As we age, the level of hormones change in our body. Testosterone, in particular, affects both men and women and everything from mood to sex drive to weight and fat placement.
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Episode: Testosterone Replacement Therapy
The following is a transcript from Dr Okojie’s Movement is Medicine podcast. Book your appointment with Doctor O today.
Hello, and welcome to another episode of the Movement as Medicine podcast with Doctor O. I’m your host Doctor Okojie.
Today, we're going to touch briefly on hormone replacement therapy or HRT, more specially testosterone replacement therapy or TRT. So typically when you think of someone who wants to get on TRT or replace their testosterone, we think about a guy who's trying to ‘bulk up’ or ‘Hulk out’ and gain a lot of muscle. When in actuality, apart from being on skeletal muscle, there's testosterone receptors on almost every single cell in the body. Brain, heart, muscle, lungs, kidneys; and it has a major role in almost every single physiologic process in our body.
So, in general, as we age, I'll use a male in this case. Men, after around the age of 30, their levels of testosterone will start to drop about 1% per year. And, we know that testosterone peaks as you know, we see a strong sharp increase in testosterone, around puberty for both males and females. Which brings me up to another key point, we think of testosterone as a male hormone. Although males have it at a greater percentage or greater amount, females have it as well. And it plays a major role in their physiology as well and does the exact same thing. Testosterone behaves the same way in a male as it does a female. So anytime I say male, just think of think about testosterone behaving the exact same way on the female.
Testosterone increases when during puberty, and as we age, it starts to decline. And most typically, we'll start to see this the symptoms of this decline in testosterone as fatigue, lack of energy, poor concentration, lack of mental focus or sharpness, difficulty maintaining ideal body composition; so it’s harder for you to gain and maintain muscle and it's easier for you to gain and maintain fat, especially around the midsection around the vital organs.
Definitely low libido is a key factor in a decrease of testosterone as well as erectile dysfunction.
So, if we're looking at it on the female, and you know, maybe pain with intercourse, or just difficulty having sexual intercourse. Again, there's that crossover between male and female. So, as we age, we start to see these things creep up. And the interesting thing and I think the reason why testosterone isn't talked about and isn't well known, or even well studied in common medical practices is the fact that there's a lot of crossover with the symptoms. So, someone could actually be suffering from depression and be treated with depression medication and their testosterone never be looked at. Someone could just have a poor diet and be suffering from obesity and their testosterone or their hormone levels whenever it be looked at.
But, it may be a missing piece for people who are suffering these things. Oftentimes, we see depression medications, weight loss programs, psychotherapy, and talk therapy being used for patients who are presenting with the symptoms, and we don't see a great resolution. Testosterone may be that missing piece. So, testosterone replacement therapy is exactly what it says: it's a replacement of those hormones. And the way you would know that if you're deficient in testosterone is you would go to the doctor, you would get a blood test as what we found to be the most efficacious. Many doctors will test it in the urine, and they'll test it in the saliva as well; the test metabolites for this.
Once you're deemed to be low, then replacement therapy is indicated. And so, the hormone can be replaced in a variety of ways. There's a cream: so topical cream that you can place on the body, let that dry, and that testosterone absorbed into the tissues and it can increase the levels of testosterone in the serum or in the body. There's also something called a Troche, which is a dissolvable tablet, you can place under the tongue and let that dissolve, and that will increase testosterone levels.
But we find that these two methods aren't as useful or aren't as strong when it comes to actually increasing levels of testosterone. So, testosterone injections, or testosterone implantation has been shown and been seen to increase the levels of testosterone more profoundly than rubbing a cream or taking a sublingual tablet. And this is what I've been seeing in my practice for the past four or five years that this has the strongest impact on increasing the testosterone levels, and more importantly, helping out with those symptoms or resolving a lot of these symptoms.
So, people are often afraid, you know, am I going to ‘hulk out’? Am I going to, you know, have roid rage. And then of course, this when it's important to get with a doctor and make sure your levels are being monitored. We see testosterone being used, and we hear about it being used a lot of times, like on the street, or in the gym: this talk is whispered in gym locker rooms, about the effects of testosterone.
And so, what are some of the things that people commonly hear and that they're afraid of. Again, like I spoke about roid rage and what I found is that taking testosterone unopposed or just taking testosterone by itself and not monitoring the other hormones, actually can cause increases in estrogen. And estrogen, high estrogen can lead to premenstrual syndrome-type symptoms, which can be irritability, raging out on less patience, less tolerance for things that you might have had greater tolerance for before. So that roid rage piece, oftentimes we find that it's an increase in estrogen. And that's tempered by monitoring your other hormones and not just taking testosterone unopposed.
Acne is a big one, because we know that as we were growing up, our testosterone levels were increasing, and we got pimples. So, acne or so testosterone does cause an increase in oil production on the skin and people can start to develop acne. It's not a guarantee that if you take testosterone replacement therapy, even high levels of it, that you'll get acne. What I found is that some people just have a higher propensity of getting acne. But that's certainly a concern that's valid. In my practice, if I've treated maybe four or 500. Guys with it, just as a rough estimate, maybe in five to 10% of guys, I see complained about having acne, but I've never seen a guy just come out and have a full face of pimples, Females as well- never seen a female just haven't have teen teenage acne after being on testosterone replacement therapy.
