DMV Bio-Identical Hormone Treatment

Hormones are chemical messengers produced in our bodies that are transported in tissue fluids such as blood to stimulate specific actions by cells or tissues.

In the case of Men, one of the most important hormones is Testosterone which is an anabolic hormone responsible for the development of male reproductive tissue such as testes and prostate as well as secondary sexual characteristics in men such as increased muscle and bone mass.

As men age, testosterone levels start declining. The average age at which testosterone starts declining is around age 30. As the levels decline in men symptoms of testosterone deficiency otherwise called Andropause.

In men when the testosterone level reaches critically low levels men start developing symptoms:?

Some of the common symptoms are 

  1. Fatigue
  2. Depression 
  3. Irritability (grumpy old man syndrome)
  4. Reduced libido and erectile function
  5. Decreased sexual desire and decreased fantasies
  6. Decreased morning erections
  7. Decreased firmness of erection
  8. Long recovery time between orgasms
  9. Loss of drive and competitive edge
  10. Stiffness and pain in muscled & joints
  11. Decreased effectiveness of exercise workouts

How to Diagnose Andropause?

Lab tests :

  • Total Testosterone/Free Testosterone/SHBG
  • LH, FSH levels 

Symptoms of low testosterone coupled with Low T levels usually is enough to make the diagnosis.

Potential Side Effects of TRT Treatment:

  –   Infertility

  • Increased red blood count
  • Testicular shrinkage
  • Worsening of sleep apnea
  • Cardiac events ( very controversial, multiple studies that show TRT actually is cardio-protective
  • Prostate cancer ( most studies show art does not cause prostate cancer but can potentially aggravate a prior undiagnosed prostate cancer 
  • Conversion of Testosterone into Estradiol(female hormone) causes the development of certain female characteristics such as gynecomastia9enlarged male breasts)

Potential Benefits of Testosterone Therapy:

  • Improved libido
  • Improved sexual performance
  • Improved sexual function
  • Reduced body fat
  • Reduced risk of cardiovascular disease
  • Improved bone density
  • Improved memory
  • Improved strength
  • Improved ability to add lean muscle mass
  • Improved mood
  • Increased energy

Treatment consists of addressing the underlying cause of low T

Causes of Low T or Hypogonadism:

Hypogonadism is a condition in which enough testosterone is not produced for it to exert its hormonal functions 

There are different types of Hypogonadism:

Primary Hypogonadism: in which the testicles do not produce enough testosterone  

Secondary Hypogonadism: in which the low testosterone levels are due to a problem in the brain mainly either the hypothalamus or pituitary gland.  

Common causes of primary hypogonadism include:

  • Klinefelter syndrome. This condition results from a congenital abnormality of the sex chromosomes, X and Y. 
  • Undescended testicles
  • Mumps orchitis. I
  • Hemochromatosis. Too much iron in the blood can cause testicular failure or pituitary gland dysfunction, affecting testosterone production.
  • Injury to the testicles. 
  • Cancer treatment. 

Secondary hypogonadism

In secondary hypogonadism, the testicles are normal but function improperly due to a problem with the pituitary or hypothalamus. A number of conditions can cause secondary hypogonadism, including:

  • Kallmann syndrome. Abnormal development of the hypothalamus — the area of the brain that controls the secretion of pituitary hormones — can cause hypogonadism. 
  • Pituitary disorders. An abnormality in the pituitary gland can impair the release of hormones from the pituitary gland to the testicles, affecting normal testosterone production
  • Inflammatory disease. Can affect testosterone production.
  • HIV/AIDS. HIV/AIDS can cause low levels of testosterone by affecting the hypothalamus, the pituitary and the testes.
  • Medications. The use of certain drugs, such as opiate pain medications and some hormones, can affect testosterone production.
  • Obesity. Being significantly overweight at any age may be linked to hypogonadism.
  • Normal aging. Older men generally have lower testosterone levels than younger men do. As men age, there’s a slow and continuous decrease in testosterone production.
  • Concurrent illness. The reproductive system can temporarily shut down due to the physical stress of an illness or surgery, as well as during significant emotional stress. 

Treating Hypogonadism:

Natural ways to increase Testosterone:

  • Zinc
  • Chrysin
  • Carnitine
  • Muira puama
  • Cruciferous vegetables
  • Quercitin (aromatase inhibitor)
  • Saw Palmetto 
  • Nettle extracts (increases free testosterone by binding SHBG Antioxidants)

Types of testosterone replacement therapy

Several testosterone delivery methods exist. Methods include:

  • Injection. Testosterone injections (testosterone cypionate, testosterone enanthate) are safe and effective. Injections are given in a muscle.
  • Patch. A patch containing testosterone (Androderm) is applied each night to your back, abdomen, upper arm, or thigh. The site of the application is rotated to maintain seven-day intervals between applications to the same site, to lessen skin reactions.
  • Gel. There are several gel preparations available with different ways of applying them. AndroGel, Testim, Vogelxo), apply with an applicator under each armpit (Axiron) or pump on your front and inner thigh (Fortesta).
  • Gum and cheek (buccal cavity). 
  • Nasal. Testosterone can be pumped into the nostrils as a gel. 
  • Implantable pellets. Testosterone-containing pellets (Testopel) are surgically implanted under the skin every three to six months.

For more information please call our office at (703) 992-9815 or email us at