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The Complete Guide to Testosterone Replacement Therapy for Men. Hormone replacement therapy with testosterone preparations Hormone replacement therapy in men drugs

Most men with low testosterone levels report improvements in energy, sexual arousal, and mood after testosterone therapy. If testosterone is not enough, why not replace it? Don't be in a hurry. In fact, people with low testosterone do not need treatment.

Substitution therapy has side effects, and what benefits it brings and how much it can threaten health is unknown. Only men with symptoms of low testosterone and blood tests showing it to be a problem should consider therapy. Only in consultation with a doctor can you determine that this therapy is right for you.

Testosterone replacement therapy - video

Hidden symptoms of testosterone deficiency

Symptoms of testosterone deficiency are sometimes obvious, but can be difficult to discern. Testosterone levels in men generally decrease with age, but they can also decrease due to various conditions.

• weak sexual excitability (libido);
• erectile dysfunction;
• fatigue and lack of energy;
• decrease in muscle mass;
• hair loss on the face and body;
• depression;
• distraction;
• irritability;
• deterioration in health.

If a man has these symptoms and the test shows low testosterone levels, the doctor may prescribe treatment. Millions of men with relevant symptoms but normal test results therapy is not recommended. It is also not suitable for men whose testosterone levels decline with age.

Types of drugs with testosterone

• patches (transdermal type): "Androderm" - a patch that is attached to the arm or torso, is taken once a day.
• gels: "Androgel" and "Testim" - bags with a transparent gel. Testosterone is absorbed into the skin, applied once a day. "Androgel", "Aksiron" and "Fortesta" are also available in the form of aerosols, which makes it convenient to take the daily dose prescribed by the doctor. "Natesto"-gel is applied to the surface of the nasal cavity.
• absorbed in the mouth: "Striant" - a small tablet, attached to the upper gums over the incisors for resorption. It is taken twice a day and restores testosterone levels in the blood for a long time.
• injections and implants: testosterone is also injected directly into the muscles or implanted in small granules into the soft tissues of the body. Gradually, it is absorbed into the blood.

Why not just take a testosterone pill? Some experts believe that these forms of drugs adversely affect the liver. All other forms - patches, lozenges, injections - deliver testosterone directly into the bloodstream and bypass the liver.

What are the benefits of testosterone therapy?

What can you expect from testosterone treatment? It is impossible to say for sure, because the body of each person has its own characteristics. Most men note improvements in potency and energy. Testosterone also increases bone hardness, muscle mass, and, in some people, insulin sensitivity. Men also report an uplift in mood after replacement therapy. These changes are pronounced or barely noticeable - they are very individualized.

About one in ten men are enthusiastic about therapy, and about the same number say almost nothing. Most of the reviews are generally positive, with little variation from each other.

What are the dangers of testosterone therapy?

Side effects of replacement therapy are mainly rashes, itching, or irritation where testosterone enters the body.

However, there have been cases of heart attack or seizures associated with the use of testosterone drugs. Experts emphasize that the benefits and harms of long-term therapy are unknown, since large-scale clinical studies have not yet been conducted. Testosterone therapy can lead to:

• benign prostatic hyperplasia (BPH): the prostate enlarges under the influence of testosterone. In most men, it increases with age, impinging on the urethra, leading to trouble urinating. So, BPH can worsen due to testosterone therapy.
• prostate cancer: Testosterone may contribute to the development of prostate cancer. Most experts recommend screening for cancer before starting replacement therapy. Men with prostate cancer or elevated levels of prostate specific antigen (PSA) should not be treated.
• temporary cessation of breathing during sleep (apnea): this problem can also develop and intensify under the influence of testosterone. It will be difficult for the man himself to identify it, but the person sleeping with him can tell about it. To make a diagnosis, a sleep study (polysomnography) is needed.
• Blood clotting: The Food and Drug Administration reports that testosterone replacement drugs are dangerous because they can cause blood clots. This develops the risk of deep vein thrombosis, pulmonary thromboembolism (its life-threatening blockage). The drugs can also cause blood clots due to polycythemia, an increase in the volume of red blood cells in the blood, which also develops under the influence of testosterone. Now this applies even to men who do not suffer from polycythemia.
• heart failure: testosterone therapy is also not recommended for men with heart failure, as it can only worsen the condition.

