Testosterone

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You see the photos of the young men in this magazine and wonder why you do not look like that. We have heard much about testosterone and anabolic steroids.

Testosterone is an anabolic (muscle builder) steroid; another is nandrolone (Deca-Durabolin). These and other medicines are controlled by law and are illegally sold to body builders to enhance their muscle mass and decrase their body fat. They typically look quite buff with very little body fat, causing pronounced definition of their muscles. Some of the models in this magazine may be using anabolic steroids.

Testosterone and the female hormones belong to the sex steroid class. There is another class of steroids, the anti-inflammatory steroids such as prednisone, dexamethosone, and methyl prednisolone. We give these for asthma and other inflammatory problems.

Testosterone is produced by cells in the testicles. Other cells there make sperm. A vasectomy stops sperm from going up the tube, but the testosterone is secreted into the blood, so it is not affected.

Testosterone helps change the fetus to a male and keeps it on track to become an adult male by influencing muscles, fat, bone growth, larynx growth, hair, genital growth and pigmentation, mood, behavior, strength, endurance, and body shape during puberty.

The testosterone level can be measured in the blood and it has a range of about 300 to 800. Some researchers feel that your testosterone level should be measured according to your age. The closer to puberty the higher; the closer to elderly, the lower. So having a level of 350 would be thought of as low in a person 40 years old, but not 80 years old.

Some Endocrinologists (hormone specialists) recommend morning testosterone levels only and measuring them a few times. That is difficult to do in a clinic where the patients have a hard time paying for transportation and must be at work every day to make money.

HIV patients have a higher incidence (20-50%) of low testosterone (hypogonadism) and these should receive supplementation. If I see a patient who is fatigued, depressed, not showing the average amount of muscle, has osteoporosis (weak bones), or having trouble with sexual desire or function, then I will check a testosterone level. A low level coupled with symptoms will result in a prescription for testosterone.

We use Marinol, medical marijuana, and megestrol to help with appetite in HIV, but these can lower the testosterone level. Chronic narcotic use for pain can also cause low testosterone levels.

In addition to HIV, men who are obese, have diabetes, or have high blood pressure are at risk for having low testosterone. Many of these men may attribute the symptoms of low testosterone to their other diseases, medications, or just getting old. They feel better when they receive supplementation. Some physicians feel it is too risky to give testosterone to elderly men. On the other hand, giving it may reduce their risk of a heart attack. One study estimates that 19% of men over 60 years of age have low testosterone levels.

Some men have a testosterone deficiency from birth. There is no evidence that testosterone levels vary from race to race.

The medication, if taken orally, is broken down by the liver so it must be given parenterally (outside of the gut), i.e. as an injection or on the skin. The injection is much lower priced than the patch or gel. The patch and gel are given daily and are better at mimicking the normal testosterone secretion pattern whereas the injection is an oil with testosterone mixed in and the drug leaks out of the oil over time.

Usually we give the injection every two weeks but if someone is finding great results the first few days and feels poor the last few days of the two week cycle, then we make the cycle every week at half the dose. Sometimes the insurance will pay for the gel or patch if the patient cannot inject himself and there is no one around to do it consistently and they cannot make it to the clinic frequently.

Hopefully the patient will experience improvement in the symptoms. If an HIV patient already has lipoatrophy (loss of fat in the face, arms, or legs) then this might get worse with testosterone therapy. The patient must weigh the risks and benefits of therapy.

If the symptoms are not better in a couple of months or they start looking like the Hulk, then I’ll recheck a level to make sure I am giving the proper dose. High levels have been associated with moodiness and increased aggression. Many need it for life; it is not a dependency like with narcotics, it is a deficiency that needs supplementation.

Testosterone doesn’t cause but can promote prostate cancer, so a check for this cancer periodically is a good idea.

When you get your sexual function back from testosterone or Viagra-like pills, don’t forget to put on a condom.

Body Builders take note: taking androgens, when not needed, can cause shrunken testicles, changes in the blood fats to make a heart attack or stroke more likely, kidney failure, infertility, breast development, accelerated baldness, blood clots in the legs and lungs, acne, enlarged forehead, separated teeth, ruptured tendons, mania, psychosis, hallucinations, delusions, roid rage, and liver cancer.

Some of this article uses MedScape and WebMd as a reference.
Please send your medical questions to Adelante.
Daniel Pearce, D.O., FACOI, AAHIVS
Associate Clinical Professor of Internal Medicine, Loma Linda University
HIV Specialist, Riverside County Public Health Department

By: Dr. Pearce

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