Testosterone is made in the testes. It circulates in the blood primarily bound to proteins and is not very active in this state. A small percentage is unbound and called free testosterone. This is what the cells of the body see and respond to, and is what is measured during treatment. The more the testosterone is bound to protein the less it is bioavailable and the less effective it is.
DHEA, short for dehydroepiandrosterone, is one of the most common hormones found in the body. Produced in the adrenal glands, it is actually a prohormone which the body converts to testosterone, estrogen and other products.
If you are a man considering hormone therapy and have questions regarding the effects of testosterone and DHEA on your body, contact our office today.
Sex hormone binding globulin, or SHBG, is an important protein which binds or inactivates testosterone. As a man ages binding increases, which further diminishes the availability of free testosterone. In addition, as one ages, testosterone production decreases, further diminishing its effectiveness. The overall result: loss of muscle mass, strength, endurance, weakness, loss of libido and sexual performance, as well as an increase in visceral (stomach) fat, with susceptibility towards osteoporosis and cardiovascular disease.
It is a weak but important androgen or male hormone, demonstrating the same benefits and actions of testosterone. In addition, it has unique anti-aging benefits. Population studies have shown men and women with high levels of DHEA have greater longevity.
Like other hormones, DHEA production decreases with age and men greatly benefit from its replacement. DHEA increases insulin sensitivity which reduces the risk of developing diabetes. It is cardio-protective and strengthens the immune system. There have not been any published studies to date which demonstrate harmful effects of DHEA replacement therapy.
There is no significant downside when these medications are given to raise levels to the upper end of the normal range for young men. When very high levels of hormones are the goal, however, such as with steroid abuse, complications are seen, primarily with an increase in red blood cell concentration in the blood.
This is not seen when the goal of andropause, treatment is to reach the upper end of the normal range. Periodic monitoring is extremely important to prevent problems.
Androgen replacement therapy can substantially improve mood for the better, providing a greater sense of well-being and optimism. However, sometimes there can be an opposite effect, where sensitivity to even low doses can cause irritability, anger and even rage. This usually is seen with very high doses of androgens and can be reversed quickly by simply lowering the dose of medicine.
In the skin, testosterone is converted to the potent androgen dihydrotestosterone or DHT. DHT, when elevated, can cause acne, stimulate hair growth and paradoxically in some cases, hair loss. These undesirable side effects may be dose or duration dependent and need to be watched for. Fortunately, if they occur they are reversible by decreasing the amount of medication or by temporarily suspending its use. In some cases, acne can be blocked without having to lower the dose and allow for a continuation of treatment.