It will be years before large laboratory studies give results and answer the question of what are the benefits and what are the harms of testosterone replacement therapy. As with any treatment, it is up to you and your doctor to decide if a therapy is worth the risks it poses.

Testosterone is a male sex hormone. However, its functions are not limited to the control of the reproductive system. This hormonal substance improves the body's susceptibility to oxygen, helps the central nervous system, regulates cholesterol and blood sugar levels. Therefore, if androgen deficiency is detected, HRT (hormone replacement therapy) is prescribed. In addition to drugs, exogenous testosterone can be obtained from healthy drinks and foods.

Who is Testosterone Treatment for?

A decrease in testosterone levels in men after 40 is a natural process of aging. But sometimes the inhibition of the production of androgenic hormones is activated by genetic diseases, oncological neoplasms, and testicular injuries. In addition, diseases associated with smoking, the use of alcohol and drugs lead to early aging and a decrease in the synthesis of hormonal substances. In this case, exogenous testosterone replacement therapy should be carried out after getting rid of the original ailment.

Separately, it should be said about the increased production of SHBG protein (globulin that binds sex hormones). It binds testosterone into stable compounds that circulate through the bloodstream and do not react to target tissues. In addition to globulin, hormonal imbalance during normal androgen synthesis causes an excess amount of estrogen. Then HRT (hormone replacement therapy) is useless without inhibition of SHBG and estrogen.

To assess the hormonal background, a patient of any age must pass a whole series of blood serum tests, namely:

1. Blood test (clinical, biochemical, metabolic).
2. Testosterone (total, free, bioavailable).
3. Estradiol, globulin.
4. FSH (follicle stimulating hormone).
5. LH (luteinizing hormone).
6. DHT (dihydrotestosterone).

The entire series of tests must be taken in the morning and checked every six months to understand how successfully testosterone replacement therapy is being carried out.

Method of drug administration

Testosterone therapy can be administered in several ways: injection, oral, subcutaneous, and transdermal. For each age and condition of the body of a man, doctors individually select the method of administration of the exogenous drug and its dosage. But there are also general norms of treatment, that is, the elimination of a deficiency of sex hormones.

To determine the pathology, a man needs to pass a whole series of blood serum tests.

Each method of replacement therapy has its advantages and disadvantages.

• Tablets

Oral drugs have a mild effect. Therefore, they are recommended for men who have a slight testosterone deficiency. Such HRT (hormone replacement therapy) is preventive in nature and is aimed at preventing the development of diseases associated with a lack of androgens in the body. Separately, it is worth noting the tablets that are not swallowed, but laid on the cheek. Their advantage is the gradual release of exogenous testosterone and low traumatism of the mucosa of the digestive tract. And the disadvantages include cases of damage to the gum tissue of the elderly.

• Solutions for injections

The positive aspect of testosterone replacement therapy, carried out by injection, is the direct entry of exogenous hormone into the body without irritation of the mucous membranes of the stomach and intestines. For intramuscular injections, oil preparations are used, which slowly break down into elements, due to which the same level of testosterone in the blood is maintained. Subcutaneous injections are often the choice of men who require lifelong HRT (hormone replacement therapy). Thus, they avoid numerous muscle punctures, especially painful after the age of 50 years.

• Transdermal gel

Exogenous testosterone can enter the body by applying a special gel to the skin. This type of replacement therapy is very popular among the stronger sex due to its ease of use and dosing flexibility. There are certain rules for the use of such drugs. So, you need to apply it on clean skin and after that do not sweat for half an hour (do not exercise). Make sure that during the first hour after spreading, other people do not touch this place, especially children, pregnant women, and the elderly. Also, to eliminate androgen deficiency, you can’t rub the affected area yourself.

When applying the gel to the skin, you can not sweat for half an hour.

