Endocrinologist with 23 years of experience compares the effectiveness of various drugs
Obesity is never a single disease. It is always accompanied by inflammation of the adipose tissue and metabolic syndrome. Metabolic syndrome, to put it simply, is a whole bunch of painful conditions - hypertension, high levels of glucose and cholesterol in the blood, etc. In men, in most cases, it is added testosterone deficiency and they are often prescribed testosterone replacement therapy (TRT).
And there is one interesting point.
The more testosterone, the less testosterone
Obesity increases the activity of the aromatase enzyme (CYP19A1). This enzyme converts testosterone to estradiol (conditionally, the main male hormone into the main female hormone). And when the activity of aromatase increases, then testosterone begins to be excessively processed into estradiol.
That is, a person may have a normal production of testosterone, but it is not enough, since this hormone "runs away" into another hormone. Or there may be an initial testosterone deficiency.
In any case, if you use testosterone from the outside, then we add resources to aromatase, which with increasing activity will distill it into conditionally female hormone estradiol.
It would seem a vicious circle. What to do?
Seek testosterone replacement therapy, which will significantly increase testosterone and not so much raise estradiol levels.
The effectiveness of drugs testosterone
At the Moscow State University clinic, we decided to see how different forms of testosterone work.
We took 60 case histories and conducted a retrospective analysis.
The patients used the following testosterone preparations:
- testosterone gel 1% -50 mg,
- injection of an oil solution of testosterone undecanoate 25% -1000 mg in 4 ml,
- human chorionic gonadotropin (hCG), on average in a dose of 2000 IU-2 times a week.
What have we seen?
1. All drugs resulted in a significant increase in the level of total testosterone, but supraphysiological (i.e. much higher than natural) numbers were achieved in the hCG injection groups and to a greater extent in the testosterone undecanoate injection group.
It can be concluded that the most physiological and sparing use is gel.
2. The level of estradiol (which, as we recall, is converted from testosterone through aromatase) was also the highest in the testosterone undecanoate group - 1000 mg. This was expected.
We also decided to confirm or deny the widespread theory that high doses of testosterone lead to weight loss, primarily by reducing the volume of adipose tissue.
We evaluated the changes that occurred in patients taking TRT within 6 months.
During this time, all groups have experienced:
- changes in weight,
- body mass index (BMI),
- the size of the waist circumference (OT),
- the size of the hip circumference (OB),
but these changes were significant and positive only in the 1% testosterone gel group, which is clearly seen in drawings.
On other drugs it has not been confirmed that high testosterone has any effect on the treatment of obesity.
What's the conclusion?
I must say that we had no commercial interest in this study.
I use all TRT options in my practice and, like other scientists and clinicians, it is extremely important for me to have objective information, even if it is at odds with the opinions of other researchers.
Of course, 60 patients is not the largest sample, but this information deserves attention, and it would be great to carry out such an analysis on a large group of people.
Because - see above: with obesity, the more testosterone, the less testosterone ...
Here is such a sad paradox ...
Your Doctor Pavlova
PS I spoke with this report a week ago at a conference on men's health in Sochi. On my instagram is there a video.
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