Male menopause is referred to as Andropause. As men age their testosterone and DHEA levels fall. The most common symptoms of Andropause are fatigue, loss of libido, erectile dysfunction, abdominal weight gain, and loss of motivation or zest for life. Other common symptoms are mood changes, sleep problems, and reduced muscle mass. Dr. Bruice has been treating Andropause with bioidentical testosterone and DHEA since 1998.
Mens’ testosterone and DHEA levels can begin to fall at the age of 35 years. There are a few ways to maintain testosterone levels: Men can get testosterone by way of patches, pills, or injections. The most common way to replenish DHEA is by oral DHEA capsule. Oral hormones have a “first pass liver” effect, which can be damaging to the liver. In addition, oral hormones cause the liver to make steroid hormone binding globulin (SHBG) which inactivates free testosterone. Testosterone injections can cause a rise in estradiol because the body cannot effectively store an excess of testosterone. This is why Dr. Bruice prefers to prescribe testosterone in transdermal cream. It is applied daily and it is easily absorbed through the skin. Dr. Bruice also prescribes DHEA in sublingual tablets to avoid the “first pass liver” effect.
Prior to prescribing testosterone it is important to check both free and total testosterone levels. This is done by blood draw, preferably in the morning. It is important to also check estradiol levels. Estradiol is a “female” hormone that can be converted from testosterone by the enzyme aromatase. As men age, they experience an increase in aromatase activity, thus their estradiol levels rise. This is why older men have an greater risk of prostate cancer. Testosterone is not bad for the prostate, but the metabolites of testosterone (estradiol and dihyrotestosterone (DHT)) can be harmful to the prostate. This is why Dr. Bruice always includes the aromatase inhibitor, Chrysin, in the cream with the testosterone: to help lower estradiol and DHT levels.
It is also important to check PSA (prostate specific antigen) prior to prescribing testosterone. PSA is a screening test for prostate cancer. Dr. Bruice also tests and manages his male patients’ thyroid. Symptoms of hypothyroidism are weight gain, fatigue, constipation, and intolerance to cold. Thyroid hormones control metabolism and these hormone levels decrease with age.
Bioidentical testosterone must not be confused with synthetic derivatives or “anabolic steroids” which have caused heart disease and cancer. Bioidentical testosterone can help protect against cardiovascular disease by lowering blood pressure, triglycerides, total cholesterol, and LDL cholesterol.
Dr Bruice’s goals are to improve his patients’ quality of life in a safe manner. Reversing Andropause can improve energy, libido, erections, moods, motivation, sleep, weight, muscle mass, and bone mass.
Dr. Bruice sees patients in Denver and Aspen. At the initial appointment he will review your medical history, symptoms, and questions. He will then draw blood to determine your baseline hormone levels. After interpreting your hormone levels, he will prescribe a combination of bioidentical hormones that is specifically formulated for you based on your hormone levels and symptoms. The hormones are produced at a compounding pharmacy. Patients usually yield positive results within four weeks. He will then want to see you for a follow-up visit six to ten weeks after your initial visit to ensure that your hormones are properly balanced. After the follow-up, he will check your levels annually. Between appointments he is available by email free-of-charge should you have any questions or minor symptoms that require attention. He will often make micro-adjustments to your hormone prescription between visits if he deems appropriate.
Contact Kenton Bruice, M.D. with your questions about bioidentical hormone therapy.