• Testosterone patch

Another modern method of testosterone replacement therapy is the fixation of a special patch. The first generation of such preparations was intended for gluing to the scrotum, since through this place the body can absorb the maximum dose of exogenous hormone. The new generation of patches can be applied to the back, thighs, arms, abdomen. The main thing is that the skin is clean, dry and devoid of hair. This convenient tool allows you to quickly replenish testosterone deficiency and ensure its constant level throughout the day. Despite the apparent harmlessness of the sticker, the uncontrolled use of such HRT (hormone replacement therapy) can have severe negative consequences for the body.

• Subdermal implants

This type of HRT (hormone replacement therapy) is very popular with many men suffering from testosterone deficiency. It is a capsule sewn under the skin in the navel area, gradually releasing exogenous male sex hormone into the body. Due to the continuous action of the drug, the androgen level remains constant for six months after the procedure. At the same time, the incision is so small that the scar is invisible even in the summer. The disadvantages of such replacement therapy are the possible displacement or expulsion of the capsule, as well as cases of bruising and hematomas in the implantation zone.

Despite the fact that all funds can be bought at the pharmacy without any problems, it is strictly forbidden to prescribe substitution therapy for yourself. An excess of testosterone is just as dangerous as a deficiency of the hormone. Remember that with age, its natural level decreases, so all patients need to do a new test twice a year to control HRT (hormone replacement therapy).

With the help of a subcutaneous implant, testosterone levels can be maintained for up to six months.

When absolutely contraindicated

Hormone replacement therapy is absolutely contraindicated for patients of oncology clinics, as it can activate tumor growth. Intensive treatment of testosterone deficiency is prohibited for men over 45 years of age who have had cases of sleep apnea, epilepsy, migraines. In addition, an androgen replacement drug is not administered for the following ailments:

1. Bronchial asthma.
2. Inflammation in the pelvic area.
3. Heart and kidney failure.

> If all the necessary diagnostic studies are completed before starting HRT (hormone replacement therapy), the specialist will draw up an effective treatment regimen to maintain the level of the sex hormone within the normal range.

However, each organism reacts to therapy individually, and what worked at forty years old no longer has power at sixty. What side effects can be observed with HRT (hormone replacement therapy) in young men and in old age?

Adolescents may notice precocious puberty, excessive sexual desire, hypersensitivity of the nipples and penis. Elderly men are characterized by a violation of the mineral and water balance, which is expressed by puffiness, obesity, and swelling of the extremities. Therefore, in the treatment of testosterone deficiency, one should not only fix the level of exogenous hormone, but also monitor changes in one's well-being and consult a doctor in time if health deteriorates to correct hormone replacement therapy.

Severe androgen deficiency can develop in men for various reasons and at any age.

Testosterone replacement therapy is prescribed to restore the functioning of the endocrine system of the male body and improve the quality of life.

A decrease in the concentration of testosterone in the blood serum negatively affects the functioning of various organs and systems of the male body. The process of testosterone decline occurs slowly and begins to develop after 30 years. By the age of forty, many men become overweight, their belly begins to grow and their sexual desire decreases. Testosterone deficiency in men leads to the development of cardiovascular disease and osteoporosis. Testosterone replacement therapy enables men suffering from male hormone deficiency to avoid negative consequences.

The only way to find out about the lack of a male hormone in the blood serum is to measure its level in the blood. To find out its exact amount, several samples are taken. Blood is taken for analysis from 8 to 9 in the morning, when it is at its highest level. With properly selected doses, after long-term use of androgen hormone, the health of men with symptoms of testosterone deficiency improves. They restore their weight, their blood pressure normalizes, libido and potency return.

Why does testosterone deficiency occur?

Decreasing testosterone levels don't always happen naturally over the years. There may be various reasons for the decrease in its production by the endocrine glands. Injury to the testicles can lead to a lack of male hormone. The cause is genetic diseases and the development of oncological neoplasms. Excess iron in the body suppresses the production of testosterone by the endocrine system. Pituitary dysfunction and the use of various hormonal drugs can cause a developing deficiency. Chronic diseases associated with alcoholism, nicotine addiction and drug use lead to early aging of the body and a decrease in the production of androgen hormone.

