Menopause and Hair Loss

Although it is not generally appreciated, discount hair loss occurs as just as frequently in women as it does in men. Half of all women experience some degree of hair loss by age 50, levitra and this figure increases to about 75% of women at age sixty five. In affected individuals, cialis sale the process begins between the ages of twelve and forty. As some women experience an acceleration of their hair loss as they approach menopause, it has been postulated, that this is attributable to the alteration in the ratio of estrogen to testosterone during the menopausal transition.

While some men who are balding may find it somewhat distressing, the psychological burden carried by women experiencing hair loss is a different story.   Contemporary society seems to suggest, that male baldness is an indication of increased virility and sexiness. This is definitely not how balding women are perceived. Society appears to dictate, that a full head of attractively styled hair is an essential component of the complete woman’s persona.

Accordingly, most of the women who come to my office with a concern about hair loss are absolutely devastated. They suffer from both a diminished body image and loss of self esteem, which affects their psychological adjustment, relationships, and quality of life.

What causes hair loss?

Hair loss appears to be genetically determined, and in susceptible women, is an inherited alteration in the way individual hair follicles metabolize the sex hormone testosterone. This type of hair loss is referred to as genetic balding or androgenic alopecia. Most of these women have normal hormonal function, including, normal testosterone levels, normal menstrual function, and fertility. Those affected are believed to undergo a higher rate of conversion of testosterone to dihydrotestosterone, or DHT. It is the effect of DHT on the hair follicles that is thought to be the mechanism responsible for the hair loss.

Fortunately, the hair loss experienced by women is usually milder, and although the pattern is generally more diffuse, it is less intense. It is concentrated on the top, or crown of the scalp. The frontal hairline is usually spared, and if there is thinning of the temple areas, it is typically more subtle. This difference is attributed to differences in (1) the level of 5 alpha-reductase and cytochrome P-450 aromatase, the enzymes responsible for the conversion of testosterone to dihydrotestosterone, DHT and (2) the number of testosterone receptors in the individual hair follicles of the scalp.

What role does menopause play in hair loss?

There is no question that the variations in hormone levels associated with menopause are influential factors in female hair loss. If an adequate estrogen level is present, it will compete with, and to some extent block, the affect of DHT, on the testosterone receptors of individual hair follicles. In contrast, as hormone levels decline during the menopausal transition, the protective affect estrogen exerts on the hair follicle is lost, and the potential of hair loss increases. Two biological models of this scenario are: first the hair loss that occurs subsequent to the dramatic fall in estrogen levels in a susceptible woman after having a baby, and second the loss of hair following removal of a woman’s ovaries when she is not given adequate hormone replacement. Typically, the actual hair thinning does not occur until three, or four months following the fall in hormone levels, and accordingly, any benefit of treatment takes that length of time or longer to be noticed.

Are there are other conditions unrelated to the menopausal transition that have been associated with hair loss in women?

Yes. These include anemia, thyroid disorders, syphilis, fungal infections, infection with the human immunodeficiency virus, and connective tissue diseases, such as lupus, hormone secreting tumors, significant weight loss and stressful life events. Alopecia areata, a condition of localized balding is considered by many to be an autoimmune disease. Traction alopecia is a form of hair loss associated with excess traction, or pulling, on the hair, either during styling, or by habitual tugging, or twirling the hair, a condition known as trichotilomania.
Women, who have abnormally high levels of male sex hormones, or androgens, may also experience thinning of scalp hair. Other signs of androgen excess include an increase in body or facial hair, especially if it appears in a masculine distribution, severe cystic acne, abnormal menstruation, breast secretions and clitoral enlargement. Women, who exhibit these characteristics, should see a physician who is experienced in the diagnosis and treatment of these disorders.

What about poor scalp circulation and clogged hair follicles?

Commonly used explanations for hair loss put forth by those selling over-the-counter remedies for hair loss, such as poor scalp circulation, and clogged hair follicles, have been found to have no role in hair loss. To my knowledge the products they sell are of no benefit.

Can medication cause hair loss?

