in therapy. Conversely, patients with erectile dysfunction and low testosterone levels who do not respond positively to phosphodiesterase inhibitors require the inclusion of additional testosterone drugs in therapy.

Recommendation 15.
Patients who have been successfully treated for a prostate tumor and who have developed clinical hypogonadism are candidates for testosterone replacement therapy, sufficiently after completion of treatment for the prostate tumor. In this case, it is necessary to exclude the presence of residual tumor. The patient should be informed of the possible risks, as well as the positive effects of such therapy. In this case, the patient should be closely monitored. There are no reliable arguments for and against this recommendation. The doctor must have good experience and knowledge to make a decision in each specific case.

Hormonal (hormone replacement) therapy is one of the necessary steps to maintain men's health and longevity. Urologists-andrologists and endocrinologists identify hormonal disorders in men. You need to see these doctors at the first signs of hormonal problems - changes in weight, body shape, hair loss, decreased sexual activity.

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

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 life expectancy, preventing the most common dangers of androgen deficiency - myocardial infarction, stroke, coronary heart disease, angina pectoris, tachycardia, diabetes mellitus, prostate tumors.

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.

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.

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.

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.

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.

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.

Restoration of other hormonal parameters

Thyroid diseases are common in men. Sometimes the cause of low testosterone is an underactive thyroid gland. Synthetic testosterone preparations only solve the problem for a short time, however, after discontinuation or reduction of the dosage, the pathology returns again, so it is necessary to be treated comprehensively.

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.

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.

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.

Libido restoration

Regular sex life is an excellent prevention of prostate cancer, and 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.

Hormone replacement therapy for men (HRT) is pharmacological compensation for the lack of own hormones. For this purpose, both medications and herbal analogues are used. Most significant for men - it negatively affects health at any age, reduces emotional, physical, sexual activity, and disrupts mineral and carbohydrate metabolic processes. Hormone replacement therapy (HRT) in most cases significantly improves the quality of life, provided that the drugs are properly selected.

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, it 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;

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

Indications and contraindications

The main indications for hormone replacement therapy are reduced levels of testosterone (total or free) and excess of estradiol (female hormone). In adult men, HRT is prescribed for signs of andropause:

• Vasomotor instability (hot flashes);
• Psychosomatic and psychological disorders (depression, excessive anxiety);
• Painful urination;
• Osteoporosis;
• Cardiovascular pathologies, high cholesterol;
• Diabetes;
• Obesity.

Doctor of Medical Sciences, Professor Alexander Samoilovich Segal talks about how male menopause occurs, is diagnosed and treated.

Testosterone hormone replacement therapy is not used for the following pathologies:

1. Liver diseases.
2. Venous thromboembolism.
3. Breast and prostate cancer. Hormonal therapy for cancer in men involves the administration of estrogens.
4. Benign prostatic hyperplasia.
5. Prolactinoma (pituitary tumor).
6. Polycythemia (blood pathology associated with increased red blood cell volume).

Relative contraindications to testosterone therapy are apnea (sleep apnea), heavy smoking, and lung pathologies.

Methods for detecting androgen deficiency

Serum testing is the primary test to detect androgen deficiency.. Several hormones are being studied at once. The results are interpreted only in conjunction with a number of other indicators. The rates for each age fall within a fairly wide range. Everything is very individual: for one man the lower value may be quite normal, but for another it is already critical. Hormone replacement therapy is not used on everyone just to bring testosterone levels to the upper limit. This can disrupt the homeostasis (self-regulation) of the body and cause harm to health.

The doctor prescribes hormone replacement therapy based on several additional criteria:

1. Bone density level.
2. Testosterone levels after 30 years. This is an important guideline for determining the individual norm. The lower the indicator, the faster andropause will occur, and the more important it is to timely correct hormonal levels.

1. Prostate condition and PSA level (tumor marker).
2. Appearance: weight, muscle tone, hair.
3. Psychological state of the patient.

Additional studies are prescribed depending on which hormone deviates from the norm. If some of them are exceeded, hormone replacement therapy may be ineffective.

Interpretation of results

If free testosterone is low, but its total amount and estradiol are normal, then it is necessary to check the level of steroid hormone binding globulin. When it is in excess, free testosterone becomes inaccessible to receptors. To reduce globulin levels, antiestrogenic drugs are prescribed.

Read more about the benefits and side effects of antiestrogens, as well as the choice of drugs for various purposes.