When to Start Testosterone Treatment

All men with symptoms of androgen deficiency, and the elderly after 50 years of age, are recommended to conduct a diagnostic examination for hormonal levels in the blood serum. The test results give true information about the production of hormones in the body. Replacement therapy is prescribed in the presence of symptoms of androgen deficiency, tests confirming an insufficient amount of testosterone in the blood, and in the absence of malignant tumors in the prostate gland. Laboratory diagnostics should exclude or confirm the presence of prostate cancer. With a lack of testosterone, the likelihood of developing carcinoma of this male organ increases. For men with a history of cancer, the administration of testosterone preparations is contraindicated. Therapy will worsen the patient's condition. After collecting all the necessary information, testosterone preparations are prescribed.

Symptoms of androgen deficiency syndrome are:

1. Prostration.
2. Decreased stamina and performance.
3. Decreased growth.
4. Prolonged depression.
5. Increased irritability.
6. Erectile dysfunction.
7. The need for an afternoon nap.
8. Increase in body fat mass.
9. Growth of mammary glands.
10. Anemia.
11. Osteoporosis.
12. Cholesterol increase.

If there are 3 or more symptoms in history, then you should consult a doctor for examination.

How to properly conduct testosterone therapy

Replacement therapy with testosterone preparations should be carried out only as prescribed by a doctor and under constant medical supervision. The uncontrolled use of hormonal drugs leads to addiction of the body, which reduces the natural production of testosterone by the organs of the endocrine system. The most common hormonal treatment option has become the intramuscular administration of preparations containing the hormone.

In addition to injections, there are other types of administration of hormonal drugs into the human body. Preparations containing testosterone, manufacturers produce in the form of tablets, gels and patches.

Pharmaceutical companies offer crystalline implants for use, which are inserted under the skin by making an incision in the abdomen. This drug, dissolving, provides a uniform release of testosterone for about six months. An implant is placed and removed surgically.

Replacement therapy using various types of preparations containing testosterone lasts for life. The effectiveness of treatment can be seen after the body accumulates the desired concentration of testosterone and the symptoms of androgen deficiency are eliminated. If you take testosterone under medical supervision, then the therapy will be safe. It allows men of any age with androgen deficiency to maintain health by leading an active lifestyle.

Hypogonadism Therapy

Male hypogonadism is a functional failure of the testicles. The development of the disease is accompanied by a low level of testosterone in the blood serum and characteristic clinical manifestations.

The causes of the development of the disease can be testicular injuries or disorders of the hypothalamic-pituitary system. Developmental pathologies can be genetically determined. Treatment of the disease involves the mandatory use of testosterone replacement therapy.

Signs of hypogonadism often begin their development in boys in childhood. If the developing disease is not treated, then the adolescent will begin to delay the development of secondary sexual characteristics. Adult males with hypogonadism have underdeveloped muscles, a high pitched voice, small scrotum and testicles.

They have a small penis, sparse hair on the pubis and in the armpits. Growth of the mammary glands and eunuchoid body composition may be observed.

Hormone replacement therapy for this disease is recommended from adolescence and continues for life, because androgen deficiency will accompany a man suffering from hypogonadism throughout his life.

There are various methods for eliminating testosterone deficiency in this disease, which the doctor uses during treatment.

Replacement therapy in the elderly

Hormone replacement therapy in older men is carried out to improve the quality of life. More and more men, having crossed the 40-year mark, want to look young and strong. They do not accept old age and agree to substitution therapy if there are indications for use.

The main goal is to reduce the symptoms of age-related androgen deficiency. Such men are recommended to wear patches, intramuscular injections, gels and capsules for suturing.

Studies have shown that such therapy leads to a decrease in blood cholesterol, reduces the risk of heart attacks and cardiovascular diseases.

Side effects of replacement therapy

Therapy with testosterone preparations can lead to the development of side effects. Skin that becomes oily develops acne. Careful hygiene should be observed during treatment. Using lotions with alcohol, hard brushes for the body, gels for oily skin will help to eliminate the development of acne.