Treatment with cancer chemotherapy is well known to be associated with hair loss. Medication-related hair loss is not fully understood, but thought to be due to a disruption of the normal phases of hair growth. The hair loss may be reversible after the medication is discontinued. Medication-induced hair loss is an occasional side effect of antidepressants and other psychoactive drugs, cholesterol lowering medication, oral contraceptives and anticoagulants.
Testosterone replacement at levels appropriate to enhance mood, sexual function, and quality of life, is rarely associated with hair loss, but, may be a factor in some susceptible women. Adding spironolactone[i] to the patients regimen, and if necessary, a reduction in the dose will usually alleviate the problem.

What about treatment?

Rogaine, a topical treatment, is available in two strengths, 2% and 5% and is applied to affected areas twice daily. The 5% dose is marketed for only men as there is a concern that this dose may cause facial hair in some women. Concentrations of minoxidil as strong as 13% are available for purchase on the internet.
Propecia is presently the most effective medical treatment for men. At prescribed doses it promotes hair growth and prevents further hair loss in a significant proportion of men with genetic balding. It is thought to work by inhibiting the conversion of testosterone to DHT. Although some research suggests it is effective for this type of hair loss in women it is not FDA approved for this use because of a known risk of fetal malformations. Regardless, some physicians, including myself, currently use it in women who are not at risk of pregnancy.

Spironolactone is an orally administered mild diuretic, which is believed to diminish the affect of androgens. I prescribe it in doses up to 200 mg daily in postmenopausal women. I use lower doses in women who are still menstruating as doses in this range may cause menstrual irregularities. The rationale for its use is based on the belief that it interferes with the ability of androgens to bind to the receptors in the hair follicle thereby not allowing DHT to exert its effect.

When estrogen replacement is either used alone or in combination the above strategies it will increase the possibility of stopping, or slowing the hair loss. Plus, it has the added benefit of alleviating menopausal symptoms, sustaining hormone dependent tissues and increasing quality of life. In some women I also prescribe a compounded shampoo containing a low concentration of estrogen and dutasteride a medication similar to finasteride. I usually suggest that the patient shampoo their hair with it three times a week or combine a small amount with their regular shampoo and use it daily.

None of these treatments are FDA approved for women and are designated “off label.”

As a practical matter, I almost always suggest combination therapy to my patients.

Treatment should be initiated at the earliest sign of hair thinning, as in almost all instances, even the most optimum therapy can only stop, or slow, the process. In women with a strong family history of genetic baldness, early intervention should be considered.

If a form of treatment is found to be effective it should be continued indefinitely assuming there are no negative side effects, as stopping the treatment results in a return of hair loss.

Hair replacement surgery is an option for some women. The best candidates for this type of treatment should have areas of dense hair growth at the back or sides of the head available for transplantation. Women, in whom a medical or surgical approach is not effective, not feasible, or not desired, may choose to use a wig, or hair extensions.

In summary
Hair loss in menopausal women is perceived uniquely by the individual woman experiencing it. Nonetheless, it is capable of negatively impacting self-esteem and quality of life. Some of the women I see who suffer from this problem, are among the most distressed and desperate patients who come to my office. Every woman who experiences this dilemma should address it in the manner she feels is most appropriate for her. It is important for women with undiagnosed hair loss to be appropriately evaluated by a physician for causes of hair loss other than genetic balding, as there are a number of underlying medical conditions that may mimic this condition.

 

 

 

 

[i] Spironolactone is a mild diuretic with antiandrogenic properties.

Male Menopause (Andropause)

Beginning at about 30 years of age, the level of testosterone in men will decrease about 10% every decade. If testosterone levels fall below a level necessary to sustain hormone-dependent tissues, affected men may suffer from anemia, decreased energy, motivation, and self-confidence, diminished muscle mass, thinning of the skin, abdominal obesity, reduced sexual desire, difficulty with erections, orgasmic dysfunction, and depressed mood. In addition, men with abnormally low testosterone levels are at an increased risk for osteoporosis, cardiovascular disease, dementia, and diabetes. Nonetheless andropause also known as male androgen deficiency and male hypogonadism, is one of the most underdiagnosed and undertreated medical conditions.

