Testosterone Replacement Therapy: Consult the Pros Only, Please

Jan 26, 2015

I’ve written before about the perils of treating low testosterone with anything other than medically sound therapies under the guidance of an expert urologist or endocrinologist. To understand why, look no further than the array of anti-aging clinics nationwide that purport to correct low T “naturally” and help men age more gracefully with what they claim are “bio-identical” hormone formulations.

The leading such organization is the American Academy of Anti-Aging Medicine, which was founded only in 1992 and offers a fellowship in anti-aging and regenerative medicine that’s open to physicians, nurse practitioners, chiropractors, pharmacists, nurses and even dentists. Much of its curriculum is provided online. Are these the people men should turn to for hormone therapy? Personally, I visit my dentist when I have problems with my teeth, not my testicles — and anyone looking for insight about testosterone replacement should seek out a urologist or endocrinologist.

Consider: The American Board of Urology (ABU), through which I’m certified, was founded in 1934 and maintains some of the highest standards of any medical organization. Likewise the American Urological Association (AUA), to which I also belong: Founded in 1902, it’s active in education, research and health-care policy. Its official publication, The Journal of Urology, debuted in 1917 and is the most respected media organ in the field.

What separates board-certified urologists from others who claim to treat low T? Dedication and credentials: Urologists are trained for six years following medical school — training not available online or through a self-study program.

Some men think that distinction doesn’t matter, that therapies deemed “natural” are safer or better than anything a trained, experienced physician would prescribe. Yet any substance obtained from a plant, animal or mineral source is natural, even the most clinical-seeming lab-derived drug. (Some pharmaceutical-grade testosterone products, as it happens, come from soybeans and yams.)

“Bio-identical” hormones, the kinds retailed by anti-aging clinics, are molecularly identical (hence the name) to those produced by the human body — they have, for example, become quite popular among women to help treat the symptoms of menopause. Yet they don’t exist in nature; they’re synthesized in a lab using plant extracts. Not exactly “natural,” is it? Compounding pharmacies produce these hormones and tout them as bio-identical wonder drugs. It’s complete nonsense.

Advocates for bio-identical hormones claim that they work just like the ones our bodies produce, only with fewer side effects. Yet no scientific data support this. 

Many of the testosterone products certified physicians use, too, are produced in labs from plant sources and are molecularly identical to men’s endogenous testosterone. Such synthetic preparations improve the delivery of the hormone to the body — and these can in fact reduce unwanted side effects such as liver toxicity.

One of the most popular forms of testosterone-replacement therapy, injectable testosterone, illustrates these attributes nicely. Testosterone cypionate, as it’s known, is an intramuscular injection administered every one to two weeks. It’s produced in a lab by taking bio-identical testosterone and adding a molecular modification called an ester group. This enables the testosterone to be released slowly into the bloodstream from the injection site. Without the ester modification, a patient would have to get an injection every day. Once testosterone cypionate enters the bloodstream, the body — that miraculous machine — cleaves the ester from the testosterone molecule, rendering it 100 percent bio-identical once again.

That’s modern medicine, not feel-good flimflam. Testosterone-replacement therapy should always be prescribed by an expert — a board-certified urologist or endocrinologist. Your health is too important to entrust to self-appointed specialists who claim to have discovered the fountain of youth. Testosterone deficiency is a serious condition, and treating it requires serious medical expertise — not pseudo-scientific “knowledge” obtained under scant supervision online.