There may be fluid retention in the body due to urinary retention, an increase in the size of the testicles. All these phenomena indicate an excess of the hormone. Therapy with testosterone preparations will be temporarily canceled if the doctor detects the development of side effects. With the normalization of the condition, testosterone treatment continues, but the doctor reduces the dose of the administered drug.

Therapy results

When carrying out testosterone replacement therapy, the conditions that develop with various somatic diseases improve. A decrease in the signs of male hormone deficiency occurs in men of different ages. A month after the start of replacement therapy, there is an increase in resistance to stress, an increase in exercise endurance and a decrease in cholesterol levels, which is required to produce testosterone. Replacement therapy has a positive effect on the cardiovascular system. It reduces the symptoms of heart failure in elderly patients, normalizes blood pressure, and reduces the number of angina attacks. Numerous studies have shown that testosterone therapy improves myocardial contractility and accelerates its recovery after a heart attack.

Hormone replacement therapy helps many men cope with inferiority complexes, find the joy of fatherhood, and stop the onset of old age. If there are any symptoms of male hormone deficiency in the body, you should consult an andrologist for advice and treatment.

Testosterone is one of the main hormones in the human body. It can be found both in the blood of men and women. A deficiency of this hormone can occur for various reasons and lead to serious consequences, since the work of not only the sexual sphere, but also other body systems is disrupted.

A decrease in testosterone can also occur for physiological reasons, as a result of the aging of a man's body. Therefore, many men suffer from overweight precisely because of the decrease in the level of this hormone. Testosterone deficiency can lead to cardiovascular disease. The process of reducing testosterone levels begins after the age of thirty, and with a decrease in the amount of the hormone, libido also decreases.

In order to find out the level of the hormone in the blood, it is necessary to take a blood test, this must be done in the morning on an empty stomach. It is during these hours that the level of the hormone in the body is maximum.

Low testosterone levels can be returned to normal, and replacement therapy will help with this. There are preparations containing testosterone synthesized artificially. All men who have crossed the age limit of fifty years must be prescribed an examination in order to determine the level of testosterone in the blood. With its deficiency, the necessary treatment is prescribed.

Testosterone deficiency can also be detected in fairly young men. Normal hormone synthesis can be disrupted by smoking and regular consumption of alcoholic beverages. Constant stress and a sedentary lifestyle lead to the same result.

If there are symptoms of testosterone deficiency in the body, treatment is prescribed only after a comprehensive examination, which should exclude the presence of a malignant tumor of the prostate. With this disease, treatment with drugs that have testosterone in their composition is prohibited. All men with a history of malignant neoplasms indicated, such treatment is not carried out.

Taking hormonal pills with these pathological changes in the patient's body will lead to a sharp deterioration in his health. Therefore, without the availability of all laboratory data and MRI data, treatment is not prescribed.

What are the signs of testosterone deficiency in a man's body?

• Weakening of sexual desire.
• Decreased body tone.
• Frequent and prolonged depression.
• Changes in the patient's behavior.
• Erectile dysfunction.
• Drowsiness.
• Weight gain.
• Breast growth.
• Decrease in the level of hemoglobin in the blood.
• Increase in blood cholesterol levels.

It is believed that if a man reveals at least three symptoms from the above list, he should consult a doctor for treatment.

HRT

Men who have been diagnosed with testosterone deficiency should undergo regular medical examinations and take medications. During the course of replacement therapy, testosterone levels should be monitored.

Testosterone replacement therapy in men can only be carried out after consultation with the attending physician. He also determines the required dose of the drug. The effect of preparations containing testosterone becomes externally noticeable only after the required level of the substance in the blood is reached.

Treatment of testosterone deficiency can take place using injections, tablets, special gels and patches. A new treatment method has recently been developed. With it, special implants containing crystalline testosterone are inserted under the skin of the patient in the abdomen. Dissolving, the crystals provide a constant supply of the hormone into the blood. The effect of such an implant is designed for six months. HRT with testosterone is carried out for life.

