Manopause (Testosterone Deficiency)

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Testosterone is practically synonymous with manhood. Unfortunately, testosterone levels in men often decline by the time they’re in their midforties, causing andropause (or “male menopause”) and producing symptoms such as:

• Loss of libido
• Erectile dysfunction
• A combination of high blood pressure, prediabetes or even overt diabetes, and elevated cholesterol (metabolic syndrome)
• A large waist size
• Fatigue, low motivation, poor concentration and memory, or depression
• Achiness
• CFS/FMS

If the testosterone level is in the lower 30% of the normal range (under about 540 ng/dL), and the person has one or two of the symptoms above, I consider treatment. I’m especially likely to recommend testosterone if deficiencies are contributing to health problems such as high blood pressure, high cholesterol, or diabetes (a very common combination called metabolic syndrome).

Treating Low Testosterone in Men

If your testosterone level is low, I recommend talking to a holistic doctor. These practitioners specialize in giving men and women over forty-five years of age regular “tune-ups” to keep their health and vitality optimized. These are much different than the checkups people get at their family doctor, which primarily look for signs of disease.

For men under 50 years of age, it is often preferable to stimulate your body’s own production of testosterone, using a medication called clomiphene (25 milligrams by mouth) at bedtime each Monday, Wednesday, and Friday. If needed, the dose can be increased to 25 or even 50 milligrams nightly. Simply recheck the testosterone levels after at least a week on the treatment to see if it is working.

If clomiphene doesn’t work, one can use HCG (human chorionic gonadotropin) hormone. Unfortunately, HCG is expensive and requires injections, so I rarely use it.

For those over 50, I am more likely to recommend a topical bioidentical testosterone cream or gel, applying 25 to 100 milligrams to the skin daily. You can get the testosterone cream by prescription (e.g., Androgel) from a regular pharmacy. It is obscenely expensive but is often covered by prescription insurance.

The good news: You can also get prescription testosterone cream from almost any compounding pharmacy. A compounded version of the drug is much less expensive and quite effective. This is an excellent option for those without prescription insurance that covers testosterone. For reproductive hormones, I recommend Women’s International Pharmacy.

Caution: Wash your hands after applying the gel or cream to your skin and apply it to a part of the skin that doesn’t come in contact with other people. Otherwise, women—such as your spouse—can develop a high, unsafe blood level of testosterone. This increases the risk of her getting diabetes.

It’s best to apply the testosterone on your thighs or other areas that people don’t often touch, so the cream does not get on anyone else. Rotate the area you put the cream on, or less may be absorbed over time.

Most men feel best with a blood level around the 70th percentile of normal range, and that’s what I aim for in my patients. Especially if it can be achieved with a dose no higher than 50 to 100 milligrams a day. Follow-up blood testing is best drawn two to three hours after applying the testosterone. Otherwise, the blood levels can be falsely low.

I generally do not recommend testosterone injections or oral testosterone.

The best way to get testosterone? Once the man is clear that they feel better on the testosterone, I recommend getting testosterone pellets. These are inserted every three to six months in a very simple in-office procedure. The main downside is the cost, if they are not covered by insurance. But they have the benefits of:

• Guaranteed absorption (sometimes the skin stops absorbing the cream after a year or so)
• Decreased conversion to other hormones that we don’t want
• Convenience
• Steady blood levels
• Not getting the cream on other people

To find practitioners near you who insert them, visit a website named Biome.

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