Hormone Replacement Therapy for Men

Male menopause is a condition where the body produces insufficient sex hormones including testosterone and is diagnosed with blood tests. The Mayo Clinic reports that a man’s testosterone levels decline on average about 1% per year after age 40, a condition often referred to as andropause. Many men have no symptoms or are unaware of the cause of their symptoms.

Diagnosis of male menopause is based on the presence of symptoms suggestive of testosterone deficiency – prominent among them are sexual symptoms like loss of libido, morning penile erection and erectile dysfunction, and demonstration of low testosterone levels.

Erectile dysfunction and decreased libido are common complaints affecting 1 in 5 older men. Studies report that testosterone therapy improves mild erectile dysfunction and libido in men with andropause.

Several factors contribute to testosterone deficiency, including:

• Aging: Natural aging is the most common cause of declining testosterone levels.
• Medical Conditions: Conditions like obesity, type 2 diabetes, metabolic syndrome, and chronic illnesses (e.g., kidney or liver disease) can contribute to Low T.
• Injury or Disease: Testicular injuries, infections, or conditions such as hypogonadism can impair testosterone production.
• Lifestyle Factors: Poor diet, lack of exercise, intense physical activity, stress, and inadequate sleep can exacerbate testosterone decline.
• Medications: Certain medications, such as opioids and steroids, may lower testosterone levels.
• Understanding the underlying cause of Low T is essential to determine the most appropriate course of action.

Symptoms include:

• fatigue
• low energy
• low motivation
• reduced muscle mass
• reduced bone density
• increased body fat
• decreased libido
• erectile dysfunction
• sweats
• mood changes
• difficulty concentrating
• low self-confidence
• insomnia
• infertility
• gynecomastia
• cognitive issues

Hormone replacement therapy involves the administration of hormones, specifically testosterone to restore hormonal balance in the body. It may be delivered through various methods, including oral tablets, patches, creams, gels, injections, or implantable pellets. The type of hormone and method of administration are determined based on the individual’s specific needs, symptoms, and health considerations.

High levels of physical stress from intense training can suppress reproductive hormone production. Intensive athletic training, particularly when it involves high volumes of endurance exercise or overtraining without adequate recovery, can lead to low resting testosterone levels in men. This phenomenon is often referred to as the “exercise-hypogonadal male condition” or exercise-induced low testosterone.

Chronic Physical Stress and Elevated Cortisol
Prolonged physical stress from excessive training increases the production of cortisol, a stress hormone. Elevated cortisol levels can inhibit the hypothalamic-pituitary-gonadal (HPG) axis, which regulates testosterone production.

Suppression of the HPG Axis
Overtraining or continuous endurance exercise can dysregulate the HPG axis, reducing the secretion of luteinizing hormone (LH) from the pituitary gland. LH is critical for stimulating testosterone production in the testes.
Inflammatory Response
Chronic inflammation resulting from high training loads may impair the endocrine system’s ability to produce and regulate hormones, including testosterone.

Sleep Disruption
Intense training schedules and high physical stress can interfere with sleep quality and duration. Testosterone production occurs primarily during deep sleep, so disrupted or insufficient sleep may further contribute to low levels.