Some drugs used to treat hormone deficiency are hepatoxic and their use is restricted or banned in some countries. This is another argument in favor of the fact that treatment should be prescribed only by a doctor. The patient cannot be aware of all the characteristics of hormonal drugs, and making a decision on self-treatment can be harmful to his health.

Injectable forms of testosterone analogues include Testosterone cypionate, Testosterone enanthate. These two drugs are administered at 200-400 mg once every three to four weeks. These injections should not be used to treat heart failure and kidney and liver disease. In lung diseases, drugs containing an analogue of testosterone are allowed to be taken, but with extreme caution and under strict medical supervision. A contraindication to treatment with these drugs can be diabetes mellitus, and acute urinary retention, which manifested itself against the background of inflammation of the prostate.

Hormonal tablet forms: Fluoxymesterone, Methyltestosterone. Both of these drugs are hepatoxic. They are forbidden to appoint patients with diseases of the liver and kidneys. The daily dose of Fluoxymesterone can reach up to 20 mg, for Methyltestosterone - up to 30 mg.

Subcutaneous forms of drugs include implants. 1200 mg of the drug is sewn under the skin, the effect of which lasts about six months.

Transdermal forms act through the skin. These include Testosterone gel and Testosterone patches. Indications and contraindications for these drugs are the same as for tablets and injections.

Treatment of testosterone deficiency began in the forties of the last century. During this time, many preparations with its content have been created. With each time, synthetic testosterone is more and more similar in its characteristics to the one that is present in the human body.

Taking hormonal drugs can improve the quality of life of a man, prolong his youth, as evidenced by the reviews of many patients. Some of these drugs are used not only for medicinal purposes. Sometimes athletes take these drugs in order to improve their athletic performance. But again, this must be done under the strict supervision of doctors.

Hormone replacement therapy for men (HRT) - pharmacological compensation for the lack of their own hormones. For this, both medical preparations and herbal analogues are used. The most significant for men - negatively affects health at any age, reduces emotional, physical, sexual activity, disrupts mineral and carbohydrate metabolism. Hormone replacement therapy (HRT) in most cases significantly improves the quality of life, subject to proper selection of drugs.

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), with its critically low level occurs. In men, this usually occurs after 50, but some feel the first symptoms after 40.

Other causes of testosterone deficiency:

• Pathologies of the pituitary 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, which caused tissue deformation, as well as castration (testicles produce 95% of testosterone);
• Pathology of the thyroid gland;
• Liver dysfunction (cannot cope with testosterone metabolism);

• Heart failure;
• Obesity. Adipose tissue in men is an endocrine organ that converts testosterone into female estrogens using the aromatase enzyme;
• Hormone-dependent tumors (prostate, testicles), the treatment of which requires a maximum decrease in testosterone levels;
• Medications: 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 a reduced level of testosterone (total or free) and an excess of estradiol (a 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.

About how the male menopause proceeds, is diagnosed and treated, says Doctor of Medical Sciences, Professor Alexander Samoylovich Segal

Hormone replacement therapy with testosterone is not used for the following pathologies:

1. Liver diseases.
2. Venous thromboembolism.
3. Breast and prostate cancer. Hormone therapy for cancer in men involves the administration of estrogen.
4. Benign prostatic hyperplasia.
5. Prolactinoma (neoplasm of the pituitary gland).
6. Polycythemia (blood pathology associated with an increase in the volume of red blood cells).

Relative contraindications to testosterone therapy are sleep apnea (stopping breathing during sleep), heavy smoking, lung pathology.

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 only interpreted in conjunction with a number of other indicators. The indicators for each age are within a fairly wide range. Everything is very individual: for one man, the lower value can be quite normal, and for another already critical. Hormone replacement therapy is not applied to everyone in a row just to bring the level of testosterone to the upper limit. So you can disrupt the homeostasis (self-regulation) of the body and harm health.

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

1. The degree of bone density.
2. Testosterone levels after 30 years. This is an important guideline for determining the individual norm. The lower the indicator, the faster the andropause will come, and the more important is the timely correction of the hormonal background.

