responsible endocrinologist
Testosteronzamestitelnaya therapy (TZT for simplicity) in men - a very popular theme, but it is not enough reliable information for doctors and patients. Let me try to clarify. And I will help take your questions.
🎯Komu need TZT?
All men with confirmed testosterone deficiency in the presence of clinical manifestations (ie complaints from the patient).
Absolute deficiency of testosterone is considered a figure 8 nmol / L or less.
Indication for TZT considered figure of 12.1 nmol / l in the presence of clinical manifestations.
In addition to total testosterone, free testosterone, and estimate that it is not necessary to define and can be counted on the site our clinic, making the data of total testosterone and SHBG (sex hormone globulinsvyazyvayuschy, ie carrier testosterone).
🎯Est whether difficulties in determining the objectivity and testosterone deficiency?
Yes, a lot.
🧬Analyzes have to take in a good laboratory where able to do such analyzes and save on reagents.
I recommend laboratory EFIS, Sklifosovsky Institute and Endocrinology Research Center (price asc). All three agencies state, no interest to doctors for tests they do not pay, but objectively and very qualitatively doing their job. Also, this analysis can be done in our clinic, because we work with the EFIS.
🧬It is impossible to estimate the testosterone deficiency is only one level of testosterone. For example, if a person has high numbers of SHBG, this will lead to insufficient levels of free testosterone, that is the one that exerts its biological action. It is necessary to do metabolic disorders and especially the liver, instead of adding testosterone from the outside, as this will only bring harm.
🧬Osobenno sad fact that many doctors do not look all hormones, and only testosterone. And because it is synthesized by two more key hormone for men's health - it estradiol and dihydrotestosterone (DHT).
If the analyzes we see high levels of estradiol and low testosterone, the treatment can consist in reducing the conversion (conversion) of testosterone to estradiol.
Excess transformation is associated with excessive activity of the enzyme aromatase. She begins to manifest itself strongly with obesity, regular use of alcohol, large and constant use of chocolate, coffee and use of a number of drugs. Also, it stimulates certain forms of cancer.
Estrogens in men do not need to be reduced to zero. They are necessary, but only in the normal range.
🧬Tozhe thing with DHT, to which men are obliged to relief muscles and a lot more than. But when this hormone too much, it threatens adenoma and / or hyperplasia of the prostate, libido disorders, and others.
Increasing this hormone occurs in the activity of another enzyme 5-alpha-reductase, which grows particularly in conditions of constant stress and age when cortisol remains approximately at the same level as in his youth, and other hormones are produced in much smaller quantities.
In such a situation, do not just prescribe testosterone (which immediately zaderet the already high levels of DHT), it is necessary to look for the cause and fix it.
🎯Which drug a patient receives, if you make the diagnosis?
Always individually. If there is any doubt in relation to the metabolic welfare of the patient, treatment should begin with kratkodeystvuyuschih testosteronzamestitelnoy forms of therapy. Then you can go on a long acting formulations. What is very important, the patient should first be thoroughly examined in order to avoid surprises.
Required control, that is, regular surveys. Initially it 1 time in 3 months, then every six months. Then, at least 1 time per year - Passing all tests and pelvic ultrasound (TRUS), lymph nodes, bladder, liver, and those areas in which some pathological changes in the primary control were found.
It is important to evaluate and the thoracic glands in the initial evaluation, especially if you are found by palpation there an excess of adipose tissue. Mammary glands can malignant, that is reborn into a cancerous tumor.
🎯Many men of great concern to a decrease in testicular volume on the background TZT and they are sometimes on the advice of some doctors, are taking stimulating hormone (human chorionic gonadotropin person), contributing to the creation of supraphysiological doses of testosterone, thereby increasing the stress in endocrine system.
It's not the most sensible decision, because body will use all options for reducing toxic doses of testosterone. There are several mechanisms, including the activation of enzymes, down regulation, inhibition of cAMP activity and others. In other words, we come to the conclusion that my favorite - nature is smarter and stronger person. And where there is not yet all clear, it is not necessary to experiment on human beings.
Please ask questions in the comments, they serve as the basis for publications.
Your doctor Pavlova
