MANopause

Bioidentical Hormone Replacement Therapy (BHRT) isn’t just for Women

When I turned 40 the wheels fell off. Seemingly overnight I started sleeping badly. I gained weight I couldn’t lose. No matter how much I worked out I couldn’t put on muscle. I was sore and achy after each workout. I was moody, irritable and snappy which is not like me. In short my hard parts were getting soft and my soft parts were getting hard. 

Despite 9 years of specialized medical training I was dumbfounded. Confiding in my male friends we remained clueless which was no surprise to the women in our lives who simply smirked knowingly at us. “MANopause” they told us. As the product of elite, solidly misogynistic and puritanical medical training I indignantly declared “Hormones?! Nonsense! Hormones are bad, we all know that”

Right? Aren’t they? Don’t they cause cancer, heart attacks and strokes? The more I said it and thought about it something didn’t seem right. We all have hormones working for us from the moment we are conceived. There are hormone receptors in every tissue of the human body. They control our growth, development, sexuality, metabolism, mood and so much more.  Our physiology and psychology depend on routines and rhythms to maintain our inner balance and sense of wellbeing. Hormones are the primary instruments running this system. 

But classical medical training was that after a certain age hormones are bad for you. Fortunately, the old medical school saying that “half of what you learn here today will turn out to be wrong” was in fact correct. 

The reality is that from an evolutionary standpoint we were not supposed to outlive our hormones. In men testosterone levels start to decline in our 30s and 40s. Low T affects 38.7% of men over 45.  Well, Mother Nature didn’t plan on most men living much beyond that and in fact for many thousands of years we didn’t. But today, thanks to the amazing work of that same flawed medical field we are living way beyond the natural decline of our hormones.

So then why would these substances which were so essential to maintaining a healthy, normal physiology and psychology now suddenly be dangerous? Remember, without hormones we would all be dead. Straight up dead. It doesn’t make sense. 

The concept of hormone replacement therapy has been around for a very long time. The problem was that much of that therapy was done using synthetic hormones. Hormones that were chemically and structurally different from those produced by our own bodies. Premarin, the primary form of oral estrogen replacement therapy, comes from pregnant horse mare urine. Hence the name Pre(gnant) Mar(e) (ur)ine. And yeah, it caused problems. Testosterone got a bad rap from stories of body builders injecting themselves with huge amounts of synthetic testosterone they bought off the internet and having heart attacks and strokes. Not a huge shock. I think the kids have a saying for that these days, F’around and find out.

The safety of Bioidentical Hormone Replacement Therapy (BHRT), the concept of using hormones identical to those produced by the human body, was shown as early as the mid-1970s. Use what the body naturally produces and there are less risks. Less risk of breast cancer, prostate cancer and cardiovascular risk.  

The benefits of bioidentical testosterone have been well documented. Maintaining a normal testosterone level actually lowers cholesterol, increases vasodilation, decreases inflammation, increases muscle bulk and tone, mood, increases libido & sexual function, energy, increases the body’s sensitivity to insulin, increases bone density and directly affects the lining of our blood vessels (endothelium) preventing atherosclerosis. 

Are there risks? Of course, this is a medical intervention and as such you need and want to have the right team managing your care. Responsible BHRT requires monitoring of your blood tests and open communication with your care team. At One Point Six we pride ourselves on making sure we take the time to both listen to our patients and provide them with as much information as possible to make an informed decision. BHRT is not a one time thing, it is an ongoing relationship. Our bodies didn’t get out of balance overnight and we won’t get them in balance overnight. It takes time and working together to find the solution and dosing that is right for each individual who comes to our practice. 

Where to start? Come get your blood drawn at the office and schedule an appointment with myself or Veronica, our experienced nurse practitioner and we can see where you are at. Feeling and living better is an option for all of us. Let’s get there together!

In Health and Wellness,

Dr. Matthew Tripp, MD

Small Sample of Relevant Clinical Studies:

As the Chairman of my residency training would say: “In God we trust. Everyone else bring evidence”

All Cause Mortality Associated with Low T: 

Key Finding: Men with highest T levels had a 30% lower mortality from all causes compared to men with Low T. 

Khaw KT, Dowsett M, Folkerd E, Bingham S, Wareham N, Luben R, Welch A, Day N. Endogenous testosterone and mortality due to all causes, cardiovascular disease, and cancer in men: European prospective investigation into cancer in Norfolk (EPIC-Norfolk) Prospective Population Study. Circulation. 2007 Dec 4;116(23):2694-701. doi: 10.1161/CIRCULATIONAHA.107.719005. Epub 2007 Nov 26. PMID: 18040028.

Prevalence of Low T in men over 45 is 38.7%

Mulligan T, Frick MF, Zuraw QC, Stemhagen A, McWhirter C. Prevalence of hypogonadism in males aged at least 45 years: the HIM study. Int J Clin Pract. 2006 Jul;60(7):762-9. doi: 10.1111/j.1742-1241.2006.00992.x. PMID: 16846397; PMCID: PMC1569444.

Testosterone & Prostate Cancer: A 2007 extensive study out of Harvard failed to establish a connection between high serum T and prostate Cancer. Men with low T in face have an increased percentage of prostate cancer positive biopsies.

Morgentaler A. Testosterone replacement therapy and prostate cancer. Urol Clin North Am. 2007 Nov;34(4):555-63, vii. doi: 10.1016/j.ucl.2007.08.002. PMID: 17983895.

Morgentaler A, Rhoden EL. Prevalence of prostate cancer among hypogonadal men with prostate-specific antigen levels of 4.0 ng/mL or less. Urology. 2006 Dec;68(6):1263-7. doi: 10.1016/j.urology.2006.08.1058. PMID: 17169647.

Cardiovascular benefits of Testosterone therapy:

Rosano GM, Leonardo F, Pagnotta P, Pelliccia F, Panina G, Cerquetani E, della Monica PL, Bonfigli B, Volpe M, Chierchia SL. Acute anti-ischemic effect of testosterone in men with coronary artery disease. Circulation. 1999 Apr 6;99(13):1666-70. doi: 10.1161/01.cir.99.13.1666. Testosterone’s effect on preventing atherosclerosis:

Testosterone’s effect of “reverse cholesterol transport” thus reducing atherosclerosis:

Langer C, Gansz B, Goepfert C, Engel T, Uehara Y, von Dehn G, Jansen H, Assmann G, von Eckardstein A. Testosterone up-regulates scavenger receptor BI and stimulates cholesterol efflux from macrophages. Biochem Biophys Res Commun. 2002 Sep 6;296(5):1051-7. doi: 10.1016/s0006-291x(02)02038-7. PMID: 12207878.