NYC Bioidentical Hormone Replacement Therapy for Men
Dr. Bissoon does not advocate a “one-size-fit-all” approach to testosterone replacement therapy. There are multiple options which will be discussed during your consultation.
Prior to going into the treatment options, there are certain facts men need to know before deciding on a treatment program. Once you start a testosterone treatment program, regardless of the option, some of your testosterone will be converted to estrogen and some will be converted to Dihydrotestosterone (DHT). Estrogenic side effects include increasing belly fat, impotence and gynecomastia. Elevated DHT has been associated with hair loss, decrease libido, acne and liver cyst. We will discuss blocking the conversion to estrogen and DHT with medications and nutrition.
Andropause or male menopause is the male equivalent of female menopause. In andropause there is decreased production of testosterone or bioavailability of testosterone. The most common symptom associated with Andropause is a decrease in libido and loss of morning erections. In addition to decrease testosterone it is also possible to have concurrent increase of estrogen.
Do You Have Low Testosterone
The US Food and Drug Administration (FDA)estimates 4 to 5 million American men may suffer from low testosterone, but only 5% are currently treated. This translates into approximately 250,000 men being treated. This means that there is over 4,750,000 men who are untreated. If you are reading this you could be one of them.
When Does Andropause Start
Men commonly start to deposit fat around the abdomen in their late twenties and slowly progress. This is why the symptoms of Andropause starts of insidiously with progressive increase in symptoms. In the late thirties to early forties is when the symptoms start to become noticeable.
We offer the following procedures and treatments:
The use of creams and gels are very common, requiring daily application once or twice a day. There are FDA approved topical testosterone and testosterone patches. We can also have testosterone cream and gels compounded to a specific dose for a particular patient. The upside to using a topical testosterone there is no injection. However, there are a few important concerns when it comes to topical testosterone.
Topical testosterone sounds quick and easy, but there are some important concerns which we have to take into account prior to prescribing. Topical testosterone can be transferred through the clothes for up to 12 hours after application. What does this means for patients? We do not recommend topical to men with small children because they can transfer it to the kids. Once testosterone is transferred to the kids they will start developing masculinization symptoms.
Not only does testosterone transfer occur up to 12 hours after application, if you are not careful with your hygiene after application will also inadvertently transfer testosterone to others. For instance, lets say you apply your testosterone gel a with your right hand and then you use that hand to open the faucet, you will leave some residual testosterone on the tap and some who comes along and opens that faucet later will inadvertently absorb testosterone.
Men who are married or involved in a relationship should really consider not using topical testosterone because it can be transferred during intimacy.
On another note, testosterone applied on the skin is quickly converted to DHT because most of the enzymes which convert testosterone to DHT is located in the skin. While on testosterone therapy the DHT levels will monitored on a regular basis.
Interestingly many men who seek testosterone replacement therapy prefer injectable therapy For those who are interested in doing self injections, Our office will schedule a training session with Dr. Bissoon in order to teach you how to perform self injections safely. This session takes about 10-15 minutes. Treatment by injection is often a better option; a shot of testosterone is usually performed 1-2 times a week based on the dose. Dr. Bissoon does prefer twice a week dosing with smaller doses to avoid extremely high and low levels. The down side is the hassle of self injection and the pain associated with the shot. In addition to the pain associated with the injection there may be some pain from the actual testosterone –which is rare.
Injectable testosterone is in an oil base and can produce some muscle soreness after injections. The oil base allows for the testosterone to be time released for 7-10 days. With testosterone injections, the injection sites can be rotated between injections. There is also the potential to develop a skin infection at the injections site-which is why we do an injection training session. This is extremely rare if you follow the injection technique as taught.
Many men prefer this option and it is the most popular option. This is a good option for men who are married or are involved in a relationship, men with small kids and single guys.
Long Term Testosterone Pellets
Recently, the FDA approved implantable testosterone pellets for men which can last about 5-6 months. This is a major breakthrough since the pellets need to be implanted 2-3 times a year beneath the skin in the upper part of the buttocks. Obviously, this option of testosterone replacement is new to the market but appears to be a better choice for longer lasting therapeutic results. It also eliminates the need for daily creams, gels, troches and weekly injections.
This is a good option for men who do no want to deal with the hassles of daily injection, but are not candidates for the topical application. Men who travel frequently for business may want to choose this option, as going through airport security with injectable testosterone, syringes and needles or topical testosterone may be a problem with international travelers. It is also good for men with small children, those do not want to use creams and certainly don’t want to do injections and for men involved in relationships.
The downside to implantable pellets is that if requires a minor in office surgical procedure which takes about 15-20 minutes from start to completion. As with any surgical procedure, there is a risk of infection and localized black and blue marks which can take about 5-7days to resolve. After the procedure, you can go about your daily activities as usual.
Most insurance companies prescription plans will pay for the pellets, you will still be responsible for the copayment and the cost of the procedure. Of the available options this is the most expensive.