Andropause is very common, although there is no agreement on the actual prevalence of hormone deficiency in aging men, and estimates vary widely. For example, a study published in the Journal of Clinical Endocrinology and Metabolism in 2001 placed the incidence of andropause in the range of 1 of 5 men older than 60 years of age, 1 of 3 men older than age 70, and half of men older than age 80.[i]   In contrast, a study published in the International Journal of Clinical Practice suggested that andropause occurred earlier and was more frequent, affecting more than 1 of 3 men older than age 45.

Early Andropause

An andropause that occurs earlier than anticipated (i.e., before the 45 years of age) is usually related to genetic factors, illness, surgery, medical therapy, or trauma.

Causes of Early Andropause

Low HDL Levels

In my own patient population, an underappreciated but common cause of early andropause is an inherited disorder of lipid metabolism. Men who are affected have an abnormally low level of a component of cholesterol known as high-density lipoprotein (HDL). HDL is sometimes referred to as the “good cholesterol,” since cardiovascular disease is less likely to develop in men and women who have high levels of HDL. In affected men, the low HDL level is often accompanied by an elevation of another component of cholesterol known as triglycerides. Men in this category seem to be at greatest risk for an early andropause. This is an important finding, and studies have shown that men with higher levels of testosterone are more likely to have higher HDL levels than men with lower levels of testosterone. Accordingly, all men with low HDL levels should be tested for the presence of an abnormally low testosterone level. In addition, hormone-deficient men (and women) with low HDL levels are also at an increased risk for cardiovascular disease and diabetes. Women with abnormally low HDL and elevated triglyceride levels are also at an increased risk for hormonal disorders, including infertility and menstrual irregularities.            

Elevated Prolactin Levels

Some men have an early andropause secondary to an elevated blood level of a pituitary hormone called prolactin. Excess production of prolactin can be due to a prolactinoma (a benign tumor of the pituitary), certain medications, hypothyroidism, or emotional stress. The pituitary is a located at the base of the brain and is sometimes referred to as the master gland because of its role in regulating growth and metabolism. Some prescription medications that are known to elevate the concentration of prolactin in the bloodstream include drugs used for psychiatric disorders such as Stelazine and Haldol, and Reglan, a medication used to treat gastroesophageal reflux.   Increased prolactin levels are frequently seen in people with hypothyroidism, and men with elevated prolactin levels should be tested for this problem. Vigorous nipple stimulation may also cause an increase in prolactin. Some authorities think that magnetic resonance imaging of the head should be performed in all men with low testosterone levels that are not directly attributable to any known cause, even if the prolactin level is normal. Their rationale is that prolactin secretion from an existing tumor can be pulsatile or intermittent and may be missed by blood tests.

Cancer Therapy

Cancer treatment, including chemotherapy, radiation, and surgical removal of one or both testicles, is a potential cause of early andropause.

Additional Causes of Early Andropause

Profound weight loss, compulsive exercising, direct injury to the testicles, and debilitating illness including kidney failure, adrenal insufficiency, and acute psychiatric depression are also potential causes of early andropause. An infection of the testicles such as that caused by the mumps virus can also be responsible for this condition. Although it not generally recognized, hemochromatosis, a disorder of abnormal iron storage, may compromise testicular function.

The Diagnosis of Andropause

Why is andropause underdiagnosed?

The main endocrine glands include the pituitary gland, pancreas, ovaries, testes, thyroid gland, and adrenal glands.[iv] These hormone-producing glands secrete their products directly into the bloodstream. Although andropause is the most common disorder of the endocrine system,, many if not most physicians do not place this condition high on their list of diagnostic possibilities. Consequently, health professionals attribute known andropause-associated symptoms such as fatigue, changes in body composition, and sexual dysfunction to other causes. Hormone- deficient men are often told that their problems are due to depression, relationship issues, medication intolerance, or “just getting older.”

In addition, the decrease in testosterone levels that characterizes andropause occurs more gradually and is generally less complete than the decrease in sex-hormone levels that accompanies the menopausal process in women. Thus, the symptoms experienced by men are more subtle and typically less severe than those that accompany menopause. And, in contrast to menopause, there is no defining event such as cessation of menstruation or loss of fertility to announce that andropause, whether age-related or early, has transpired.

