for drs by neil burman

THE NEED FOR TESTOSTERONE AS PART OF BIOIDENTICAL HRT BHT FOR MEN & WOMEN

Why is testosterone  TT necessary?

Because we evolved on it for millennia,

And  it is the most important anabolic and antiarrhythmogenic agent  we   have.

We now live twice as long as we did a century ago-

Thus potentially while we fatten with increasing cortisone & estrone,

We now live half our lives without the necessary good  TT level of serum/tissue  sT.

Philip Rabinowitz 1904-2008- world centenarian sprint champ- died peacefully planning his next run!

We depend on anabolics (testosterone, vitamin D3) for maintenance repair, strength- muscle, antiarrhythmia,   drive and  immunomodulation – far more than just for reproduction..

But with increasing stress & longevity & pollution,

Catabolic fatteners increasingly dominate – cortisol & other estrogenics,

While

Levels of the anabolics – including dozens of  our  insulin sensitizers – fall-

    Androgens (TT, DHEA) , Vit D, exercise, CoQ10, carnitine, cysteine, arginine, ribose etc.

Body fat & OHRT promote estrogens.

    Estrogens protect bone (antiresorptive)  but build fat & weaken collagen, muscle (except uterus)-

    And even the androgenic progestins (NETA, LNG) only partly mitigate this, lessen incontinence. .

OUR CRITICS  (of BHRT) ARE PARTLY RIGHT about appropriate OHRT:

-          in the WHI  and the Oulu Finland  trials up to 9 years, both Premarin alone, and oral E2+NETA

in early post menopausal women reduced all common disease and mortality by 1/3.

But this does not excuse oral HRT use at all, since BRCA  risk accumulated

       with total dose  OHRT after 10- 15 years (B Henderson ea 1980). .

The KEEPs RCT under way across USA is testing lower premarin 0.45mg/d vs E2 patch, with progesterone – so far so good in this and the TEAM trial (testost in aging males).

Major observational  studies like the Nurses Study; Scandanavian studies; WHI; the Cache County Study;; & the experience of major academic clinics like Byrd & Byrch for 30years, showed only good outcomes from appropriate oral HRT, even with OEPT- oral estrogen & progestin therapy.

BUT ALL OF ENDOCRINOLOGY uses ONLY appropriate BHRT by the best route-

Cortisone,   diotroxin,   DHEA,    melatonin             orally;

But parenteral Insulin; HGH; CGH; ADH; EPO; calcitonin; glucagons; PTH; & testosterone  .

MEN get most HRT parenterally including testosterone.

So why are WOMEN forced by marketeering to take oral xenohormones – Estinylprovera & then  premarin -  from puberty? Oral HT is fattening and arrhythmogenic.

So ost menopausal women have worse CVD outcomes & arrhythmias than men. .

In 1953 Masters & Grody showed that ~73yr old women flourish for 13 months on BHRT -T+ERT.

But in 1957 Masters suddenly announced that women should get HT pills- “for their convenience”

-          Premarin,  then Estinyl – the OC Pill from the ‘60s.. Robert Wilson’s Forever Feminine…

1970s- increasing thromboses, strokes, cancer uterus  - so Progestin was added,

     despite the Seaman’s warnings 1976..

1980  Henderson- increasing BRCA after 10-15yrs of OHT..

ANDROGEN TRT  FOR MEN IS EASY:

  Alcohol, fattening, stress, illness, statins, serotoninergics & all diseases  & trauma suppress androgens.

All that is needed as indication for  TRT

  is either PADAM syndrome

Or

    Any chronic disease with demonstrated (relative if not absolute) androgen deficiency

  Eg a   sT of even 20nmol/L may be low relative to the fixed point for that man of eg  30nm,

          May justify a trial of TRT for 3 mo since we cannot measure antiandrogens or androgen resistance.

Like sperm counts & fertility, sT levels have fallen by about 1/3 the past 40yrs (USAF Veterans; Baltic; RSA studies)- from eg 32 to 22nmol/L.    In  RSA our mean TT is only 13-16nmol/L.

Provided prostate screen, zinc & prolactin are  normal,

TRT aim is to raise sT to ~16-18nm (elderly) to ~30 (young men) with CREAM

    Adjusted  daily  per response ; 

    (or Androxone -too labile levels;   implants, patches (highs-lows) ,

          Or Nebido inj  q 13wks (R100/wk) or Depotrone sc fortnightly (R10/wk)..

