Revitalizing Testosterone Levels in Aging Men

By Leon Tcheupdjian MD

You are welcome to call my office at 1-847-259-1000 to schedule an appointment for a medical consultation.

“Ever since the ancient Egyptians and Ponce de Leon we have been searching for ways to restore our youth”.

By the age of 80, a man’s testosterone level may only be 20% of what it was in his youth. This decline in testosterone occurs gradually, starting as early as his mid-30s, and can result in an increased risk of life-threatening and all the degenerative illnesses you have heard about such as obesity, diabetes, and heart disease and Cancer.

Testosterone deficiency can also lead to a number of disturbing symptoms, including loss of stamina and lean muscle mass, reduced libido, anxiety, depression, and cognitive decline. Known as the andropause, these changes are the male equivalent of female menopause. Unlike menopause, however, the drop in testosterone is so gradual that the symptoms of andropause appear over a longer period of time and are often ignored for a while or are attributed to “getting older.”

The good news is that many symptoms of testosterone deficiency can be reversed by restoring youthful testosterone levels in a variety of ways. Millions of men are now under close medical supervision are using testosterone and even testosterone inducing supplements for this reason.

RECOGNITION OF AN INCREASINGLY PREVALENT PROBLEM

Testosterone is the primary male sex hormone that is vital for sustaining proper libido and erectile function. It is also critically involved in building muscle, burning fat, and supporting inner lining of our blood vessels, energy level, mood, immune function, and bone and cartilage strength.

Millions of men in the United States suffer from the effects of low testosterone levels. This population of testosterone deficient men will only grow in the future, as the number of aging American men increases.

WHAT YOU SHOULD KNOW ABOUT TESTOSTERONE

1) Low testosterone is associated with increased morbidity and mortality. A recent study found that men with lower testosterone levels were more likely to die from cardiovascular disease and all causes compared with men who had higher levels. I strongly believe that low testosterone may be a predictive marker for those at high risk of cardiovascular disease.

2) Baylor College of Medicine reported that there is a higher prevalence of depression, coronary heart disease, osteoporosis, fracture rates, frailty, and even dementia with low testosterone.

You might now be asking yourself these questions—Why hasn’t my doctor discussed these risks with me and why haven’t I been tested for low testosterone levels? Why am I just hearing about this?

TESTOSTERONE SUPPLEMENTATION — A shady past

The medical community has been slow to recognize the consequences of low testosterone levels in aging males and, in fact, wrongly believes that restoring youthful levels of testosterone is dangerous and unwarranted.

While testosterone is a member of the group of compounds known as “anabolic steroids,” it is different and less potent than the illegal synthetic compounds that have been taken in excessive doses and abused. Beginning in the late 1980s, overambitious and unscrupulous professional athletes began taking illegal anabolic steroids to gain an unfair competitive edge. They used “very high doses” of synthetic and chemically altered testosterone, they pawned this chemical off as real testosterone, even though it does not naturally exist in the human body. After several years on the market, some men taking this particular chemical developed liver cancer. Hence erroneously “Testosterone therapy” was then declared to be dangerous, and research on testosterone fell by the wayside.

Unfortunately, this abuse has wrongly clouded the important health benefits of prescribing testosterone therapy to correct its decline associated with aging and other diseases. In response to the sports abuse issue, federal law has made testosterone a controlled substance just like narcotics and amphetamines.

Although this has made some doctors reluctant to prescribe testosterone, medical prescribing of the hormone jumped by 50% in the new millennium

To a total of 2.3 million prescriptions in 2005. Some physicians therefore are increasingly recognizing the consequences of low testosterone levels in aging males.

CHANGING OPINIONS ON TESTOSTERONE SUPPLEMENTATION

There are hundreds of studies in the medical literature showing the health benefits and safety of testosterone therapy.