How is andropause diagnosed?

I never make the diagnoses of andropause using blood tests alone. It is important to carefully consider the patient’s history and symptoms as well as to perform a detailed physical examination for changes that may be attributable to hormone deficiency.

What are the physical findings, signs, and symptoms of andropause?  

The signs and symptoms that suggest andropause are fatigue, infertility, erectile dysfunction, small testes, diminished muscularity and strength, an increase in breast tissue and diminished pubic, axillary, and facial hair. The more severe and prolonged the hormone deprivation, the greater the potential for distressing symptoms and negative consequences. If the deficiency has been longstanding, there may be a loss of bone mineral density leading to an increased potential for fractures. Other potential manifestations include an increase in body fat, mild anemia, poor motivation, depressed mood, irritability, sleep disturbances, and difficulty with concentration and memory.[v]

Do hormone-deficient men suffer from hot flashes and sweats?

Yes, some men do, but this occurs with far less frequency than would be expected in menopausal women.

What level of testosterone is normal in men?

Most laboratories report the normal value for total testosterone somewhere in the range of about 240 to 950 nanograms per deciliter (ng/dl) and the normal range for free testosterone about 9 to 30 ng/ml.[vi] Total testosterone is a measure of the portion of testosterone that is bound to the proteins in the blood plus the portion that is unbound to blood protein. Free testosterone, the unbound portion, is thought to exert the most hormonal activity or influence on hormone-sensitive tissues. Accordingly, some authorities suggest that assays of free testosterone are the most accurate measure of hormonal activity.

Why not just rely on the blood test to make the diagnosis?

The blood levels associated with signs and symptoms of with low testosterone will vary from patient to patient. Further, there is no uniform testing method used to assess testosterone levels or agreement by clinicians defining the testosterone level beneath which a patient is considered to be hormone-deficient. Accordingly, the Institute of Medicine, a Washington, D.C.-based organization that serves as a health advisor to the nation, recommends that the symptoms of andropause and not just the testosterone level should be considered in the diagnosis.[vii] Nonetheless, many, if not most health professionals persist in using laboratory values as the sole criteria for the diagnosis of andropause.   And, unfortunately, if a physician rigidly adheres to this rationale, he or she is underdiagnosing and ultimately undertreating men who are suffering from the symptoms and signs of andropause.

The following story illustrates the problems that hormone-deficient men may encounter in attempting to resolve their problems with hormone deficiency:

Mike is a 65-year-old man who came to my office with symptoms of fatigue, a loss of libido, difficulty with erections, and a diminished urge to ejaculate. “I’m so tired that when I get home from work…I sit down in my chair and I don’t want to get up. I don’t even think about sex any more, and even if I use Viagra and actually get an erection it doesn’t last long or feel as good as it should. Half the time I don’t even ejaculate, and what’s worse, I don’t even care.” Mike had seen another physician and was told that his testosterone level was “normal” and that his problems did not have a hormonal basis. Mike asked his physician if he could try hormone therapy to see if it made him feel any better. His physician declined, telling him that he was not a candidate for testosterone replacement. I looked at the records Mike had brought with him. His total testosterone level was about 400 ng/dl, a value considered in the lower range of “normal” by most laboratories. Regardless, Mike’s symptoms were suggestive of being andropause-related. I told him that if he was interested, we would start him on a program of testosterone replacement, and that there was a very good chance it would resolve some of his problems. Three weeks after starting testosterone, Mike had considerably more energy and a mild increase in his libido. At 8 weeks after beginning treatment, Mike shared that his desire for sex was not like it was when he was 18, but it was “pretty good.” Although he was still using Viagra, he was not having any problems maintaining his erections and sex was more pleasurable. Mike was having intercourse about twice a week, and he had an increase in his desire and ability to ejaculate.

Mike’s story is unfortunately commonplace. He was experiencing symptoms suggestive of hormone deficiency, but he had laboratory evidence of testosterone levels that were low but still in the “normal” range. Consequently, he was told his problems were unrelated to a hormone problem and he was denied a trial of therapy.