Watch Hb; PSA; prostate; lipids; ALP; creatinine; ‘roid rage;  sT; SHBG & E2 levels.

Nieschlag-Behre- Zietzmann- Jockelson   in Germany, Moller-Tvedegaard in Denmark, Carruthers in London, Kaufman in LA  - report major reduction in all disease –including  depression, dementia Parkinsons,  & mortality

     with TRT for up to 30 ys.

ANDROGENS FOR WOMEN:

   Confounded by myths vs facts:

MYTH: Women don’t need testosterone, libido, sex… its  true, they are then  safer for men!

MYTH: PCOS is due to, caused by high androgens;

MYTH: HRT is unsafe (per the drug industry), not needed with available phyto, prozacs, statins, Fosamaxes,   SERMS, glitazones etc…

Yet not one oral modern  chronic drug has ever been shown to reduce all-cause morbidity & mortality like appropriate HRT does -  without any serious adverse reactions that modern drugs cause

Eg Fosamaxes- osteonecrosis;

Statins- myo-renal-hepatic-lung-depression problems;

Prozacs – suicide, little better than placebo;

Liver failure (black cohosh, kava);

Glitazones, sulphonylureas – heart/ bone/ brain failure.

SERMS-  stress incontinence.

NSAIDs – heart attack; sudden death; peptic ulcers.

As the International Menopause Society  website and Proceedings detail,

Estradiol alone has major benefit on menopause symptoms, hearing, vision, insulin resistance, memory,  arterial disease, spine and certain cancers;

but does little to reduce hip fractures, and worsens fattening  and muscle-heart wasting – collagen loss, incontinence.

Progestins increase osteoporosis & breast cancer.

But Progesterone itself also worsens hearing  and bone loss.

But 50yrs of experience with testosterone replacement in major clinics-Gelfand & Sherwin (Montreal), Greenblatt Gambrell & Karpas (Augusta/Atlanta) , Buster (Houston),  Notelovitz (Florida), Vliet (Arizona), Shippen (Philadelphia), Schleyer-Saunders Whitehead & Studd London, Hansen (Denmark),    Bondi & Dimitrikakis, Burger & Davis (Australia), our group in Cape Town (Prof Dennis Davis et al),

and primate studies by Thomas Clarkson at Wake, and Dimitrikakis & Zhou (Australia)  -

  show that adding testosterone  to appropriate ERT  for treatment of FADS dramatically improve depression,    diabetes, vascular disease, breast-endometrial proliferation, body fat

     while increasing muscle mass &  strength.

TRT for women is easy:

For Premenopausal libido loss- testost alone to balance excess E2;

For peri menopause – progesterone +- testosterone;

Postmenopause – testosterone + less estradiol (20:1)-

Either as  cream (eg T 1% +  E2 0.05% +  progesterone 0.75%; or for the very old, 1/10^th strength);

 (Or as Mixogen/ Primodian Depot (T:E2  20:1) eg 0.2ml sc fortnightly – R40pm;

 Or  implants, patches; or oral micronized TT;

 Or  oral Androxone 40mg 3x/week).

The recent paper from Bo von Schoultz’ unit at the Karolinska confirms the first HRT   RCT of 50 years ago that TRT suppresses breasts and endometrium:  Masters & Grody followed Allbright & Papanicolau’s work around WW2 in showing that combined injection TT 40mg +E2 2mg/week for 13 months in women in their mid-seventies rejuvenated them and wiped out the endometrium after a tiny vaginal bleed at about 5 weeks.

          We  use  about ¼ the dose of Mixogen sc  that Masters used, and also find the endometrium disappears; so we no longer use progesterone for this purpose, unless the woman can afford it for the many other demonstrated benefits

    - although no-one has yet shown that adding progesterone to T+E gives any added benefit over T+E alone.  We continue to monitor the breast and endometrium.

          The landmark Supermouse RCT at McMaster University (Jenny Lemon & David Rollo 2003-5) showed that giving these short- lived metabolic -syndrome  mice  lifelong supplement of all know micronutrients  (vits, minerals & biologicals including flaxseed and DHEA)  speeded learning and increased lifespan and healthspan by 28%.

             We know that we humans  are doing better  than mice,

                   with fishoil rather  than flaxoil,

                   and with testosterone +- estradiol rather  than with DHEA.