1. Prostate condition and PSA level (tumor marker).
2. Appearance: weight, muscle tone, hairline.
3. The 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, and its total amount and estradiol are normal, then it is necessary to check the level of globulin that binds steroid hormones. With its excess, free testosterone becomes inaccessible to receptors. To reduce the level of globulin, antiestrogen drugs are prescribed.

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

With a low level of free testosterone and a normal globulin, the state of the liver (ultrasound, blood test), the level of aromatase (an enzyme that converts testosterone into estrogen) and luteinizing hormone (LH) in the blood are examined. If the indicators are normal, then the testicles are checked (ultrasound, spermogram). With a lack of luteinizing hormone, a testosterone synthesis stimulator, chorionic gonadotropin (hCG), is first prescribed. If there is no effect, then the lack of functioning of the testicles is corrected by 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, therefore, it is necessary to diagnose its functioning (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 ultrasound of the adrenal glands and thyroid gland is prescribed. Additionally, they take a blood test for thyroid hormones (synthesized by the thyroid gland), conduct a biochemical study of the serum to determine the state 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 lack. Androgenic drugs are well combined with antihypertensive (lowering pressure) and hypoglycemic agents.

Medications are selected depending on the degree of testosterone deviation from the norm. Synthetic injectables are stronger. Oral and transdermal (through the skin) are weaker, 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 that are similar in principle of action. Prices from 160 and 140 rubles. for 1 ml, respectively. When introduced into the body, they form a depot, from which the substance is gradually released into the blood. Minus - a sharp increase in testosterone levels in the first 2-3 days, followed by stabilization for two weeks. The drugs are administered at 200-400 mg once every 2-4 weeks.

The drug of the new generation includes "Nebido" based on testosterone undecanoate. Its main plus is the absence of peak testosterone increases and a long duration of action (it is enough to inject 4-5 times a year). The drug is well tolerated, does not cause side effects. The price starts from 5800 rubles.

Oral

Of the tablets, undecanoate ether is also preferred. A popular remedy is Andriol. The active substance is absorbed into the lymphatics without affecting the liver. After 3-4 hours, it is excreted, so it should be taken 2 times a day. Price from 1150 rubles. The drug is effective in the initial manifestations of andropause.

Other oral hormone replacement therapy:

• "Proviron" (mesterolone), 850 rubles. for 20 tablets;
• "Halotestin" (fluoxymesterolone), 2700 rubles. for 20 tablets;
• "Metandren" (methyltestosterone), 1800 rubles. for 100 tablets.

The above drugs are also used in sports pharmacology.

Transdermal

Transdermal hormone replacement therapy includes:

1. Plasters: Androderm, Testoderm. "Androderm" is available in 2 types: scrotal and cutaneous. Minus skin patches - frequent allergic reactions. Apply once a day. Price from 2500 rubles.
2. Gel "Andraktim" (no registration in the Russian Federation, you can only buy through websites). Apply 2-3 times a day. Price from 7000 rubles.
3. Gel "Androgel". Rub once a day on the shoulders or abdomen. Price from 2600 rubles. for 30 sachets.

The disadvantage of gels is the prohibition of 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 in the body.

Implants

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

Implants are sewn under the skin in the lower abdomen. To do this, a 2 cm long incision is made, which is then closed with a sterile dressing for 2 weeks.

The drugs are not sold on the territory of the Russian Federation, and they cannot be purchased on the websites either. The only option is to buy in the country of origin - the United States.

Side effects

Testosterone is easily transformed (aromatized) into estradiol. This property of it causes the main negative reactions of the body to hormone therapy:

• Increased apnea;
• breast augmentation;
• Violation of spermatogenesis;
• swelling;
• Hypertension;
• Enlargement of the prostate.

Antiestrogen drugs (Tamoxifen) or aromatase inhibitors (Arimidex) help prevent side effects.

If the dosage is correct(the volume of injected testosterone does not raise its level in the body above the physiological limit), there will be no side effects. Reception of hormonal preparations should be carried out under the supervision of the attending physician. Their independent use can lead to the development of a cancerous tumor and disruption of the work of all body systems.