The Treatment of Andropause

Andropause is treated by replacing testosterone — the hormone that’s missing. An ideal program of hormone replacement in men would follow the same principles as one for hormone replacement in menopausal women. The difference, of course, is that only testosterone is replaced and that men require a considerably higher dose than would be appropriate for women. Accordingly, the form of testosterone used should be indistinguishable from that produced by the testes and should be delivered into the bloodstream intact and in sufficient quantity to exert its intended effect. I will only mention testosterone- containing transdermal patches, gels, injections, and implantable pellets as appropriate treatment options. Other treatments are available, but they are used with lesser frequency.

Naturally-occurring testosterone is not effective when given as an oral tablet, since it is deactivated during its passage through the gastrointestinal tract. Accordingly, it is necessary to chemically alter the structure of testosterone if it is to be used for oral administration. The most well-known oral preparation is methyltestosterone. These formulations have the potential to cause liver toxicity,[viii] and since more ideal options are available, I don’t prescribe them.

Injections of testosterone are an effective and useful therapy, but they must be given at 2- to 4-week intervals. The testosterone level is relatively high in the first few days after the injection and tapers off over the next 2 to 4 weeks, at which time another injection is required.

Androderm is a patch containing testosterone that is applied to the skin once every 24 hours. Testosterone is available in a topical gel form under the brand names AndroGel, Testim and Fortesta. There is also a topical solution available marketed under the name Axiron. The topical formulations are applied once or twice daily to dry clean skin. Each product has its own specific instructions as to the area of the body where it is to be applied. Testosterone-containing pellets are available and can be surgically implanted into the subcutaneous tissue of the buttock. From there, testosterone is released gradually into the bloodstream. The day-to-day levels are relatively stable, but as would be expected, they decrease over time. After a period of 3 to 6 months, when the testosterone concentration decreases below an acceptable level, the procedure can be repeated.    

How effective is testosterone replacement?

If the problems treated are secondary to testosterone deficiency and the replacement regimen is appropriate, the treatment is very successful. Within a few weeks, there is an improvement in energy, motivation, mental processing, and sense of well-being. A return of libido, sexual response, and erectile function typically may take a bit longer, but should be well established by 8 to 12 weeks and should continue to improve over the next few months. Assuming a reasonable diet, a modicum of exercise, and the absence of a significant coexisting disease process, there is an increase in muscle mass, strength, and stamina. Andropause-related bone loss will stop, but unfortunately, if there has been a significant decrease in bone mineral content, a return to the bone density that existed before the patient’s hormone deficiency will not be possible.

Does testosterone replacement always help men with erectile problems?    

Often it does, especially when it is combined with Viagra and similar products such as Cialis and Levitra. This class of medications is known as phosphodiesterase type 5 (PDE5) inhibitors, and when these drugs are used in combination with testosterone, in many cases they are capable of restoring erectile function even when either testosterone or a PDE5 inhibitor used alone has been unsuccessful. In addition, the combination appears to improve orgasmic function.[ix] However, if the erectile dysfunction is related to medication, alcoholism, a psychiatric or neurologic disorder, diabetes, a vascular problem, or a debilitating disease, there may be limited or no improvement.

Risks and Side Effects of Testosterone Replacement

Testosterone-replacement therapy, when administered appropriately, is safe and is associated with few side effects. Among the purported risks of therapy, the most important concern for health professionals is the effect of treatment on the prostate and the red-cell concentration of the blood.

Prostate Cancer

For many physicians, the primary concern regarding the use of testosterone replacement in older men is the fear that testosterone replacement therapy will either cause prostate cancer or stimulate the growth of an undiagnosed preexisting cancer of the prostate. However, there is compelling evidence that testosterone replacement in healthy and high-risk men does not increase the risk of prostate cancer.[x], [xi], [xii] Regardless, pretreatment screening, especially in older men being considered for testosterone replacement, is prudent. The evaluation should include a digital rectal examination of the prostate and a blood test to measure the patient’s serum level of prostate-specific antigen (PSA). PSA is a protein produced by the cells of the prostate gland which is present in relatively small quantities in the serum of normal men and is often elevated in prostate cancer as well as some nonmalignant conditions. For example, the PSA level may be elevated if the prostate is enlarged or if the prostate is inflamed due to an infection. In addition, the PSA level may be elevated for a few days after ejaculation, bike riding, or a digital examination. Regardless, if either the digital rectal examination or the PSA level is abnormal, referral to a urologist to determine the cause for the elevation and to exclude the presence of prostate cancer would be in order before making a decision to begin therapy.