If the level of free testosterone is low and the globulin level is normal, the condition of the liver is examined (ultrasound, blood test), the level of aromatase (an enzyme that converts testosterone into estrogen) and luteinizing hormone (LH) in the blood. If the indicators are normal, then the testicles are checked (ultrasound, spermogram). If there is a lack of luteinizing hormone, a stimulator of testosterone synthesis, human chorionic gonadotropin (hCG), is first prescribed. If there is no effect, then the lack of testicular functioning is corrected with hormone replacement therapy. When LH levels are low, the testicles cannot work to their full potential. The pituitary gland is responsible for the release of this hormone, so diagnostics of its functioning is necessary (MRI, CT, blood donation for pituitary hormones).

An important indicator for low testosterone is the level of dihydroepiandrosterone (DHEA). This substance is directly involved in the synthesis of androgens (it is their precursor).

If the level of all of the above hormones is low, then an ultrasound scan of the adrenal glands and thyroid gland is prescribed. Additionally, a blood test is taken for thyroid hormones (synthesized by the thyroid gland), and a biochemical study of the serum is performed to determine the condition of the liver and kidneys.

Hormone replacement therapy drugs

Hormone replacement therapy involves a set of measures aimed not only at stabilizing testosterone levels, but also at correcting the consequences of its deficiency. Androgenic drugs combine well with antihypertensive (pressure-lowering) and sugar-lowering drugs.

Medicines are selected depending on the degree of testosterone deviation from the norm. Synthetic injectables are stronger. Oral and transdermal (through the skin) have a weaker effect, but without pronounced hormonal surges. The cost of an annual course of treatment with modern effective drugs can reach 40,000 rubles.

Injections

The most well-known injectable drugs used in hormone replacement therapy are testosterone cypionate (“Depo-testosterone cypionate”) and enanthate (“Testosterone E”) - esters similar in principle of action. Prices from 160 and 140 rubles. for 1 ml respectively. When introduced into the body, a depot is formed, from which the substance is gradually released into the blood. The downside is a sharp increase in testosterone levels in the first 2-3 days, followed by stabilization over two weeks. The drugs are administered at a dose of 200-400 mg once every 2-4 weeks.

A new generation drug includes “Nebido” based on testosterone undecanoate. Its main advantage is the absence of peak increases in testosterone and a long duration of action (it is enough to administer 4-5 times a year). The drug is well tolerated and does not cause side effects. The price starts from 5800 rub.

Oral

Among tablets, preference is also given to undecanoate ether. A popular remedy is Andriol. The active substance is absorbed into the lymph flow without affecting the liver. It is eliminated after 3-4 hours, so it should be taken 2 times a day. Price from 1150 rub. The drug is effective in the initial manifestations of andropause.

Other oral hormone replacement therapy:

• “Proviron” (mesterolone), 850 rub. for 20 tablets;
• "Halotestin" (fluoxymesterolone), RUB 2,700. for 20 tablets;
• "Methandren" (methyltestosterone), 1800 rub. for 100 tablets.

The above drugs are also used in sports pharmacology.

Transdermal

Transdermal hormone replacement therapy products include:

1. Plasters: “Androderm”, “Testoderm”. "Androderm" is available in 2 types: scrotal and cutaneous. The disadvantage of skin patches is frequent allergic reactions. Apply once a day. Price from 2500 rub.
2. Gel “Andractim” (no registration in the Russian Federation, can only be purchased through websites). Apply 2-3 times a day. Price from 7000 rub.
3. Gel "Androgel". Rub once a day into the shoulders or stomach. Price from 2600 rub. for 30 sachets.

The disadvantage of gels is that they prohibit contact of the smeared area with the bodies of other people. The main advantage is the ability to reproduce the circadian rhythms of hormone production by the body.

Implants

Testosterone implants (Testopel) implanted under the skin are intended for long-term hormone replacement therapy: Klinefelter syndrome, cryptorchidism, consequences of heavy metal poisoning, castration. They need to be implanted twice a year. Compressed testosterone implants are available in the form of sterile beads or cylinders. Each contains 97-98% of the hormone.

The implants are sewn under the skin of the lower abdomen. To do this, a 2 cm long incision is made, which is then covered with a sterile bandage for 2 weeks.

The drugs are not sold on the territory of the Russian Federation, and they cannot be purchased on websites either. The only option is to purchase from the manufacturing country – the USA.

Side effects

Testosterone is easily transformed (aromatized) into estradiol. This property causes the body’s main negative reactions to hormonal therapy:

• Increased apnea;
• Breast augmentation;
• Impaired spermatogenesis;
• Edema;
• Hypertension;
• Prostate enlargement.

