Published May 14, 2020, updated July 23, 2020
This is the first of 3 blogs on the benefits of TRT. These discussions are designed to explore the significant health benefits to a medical based TRT program as a foundational base for a longevity program. The longevity movement continues to pick up speed as evidenced by the numerous associations springing up in the USA. The reprogramming of genetic pathways associated with aging is accelerating. Just following the publications of Dr. Michael West, Dr. David Sinclair and Dr Gregory Fahy support the incredible progress that is happening as I write. While the concept of living longer may be exiting to some, it raises serious questions about preserving quality of life as we age. There is no point to living longer if we can’t maintain or reclaim the level of function we enjoyed in our youth.
As we age, there are certain changes that happen to our bodies that are inevitable. Women go through menopause and experience a dramatic decline in Estrogen and Progesterone production. Men go through a similar but very gradual process that has been termed the andropause. The andropause results in a slow and steady decline in Testosterone (T) production starting at about age 30. At the same time, Estrogen (E) levels are rising due to weight gain and harmful chemicals in the environment, such as pesticides and herbicides. Our very poor quality diet on a societal level ( I am sure all of you eat great! ), leads to extra belly fat that increases the conversion of Testosterone to Estrogen. The net effect is a decreased Testosterone to Estrogen ratio. Contrary to popular belief, this ratio is just as important as overall Testosterone levels to men’s well being. Low Testosterone with a low Testosterone/Estrogen ratio leads to symptoms of low Testosterone, or Androgen Deficiency. Low T symptoms include
- Loss of sex drive or libido.
- Erectile dysfunction.
- Reduced muscle mass.
- Reduced cognitive function.
- Irritability. ( that’s why they made the movie “Grumpy Old Men” )… sometimes Hollywood does get it right!
The slow decline in T levels does not create dramatic symptoms like the menopausal transition in women and most men just feel that it is a new but unwelcome ‘normal’. True Balance has prescribed Testosterone Replacement Therapy (TRT) for over 15 years. Over that time it has been gratifying to see attitudes change towards the andropause and TRT. Fifteen years ago, low T symptoms were associated with erectile dysfunction and TRT was associated with the treatment of impotence. We now understand that there are many serious health implications to low T levels in men. Testosterone is a very powerful anti-inflammatory hormone that acts at the level of our DNA to reduce inflammation. As young men, our T levels are high and our levels of inflammation are low. Most of the major diseases seen in the aging population are linked to higher levels of inflammation. These include heart disease, diabetes, hypertension, Alzheimers Disease and cancer. This association led to the term ‘inflammaging’ and was featured on the cover of Time magazine a number of years ago. TRT works at the level of a man’s DNA in all sex hormone responsive tissues of the body, to reduce production of inflammatory chemicals called cytokines. These tissues include heart, endothelium, muscle and neurons. The net effect of T action in these tissues is to promote increased quality of life and reduced chances of disease. TRT has been associated with a reduced risk of heart disease and prostate cancer. We can go in to evidence for both of these effects in a future post as they are way too complicated for this post.
The first step in treatment is a comprehensive blood test to measure T and E levels, along with a many other blood chemical levels. This is followed up by a lengthy virtual visit to understand your past health history and any medical conditions that might alter the treatment plan. TRT involves the replacement of Testosterone, most commonly by a weekly self-administered injection. We used to use topical creams when we first started TRT, but they are not as effective for most men and can be transferred to female partners and children with negative effects. Commonly, a hormone called DHEA is prescribed as well, to improve brain and immune function. An estrogen conversion blocker is used in men with elevated Estrogen levels to reduce these to the normal range. Follow up bloodwork is done 8 weeks after the start of the program. A follow up visit documents improvement and allows for a dosage adjustment. Usually only yearly visits are required after the second visit.
Most men experience increased energy, muscle mass, libido and erectile function. As well, most men will experience decreased irritability on the program. This post is running a bit long. Lets deal with how long to stay on the program and is it ‘healthy’ for one of the next 2 posts.
I have attached a number of links to Vitamin D and reduction of risk for serious Covid-19 infection sent to me by my colleague Dr. Herbers (below). Where does he find the time to read so much? The evidence continues to mount that you can reduce your chance of serious infection from the Covid virus by 50%. Adequate Vitamin D supplementation in my mind is 5,000 IU/day. Of interest, Wuhan has been locked down again due to a second Covid-19 wave! Any chance we could see a second wave of infections this fall? Why not reduce your risk as low as you can?
Dr. Ron Brown
Sunshine, Vitamin D and Covid-19
When this virus first hit, many were wondering if this viral infection would be seasonal as so many respiratory viruses are. It certainly appears that is is, which is not surprising! Four of the common cold viruses are CoronaVirus's (OC43, HKU1, 229E,NL63) , and they are indeed seasonal. https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiaa161/5815743
Why would this one be any different? All 4 of these old CoronaVirus's can cause severe disease in compromised individuals, but rarely do as we develop a degree of immunity to these in the 1st few years of life. Here is a graph of time of year and incidence.
So why are these infections seasonal? You likely thought 'sunshine' and that is a big part of it. These viruses, including SARSCoV-2,quickly die when exposed to UV light, as well as heat and humidity. https://www.kxan.com/news/local/study-coronavirus-appears-to-die-quickly-in-direct-sunlight/ . But it is also related to the Vitamin D we produce when our skin is exposed to this healthy sunshine.
Over the last few weeks, multiple studies have shown a very strong association between Vitamin D status (blood levels of D) and Covid-19 outcomes. A Vietnamese study concluded "Serum 25(OH)D level (vitamin d level) was lowest in critical covid cases, but highest in mild cases.....The results suggest that an increase in serum 25(OH)D level in the body could either improve clinical outcomes or mitigate worst (severe to critical) outcomes, while a decrease in serum 25(OH)D level in the body could worsen clinical outcomes of COVID-2019 patients" https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3571484.
Another paper looking at severe outcomes with Covid-19 https://www.medrxiv.org/content/10.1101/2020.04.24.20075838v1 concluded: "Vitamin D insufficiency is highly prevalent in severe COVID-19 patients. Low vitamin D and severe COVID-19 share numerous associations including hypertension, obesity, male sex, advanced age, concentration in northern climates, coagulopathy, and immune dysfunction.". And this study shows Vitamin D insufficiency was associated with a 10 to 20 times risk of death from Covid-19!! https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3585561. Here is a review paper https://www.bmj.com/content/356/bmj.i6583 "Conclusions: Vitamin D supplementation was safe and it protected against acute respiratory tract infection overall"
A stunning study just came out looking at intensive care unit patients with Covid-19 and Vitamin D levels. "Strikingly, 100% of ICU patients less than 75 years old had VDI (Vitamin D insufficiency). https://www.medrxiv.org/content/10.1101/2020.04.24.20075838v1.
There are several more studies with the same results, Vitamin D is very strongly associated with novel CoronaVirus outcome. It will not stop you from becoming infected, but could possibly decrease odds of death in half! https://news.northwestern.edu/stories/2020/05/vitamin-d-appears-to-play-role-in-covid-19-mortality-rates/?fbclid=IwAR06xviK9abMSM6xSvT6surN7d3gupF8Bf1BEdCRSMvl8sO--BfA6-ewgbs
There is evidence that Vitamin D is incredibly important for Covid-19 defence, but I believe sunshine is even more effective. Sunshine does much more than just Vitamin D!