What if a man is suffering from hormone deficiency but has a history of prostate cancer?

Although it is not generally appreciated, a history of prostate cancer is not an absolute contraindication for testosterone-replacement therapy, and withholding therapy in hormone-deficient men who have been successfully treated for this form of cancer is not warranted.[xiii] In the few men who have been treated with testosterone-replacement therapy after a surgical removal of the prostate, there has been no evidence of recurrence.[xiv]

Benign Prostatic Hypertrophy (BPH)

BPH refers to the increase in the size of the prostate gland in middle-aged and elderly men. This condition is actually quite common, and about 50% of men have some evidence of an enlarged prostate by 50 years of age and about 75% by age 80. A prostate that becomes sufficiently large leads to symptoms such as urinary hesitancy, the need to urinate frequently, and — in extreme circumstances — urinary obstruction, or an inability to empty the bladder.[xv] Some physicians hesitate to prescribe testosterone to men with BPH because of a concern that the therapy will lead to a further increase in the size of the prostate and worsen symptoms. There have been some reports of a modest increase in the size of the prostate in some patients receiving testosterone therapy, but no increase in symptoms.[xvi] In my own patient population, this has not been a problem.

Increased Concentration of Red Cells in the Blood

In some men, testosterone replacement, especially when administered by injection, has the potential to increase the production of red cells. This is a welcome effect in patients with andropause-associated anemia. The percentage of the blood that consists of red cells is called the hematocrit. If this percentage increases beyond expected normal limits, the blood becomes thicker, or more viscous. The concern is that blood that is more viscous is more likely to coagulate, and patients with thicker blood may have a higher incidence of cardiovascular complications. For this reason, it is important to obtain a pretreatment measurement of the patient’s hematocrit and intermittently monitor the patient’s blood for this possibility. If the patient’s pretreatment hematocrit is found to be elevated, an evaluation to elicit the cause would be reasonable before starting therapy. As a practical matter, men who have an elevated hematocrit before therapy are often discovered to have a genetic disorder of iron absorption. This condition is easily managed, and the patient can use testosterone replacement after the hematocrit is normalized.

What if the hematocrit becomes too high while using testosterone?

If the hematocrit elevation can be attributed to treatment with testosterone, there are a number of effective options for restoring the concentration of red cells to a normal level. They include switching to another form of therapy, reducing the dose, or discontinuing therapy. Most of my patients in whom testosterone-related elevations in their red-cell volume develop are using injections as their form of therapy. Thus, simply switching an alternate method such as a testosterone transdermal gel often resolves the problem.

If testosterone injections are likely to cause an elevation in hematocrit, why not just use a testosterone gel to begin with?

From my perspective, a testosterone gel is the most ideal replacement regimen. However, these preparations are expensive, and if the patient does not have prescription coverage, the expense may be prohibitive. This is particularly an issue for hormone-deficient men who are retired, older than 65 years of age, and purchase their medications on an out-of-pocket basis. Many of my patients find that a good alternative is to obtain testosterone-gel formulations from selected compounding pharmacies, where they are available at a fraction of the cost.

Years ago, I discussed the issue of hematocrit elevations in some testosterone users with the late Dr. R. Don Gambrell, a pioneer in the treatment of sex-hormone disorders of both and women. He told me that he advised his male patients with testosterone-associated elevations of their hematocrit to donate blood to the Red Cross on a regular basis. He said that this lowered their concentration of red cells to an acceptable level and allowed them to continue their treatment. Apparently his local Red Cross was quite fond of him. I have suggested this approach to some patients, and it has been effective in keeping their hematocrit at reasonable levels. Nonetheless, if these options do not reduce the hematocrit, or if the cause of the elevated hematocrit is in question, referral to a hematologist, a specialist in blood disorders, is indicated.