So another concern is the fact that you know, if you take testosterone, you'll get a heart attack, you'll have a stroke. Which is a valid concern if you're taking testosterone, not under the guidance of a medical professional. Testosterone does have the ability to increase the amount of red blood cells in your body, which is ironically one of the benefits of it. Red blood cells have oxygen in them so you'll tend to find that once you're on testosterone that's properly monitored, you'll have more energy, you'll be more awake and vibrant. But again, if you're not getting it monitored, then it can increase the thickness of your blood and increase the propensity or the chances of you having a heart attack or stroke. But that's easily quelled by just having it monitored by a licensed physician.
So what are some of the things that testosterone can do for you? So, like I said, testosterone receptors are on almost every single cell in the body. So, it can improve body composition in the sense that if you have a regular, steady, consistent, healthy and safe exercise and workout regimen, testosterone can enhance those effects. So imagine that you've been working out for the past six, eight months, and you see some improvement, but then you plateau. With properly managed testosterone, you can kind of crack that plateau or overcome that hump.
Now, it's not a magic pill. Certainly not. You can't just be sitting on the couch, take testosterone and expect to have the body of your dreams. Testosterone combined with a consistent workout program can help to improve your body composition. I mean, you can do a quick Google search and see a ton of before and after pictures of guys and gals who were working out before TRT, and then had that same workout regimen and had great improvement in their aesthetics and in their body composition after TRT.
Another huge thing that testosterone replacement therapy helps with is libido, so sex drive. A lot of females, when they go through menopause, one of the main things that they noticed one of the first things that they noticed is that their desire for sex drops, so they have poor libido. And that tends to drop with age. Maybe you can think back to when you were a teenager or in your early 20s, how much you wanted to have sex. And if you're in your 40s or 50s now, it may not be the same. So that's usually due to a drop in libido. And we'll see a kind of parallel with a drop in testosterone. Sp, I've had several ladies come in to my office and you know, they're complaining that they don't have that drive, they don't have that desire for sex anymore. And then with testosterone replacement therapy, they come back and they're like, whoa, you know, is back. It's like I'm in my 20s again! And that's actually one of the first things that I notice that people speak about. When they get on the therapy. One of the first things that kind of cracks, they kind of shock them is like well, my libido is back.
So, balancing your hormones, more, especially increasing the levels of testosterone back to a healthy range can increase your libido, sexual function in both males and females, guys suffering from erectile dysfunction, and females suffering from vaginal dryness, or pain during intercourse. Again, testosterone can help increase lubrication and that area for females and help with erectile function.
Then we kind of get into a little slippery area again as well. Because for libido and erectile function in both males and females, there's a strong psychological component to that. So, it may not be that you're deficient in testosterone, it may be that you're angry, it may be that the mood isn't right. It may be that you're just not interested in your in your partner. And oftentimes, they kind of think that this is the reason why they say oh, I might I may not be attracted to my partner anymore, and it may kind of cause a rift in their relationship. So it's important that those other issues those psychological issues with regard to libido and erectile function get addressed, in addition to just increasing your hormones because I can put as much testosterone as I want in you…If you're not attracted to your partner or if you're always stressed out, you're going to have a hard time achieving that good sexual balance that you want.
So another factor that I see testosterone playing a key role in is the issues of anxiety and depression. Anxiety and depression are closely linked. And with our current state of affairs in the world, and with the pandemic going on, we're seeing increases in anxiety and depression. And so, as I mentioned before, their testosterone is testosterone receptors on the brain as well. So we noticed that when hormone levels more especially testosterone levels get balanced, that people's mood is better, they tend to get out of that funk a little bit easier. Their outlook on life has improved.
So when you're less anxious and you're less depressed, you're more likely to have a better libido, better sex life, you're more likely to want to go to the gym, you're more likely to stick with something, even if it's difficult. So anxiety and depression is a huge piece that's affected by testosterone. And even if, you know folks are not depressed, even if folks have never been diagnosed with depression, or even anxiety, there's just a little bit more drive: Mojo is like what we like to call it, like you're getting your groove back. Just that little extra push that we see that people have and regain once their hormones are balanced.
And like we said before, TRT or testosterone replacement therapy is just under the umbrella of HRT. So there's other hormones that play a role. You know, we look at things holistically, testosterone is certainly a huge piece of it. But there's estrogen which both men and women have. There's progesterone, which both men and women have, there's thyroid hormones, as well, which play a role in our entire physiology. And we see that these all of these hormones tend to be out of balance, or not in the proper ratios as we age. It's a natural process for us to age, it’s a natural process for our hormones to start to decline. But our goal is to try to live a fully optimized happy full life for as long as we can, and to make that decline that this natural decline in hormones as less dramatic as possible. So, if we can do that, that's our goal.
Thank you guys once again for tuning in to another episode of the Movement as Medicine podcast with Doctor O. I'm your host, Doctor Okojie. If you guys want me to speak on any topic with regards to health, wellness, medicine, physical activity, exercise, and any and all things holistic, reach out! Phone call, YouTube, Instagram, website, all of that – totally available.
So thank you so much again, and until next time.