Hormone Replacement Therapy (HRT), Is It Safe? Men's Edition.
Hormone optimization is an important topic and one that I feel deserves some attention. As with many things in the health industry, there is much misinformation and stigma around exogenous hormone use and its effects.
Many people have read, or heard, that using exogenous hormones like testosterone and estrogen can increase rates of certain cancers. There have been studies that linked testosterone supplementation to an increase in prostate cancer and many of us know about the Women’s Health Initiative that showed estrogen plus progestin supplementation increased rates of breast cancer in participants. Listening to multiple Drs. and experts in this field dissect this broad topic, there is a lot of nuance to its application.
In regards to men with low testosterone, or who want higher testosterone, you should first get checked to see where you are truly at. It is possible to have a normal to high level of total testosterone but still have a low amount of free, or usable, testosterone. A comprehensive blood panel will be able to tell you where you are. After getting my blood work results back, I found that my testosterone levels were fine but my free testosterone was lower. To increase that, boron was added to my supplement regimen. Even if you have lower testosterone there are multiple nutritional, supplemental and lifestyle factors that can be adjusted to increase your levels to a more optimal range. If you meet with your healthcare provider and decide that testosterone replacement would be the best treatment option for you but are unsure because of the chance of increased prostate cancer you should be aware of the Testosterone Saturation Model. In this model it shows that there is a lower risk of prostate cancer in men with lower testosterone levels, and that prostate cancer risk does go up with testosterone levels but only to a certain point. After ~250-300 ng/dl, saturation has been reached and there is no longer an increased risk. To put this into perspective, normal levels of testosterone range from 300-1,000 ng/dl and can be naturally higher. There can be negative health impacts if you use supplemental testosterone to elevate yourself out of natural-optimal ranges, but staying within those ranges is safe and improves quality of life in many ways.
There can also be negative stigma around using exogenous hormones. In sports, we as a society in general feel like it is “cheating” to use super physiological doses of testosterone and other prohormones. However, if you are just a regular guy with low testosterone, getting yourself into optimal range should not be a shameful choice. To put it simply, optimal testosterone levels will make you feel good. Most men report being happier, having more energy, having a drive to get things done and having an overall more positive disposition. Unfortunately, anger has been associated with testosterone. In reality, men with higher levels who feel better have more patience.
If you would like to know more about this topic, please check out the work of Dr. Abraham Morgentaler, Dr. Rob Kominiarek and Dr. Gabrielle Lyon. Next newsletter, we will be learning more about hormone replacement for women. If you have any questions, please contact me.
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