Are their other side effects or risks?

Other purported side effects of nonoral testosterone replacement include sleep apnea, edema, breast enlargement, lowering of the sperm count, skin irritation, acne, oily skin, and liver toxicity.

Sleep Apnea

The association of testosterone therapy and sleep apnea is mentioned in the literature; however there is no convincing evidence of a causal relationship and I doubt one exists.

Edema

Edema, or swelling of the lower legs has been mentioned in the literature as a potential side effect, but I have seen this only rarely in my patients.

Increase in Breast Tissue

An increase in breast tissue, an unusual side effect associated with testosterone replacement, is troubling to men who are affected.   In the past, options for addressing this issue included discontinuing therapy, reducing the dose, radiation therapy, or surgery. Unfortunately, these options were either invasive or denied the patient the benefit of optimum therapy. However, these drastic measures are no longer necessary, since breast-tissue stimulation in susceptible persons can be prevented with the use of an oral medication called an aromatase inhibitor.

Decreased Sperm Count

Monthly injections of testosterone have been shown to reversibly lower the sperm count, but they cannot be relied on to prevent pregnancy. Once therapy has been discontinued, the sperm count will usually return to pretreatment levels.

Skin Irritation

Skin irritation can be troublesome for users of the testosterone patch Androderm, and the manufacturer recommends that the patch be placed on a different area of skin daily to help prevent this problem. Nonetheless, the skin reaction can be severe and persistent enough in about 5% of patients to require that they discontinue the patch. Skin irritation is less of a problem with the testosterone-gel preparations, and I have not seen it.

Acne and Oily Skin

 Acne and oily skin are generally limited to persons who have had this problem in the past. In persons who are receiving testosterone, these conditions are a result of restoring the skin to its pre-hormone-deficient state.

Liver Toxicity

 Toxic effects in the liver are limited to users of oral testosterone preparations, and I have not seen them with the use of nonoral products.

 Summary

 Andropause, also known as male hypogonadism, male-androgen deficiency, and male-hormone deficiency, is the most common disorder of the hormone-producing glands, the endocrine system. Although andropause is often associated with the aging process, it occurs with frequency in young men. Nonetheless, for the reasons discussed this condition is underdiagnosed and undertreated. Despite the effectiveness and safety of testosterone-replacement therapy, affected men who are unaware that they are hormone deficient suffer needlessly from the symptoms and the short-term and long-term health consequences of hormone deficiency.

A thorough discussion of andropause is beyond the scope of this website and as such this is a limited, simplistic, and incomplete treatment of a topic that is clearly complex. Nonetheless, it should be apparent to the reader that although the symptoms and timing of andropause and menopause may differ, the defining element in both conditions is a state of hormone deficiency. Although the precise nature and function of the specific organ systems affected is sex-specific, the process that affects them is the same. Without treatment, no individual of either sex with a hormone deficiency will be capable of attaining an optimal life experience in terms of health, lifestyle, sexuality, or relationships.

Dr. Jerry Nosanchuk is a practicing physician who has specialized in the care of menopausal women for over 30 years.  His office is located in Bingham Farms, Michigan.  Appointments with Dr. Nosanchuk can be made by calling: (248) 644-7200 and speaking to Caroline Monday through Friday from 10AM to 6PM

IMPORTANT: This website is for educational purposes only.  It is not intended to suggest a specific therapy for any individual and must not be construed to establish a physician patient relationship.

 

Testosterone As An Aid To Libido

Dr N, prescription

I read with interest your comments on the importance of testosterone in HRT therapy if one is experiencing low libido. I am 54 yrs old and had a complete hysterectomy at 48 due to a very large fibroid attached to my uterus. I started estrogen treatment right away and have felt fine physically but have experienced a big loss of desire and pleasure in the libido department. My ob-gyn suggested Estratest, online a combo of testosterone & estrogen but I did not find any significant improvement. You suggested a different delivery system for the testosterone. Could that make a difference in the effect for me? I currently am on .625 Premarin daily…I previously enjoyed a healthy sexual relationship with my husband so this is a real bummer for both of us…..Please advise…Thank you.

find Arial, Helvetica, sans-serif;”>Reply:

