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Article: Understanding HRT for Men

Understanding HRT for Men

Hormone Replacement Therapy (HRT) is a treatment that has been used for decades to supplement the body with hormones it is lacking. HRT has been traditionally used to treat a variety of conditions, including menopause, andropause, osteoporosis, and hormonal imbalances. Recently, HRT has become a popular treatment for men with low testosterone levels. In this article, we will explore what HRT is, how it affects men's health, its side effects, benefits, treatment modalities, and conclude with important considerations.

 

What is HRT and How Does it Affect Men's Health?

HRT is the administration of hormones to supplement the body's natural hormone levels. In men, testosterone plays a crucial role in the development of male reproductive tissues, such as the testes and prostate, and promotes secondary sexual characteristics, such as increased muscle and bone mass, and the growth of body hair (1). Low testosterone levels can lead to a variety of symptoms, including decreased libido, erectile dysfunction, decreased muscle mass and strength, and decreased bone density (2). HRT can be used to supplement testosterone levels in men and alleviate these symptoms.

 

Side Effects

Like any medical treatment, HRT can come with side effects. In men, the side effects of HRT can include acne, hair loss, fluid retention, breast enlargement, and an increased risk of blood clots and prostate cancer (3). It is important to discuss the potential risks and benefits of HRT with a healthcare provider before starting treatment.

 

The Benefits of HRT

Testosterone plays a crucial role in the development of male reproductive tissues, such as the testes and prostate. It also promotes secondary sexual characteristics, such as increased muscle and bone mass, and the growth of body hair. In men, low testosterone levels can lead to a variety of symptoms, including decreased libido, erectile dysfunction, decreased muscle mass and strength, and decreased bone density (4). HRT can be used to supplement testosterone levels in men and alleviate these symptoms.

 

Treatment Modalities

Various strategies for testosterone delivery have been used, including parenteral injections, patches, pellets that are inserted under the skin and release testosterone over a period of several months (6), creams, gels, and troches. However, human-identical testosterone is not effectively absorbed via oral administration, and synthetic testosterone is characterized by poor absorption and poor bioavailability (7). Topically applied testosterone that are cream and gel based can also be compounded and are an effective and convenient means of hormone replacement(8). The latest approach in testosterone replacement therapy involves the use of compounded testosterone troches, combined with an aromatase inhibitor like generic Anastrazole for estradiol level control and a 5α-reductase inhibitor like generic Dutasteride or Finasteride for dihydrotestosterone control. The testosterone troches are effective in quickly elevating serum testosterone levels to the optimal range and are also cost-effective. This makes compounded testosterone troches for replacement therapy accessible and affordable to many men who require it (9).

HRT can be an effective treatment for men with low testosterone levels. While there are potential risks associated with the treatment, the benefits can outweigh the risks for many men. It is important to discuss the potential risks and benefits of HRT with a healthcare provider before starting treatment.

 

References:

  1. Traish AM, Kang HP, Saad F, Guay AT. Dehydroepiandrosterone (DHEA)--a precursor steroid or an active hormone in human physiology. J Sex Med. 2011 Mar;8(3):296-306. doi: 10.1111/j.1743-6109.2010.02164.x. PMID: 21143447.

  2. Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, Montori VM; Task Force, Endocrine Society. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010 Jun;95(6):2536-59

  3. Morales, A. (2009). Androgen replacement therapy and prostate safety. The aging male: the official journal of the International Society for the Study of the Aging Male, 12(4), 121–127. https://doi.org/10.3109/13685530903296785

  4. Snyder, P. J., & Bhasin, S. (2016). Effects of Testosterone Treatment in Older Men. The New England Journal of Medicine, 374(7), 611–624. https://doi.org/10.1056/NEJMra1506119

  5. Carruthers, M. (2013). Testosterone replacement therapy with long-acting testosterone undecanoate improves sexual function and quality-of-life parameters vs. placebo in a population of men with type 2 diabetes. The journal of sexual medicine, 10(6), 1612–1627. https://doi.org/10.1111/jsm.12143

  6. Feneley, M. R. (2018). Androgen deficiency in the ageing male: when, who, and how to investigate and treat. The British journal of general practice: the journal of the Royal College of General Practitioners, 68(676), 304–305. https://doi.org/10.3399/bjgp18X696893

  7. Glaser, R. L., & Dimitrakakis, C. (2015). Reduced breast cancer incidence in women treated with subcutaneous testosterone, or testosterone with anastrozole: a prospective, observational study. Maturitas, 80(3), 325–329. https://doi.org/10.1016/j.maturitas.2014.12.004

  8. Cutter, C. B. (2001). Compounded percutaneous testosterone gel: use and effects in hypogonadal men. The Journal of the American Board of Family Practice, 14(1), 22-32.

  9. Guth MA. Compounded Testosterone Troches to Optimize Health and the Testosterone Controversy. International Journal of Pharmaceutical Compounding. 2015 May-Jun;19(3):195-203. PMID: 26714360.






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