Anti-estrogen drugs (Tamoxifen) or aromatase inhibitors (Arimidex) help prevent side effects.

If the dosage is chosen correctly(the amount of testosterone administered does not raise its level in the body above the physiological limit), then there will be no side effects. Taking hormonal medications should be carried out under the supervision of the attending physician. Their independent use can lead to the development of cancer and disruption of all body systems.

As a man ages, hormonal levels change. As a rule, this begins at the age of 35–40, but in each case the process proceeds individually, and the timing may be different, both up and down.

The main male hormone is testosterone, which is responsible for gender, temperament, reproductive function and sexual activity. Starting from the age of 25, the amount of androgen produced gradually decreases, and by the age of 40 its concentration decreases by 25%.

The main symptoms of testosterone deficiency in men are:

• irritability, aggressiveness;
• decreased sex drive;
• erectile disfunction;
• fast fatiguability;
• decrease in muscle mass;
• hair loss on the head and body;
• weight gain, deposition of adipose tissue on the abdomen, hips, and chest.

With a significant deficiency of testosterone, the size of the testicles decreases, gynecomastia develops, and the figure changes to a female type.

When are hormonal drugs prescribed?

You can increase testosterone levels through active physical activity, lifestyle changes, proper, balanced nutrition, and giving up bad habits. If these methods do not help normalize androgen levels, male hormones are prescribed as replacement therapy.

Medicines are prescribed based on the results of a blood test, examination and interview with the patient. The doctor selects the dosage and treatment regimen individually for each patient. Indications for taking hormonal drugs may be impotence, weak erection or infertility.

Types of hormonal drugs

Hormones for men used for replacement therapy are produced in the form of capsules, injection solution, patches, subcutaneous implants and gels for external use.

Gel preparations are considered the most effective; they are applied to the skin and ensure uniform absorption of the active substance within a short period of time. Disadvantages include local irritation of the epidermis, allergic reaction and inconvenience when wearing clothes and bathing.

The main advantages of the drug are:

• no negative effect on the liver;
• aromatization of testosterone does not occur;
• the own production of the sex hormone is not suppressed;
• fewer side effects are observed.

Disadvantages include low bioavailability, the need for continuous use and high cost.

Androderm patch

Another tool for hormone replacement therapy is the Androderm body patch. This is a transdermal drug that ensures a uniform supply of the hormone to a man’s body over a 24-hour period. During treatment, there are no sharp jumps in testosterone levels, the patch does not cause difficulties during use, and has fewer side effects than oral medications.

The patch is fixed on the shoulders, hips, stomach or back. The only disadvantages are the possibility of skin irritation, the need for daily replacement, and difficulties during hygiene procedures.

Injection therapy

Drugs for intramuscular injection are Nebido and Sustanon-250. The main active ingredient is testosterone ester; in addition, castor oil is present in the composition of the drug.

Nebido injection is given once every 10-14 weeks, Sustanon-250 - once every 3 weeks. The oily substance, entering the body, is gradually released from the reserve depot, maintaining the concentration of testosterone at the required level without sudden jumps. Treatment is carried out under constant monitoring of androgen concentration in the blood.

Based on the results of the analysis, the doctor adjusts the dosage and may increase or decrease the interval between injections.

Side effects of hormone replacement therapy

Hormonal drugs for men can cause the following side effects:

• aggressiveness, nervousness;
• muscle weakness, fatigue;
• acne on the face and body;
• increased sexual desire;
• alopecia;

• adolescents experience early puberty;
• nausea, vomiting, diarrhea;
• suppression of the production of own hormones;
• withdrawal syndrome;
• testicular atrophy;
• increased blood pressure;
• swelling of the body;
• prostate cancer.

To exclude the possibility of developing side effects, it is necessary to undergo a course of treatment under the supervision of a doctor, strictly adhere to the prescribed dosage of drugs, and do a control blood test to check testosterone levels every 2 months.

Bibliography

1. Ivanova N.A. Syndromic pathology, differential diagnosis and pharmacotherapy.
2. Internal diseases in 2 volumes. Ed. A.I. Martynova M.: GEOTARD, 2004. (UMO stamp)
3. Guide for emergency doctors. help. Edited by V.A. Mikhailovich, A.G. Miroshnichenko. 3rd edition. St. Petersburg, 2005.
4. Clinical recommendations. Rheumatology. Ed. E.L. Nasonova - M.: GEOTARD-Media, 2006.
5. Kugaevskaya A.A. Modern principles of diagnosis and treatment of arterial hypertension. Tutorial. Yakutsk: YSU Publishing House. 2007