Hi,

There is no question in my mind that this is possible and likely. Estratest is affective for some women with this problem, but as discussed, others may require a different approach. You might discuss the possibility with your Dr of trying one of the male testosterone replacement patches and cutting it into quarters or smaller and monitoring blood levels to assure yourselves that the dose is appropriate for you. Other alternatives that could possibly be affective are injections of depotestosterone 50 mg every 4 weeks, or a testosterone gel from a compounding pharmacy. Ultimately, when all else fails, subcutaneous hormone implants of estradiol and testosterone rarely fail to restore a libido. If you choose this approach, you will need to find someone trained in this technique. Let me know what and how you do.

Dr N

HRT Patch Will Not Stay Put

Dr N:

I had a “total” hysterectomy in January. My ovaries and all were removed. My OBGYN put me on the Climara patch. (I tried Premarin, look but had hot flashes and mood swings) After a “dip” in my sex drive that I couldn’t stand, cialis I got him to give me a shot of testosterone. Boy, cialis did it ever help, and I am sure pleased with it’s results! The only problem I am having now is that the patch will not stay put for more than 3-4 days. It starts wrinkling and crawling, and gets real annoying. I know my “no-where-near perfect” body, with its folds and all, doesn’t make an ideal sticking place, especially on the weeks I wear it in front. Yet, I have just as much trouble keeping it in place when it is on my upper hip. Any suggestions?

Reply:

Hi,

Actually, you have a number of options. If you like the way things are going with the Climera and the testosterone shot, you can probably stay on this program, but remember that the injections only last about a month and usually need to be repeated approximately every 4 weeks. One way is to insist that you be given extra patches to replace the ones that fall off. If you can afford it or your insurance company is willing to pay for it, there is no reason that you can’t put on a new patch every day.

Another option is to use estrogen gel which can be made for you by a compounding pharmacy. This is basically the patch without the stickum and you just rub it on once a day. Alternatively, you can use hormone implants of estrogen and testosterone, which usually work great and then you wouldn’t have to do anything for the 4-6 months that they usually last.

If you read the Methods of HRT section of the web site, it will provide additional insight.

Dr N

Hysterectomy – Menopausal Symptoms With Ovaries Present

Dr N:

I’m sure this is a question you’ve heard before , treatment I had a hysterectomy done two years ago, generic everything was removed except one ovary. I had a prolapsed uterus and fibroid tumors. My doctor says that I am not in need of any hormone therapy because I still have the one ovary. I have sweats ( not intense, viagra but uncomfortable) depression, and can’t seem to achieve orgasms. When I told him this , he gave me Paxil. This is something I don’t want to take, and have not taken. I hope you can help in some way. ( I am 46 years old) thank you.

Reply:

Hi,

You’re right, this is a frequent question, and I need to write a section on this topic. It is addressed in one of the Ask Dr N questions and you should look at this as it will provide some insight. The Menopausal With Ovaries on the drop down list on the Ask Dr N Archives page of the web site. The bottom line is that your Dr just does not know any better, because he is wrong. There are a number of studies that show that ovaries fail after hysterectomy, especially if one is removed. You are entitled to HRT if you want it. If he cannot see the light, find another physician who is more knowledgeable.

You will find a summary, or abstract of a study about this, below this e-mail for you to look at.

Let me know what and how you do.

Dr N

Abstract
Ovarian failure phenomena after hysterectomy.

Authors:
Riedel HH , Lehmann-Willenbrock E , Semm K
There is no Department for this article
J Reprod Med 1986 Jul;31(7):597-600

Article Number: UI86307795

Abstract: Previous studies have shown that simple hysterectomy with both ovaries left intact may cause ovarian failure. Questionnaires on climacteric symptoms were mailed to 243 patients between 27 and 42 years old who had been hysterectomized during the past ten years in the Kiel University obstetrics and gynecology clinic. From the 164 replies we found typical signs of ovarian failure in 39%. Some of the patients were asked to undergo endocrinologic investigation, which showed biphasic cycles in most cases. However, the average progesterone and estrogen concentrations in the suspected luteal phases were lower than in healthy women in the same age group.