In 2007, Drs. Miner and Seftel published a review of the medical literature on testosterone The summary of their article states: “Recent studies have demonstrated that hypogonadism [low testosterone] in men may be more prevalent than previously thought, is strongly associated with metabolic syndrome, and may be a risk factor for type 2 diabetes and cardio-vascular disease. Clinical studies have shown that testosterone replacement

therapy in hypogonadal men improves metabolic syndrome indicators and cardiovascular risk factors. Maintaining testosterone concentrations in the normal range has been shown to contribute to bone health, lean muscle mass, and physical and sexual function, suggesting that testosterone replacement therapy may help to prevent frailty in older men. Based on current knowledge, testosterone replacement therapy is unlikely to pose major health risks in patients without prostate cancer and may offer substantial health benefits.”

TESTOSTERONE AND CARDIOVASCULAR HEALTH

Let’s take a closer look at what the medical literature says about the specific benefits of testosterone restoration. Many studies have shown an association between low testosterone levels and a higher prevalence of coronary artery disease8-10 and aortic atherosclerosis. Lower testosterone levels are also associated with reduced cardiac output (pumping ability of the heart).

Recent studies suggest that testosterone-replacement may improve the symptoms of coronary artery disease. A placebo-controlled crossover study in men with ischemic (poor coronary blood supply) heart disease and low testosterone levels reported that exercise time and the time to development of abnormal ischemic changes on a treadmill test were both increased with testosterone-replacement therapy.

Another placebo-controlled study found that 12 weeks of oral testosterone-replacement therapy improved the ability of the brachial artery to dilate in men with coronary artery disease, suggesting an improvement in endothelial function.

These and other medical studies provide mounting evidence of the clinical benefits of testosterone-replacement therapy in men with coronary artery disease.

TESTOSTERONE AND INSULIN RESISTANCE/ DIABETES

Type 2 diabetes is reaching epidemic proportions in America today. Likewise, metabolic syndrome—a condition marked by insulin resistance – Obesity – High blood pressure that dramatically increases the risk of heart disease and diabetes—is becoming increasingly more prevalent.

We have come to believe low testosterone levels may be intimately linked with insulin resistance and its related conditions of metabolic syndrome and diabetes.

Recent research suggests that three out of four men with diabetes have low testosterone levels; older men appear to be particularly susceptible.

Likewise, low testosterone is common among men with metabolic syndrome, and some scientists have proposed that low testosterone might serve as a prognostic tool for early detection of the condition.

Hence restoring testosterone to youthful ranges may confer a wide array of benefits to men affected by type 2 diabetes. The reported benefits of testosterone administration in these men include improved blood glucose balanced levels, reduction in abdominal fat, and improved erectile function.

Growing research suggests that testosterone replenishment may help reverse some of the key biochemical abnormalities that underlie metabolic syndrome, such as insulin resistance and abdominal obesity (beer belly).

FAT vs LEAN:

TESTOSTERONE AND BODY COMPOSITION

With the obesity epidemic raging and its tremendous impact on the overall health of our nation’s population, integrative physicians are particularly interested in the role testosterone plays in body composition.

Testosterone appears to affect fat cell metabolism and fat loss in several ways; 1) Through inhibiting fat storage by blocking a key enzyme called lipoprotein lipase that is necessary for the uptake of fat into the body’s fat cells.

When fat cells are exposed to testosterone in a test tube, the activity of lipoprotein lipase is dramatically reduced by stimulating fat burning by increasing the number of certain receptors on the fat-cell membrane that release stored fat. 2) Increasing insulin sensitivity and improving lipid and insulin metabolism.

3) Enhancing growth of muscle fibers.

4) Decreasing fat deposits.

All of these effects benefit body composition by promoting lean body mass and reducing fat mass.

In a famous study out of Sweden in 1991, researchers gave a group of overweight men supplemental testosterone for six weeks.20 After this time, they found the activity of the fat storage enzyme lipoprotein lipase to be dramatically reduced in abdominal fat tissue. Waist and hip circumference also decreased in 9 of the 11 men.

Furthermore, a recent review highlights numerous placebo-controlled trials that have demonstrated both significant increases in lean body mass and decreases in fat mass after varying courses of testosterone supplementation in older men. In these studies, the greatest favorable changes in body composition were seen in participants with low baseline testosterone levels who received testosterone therapy for a period in excess of 12 months.

TESTOSTERONE AND THE PROSTATE

A common misconception among physicians is that testosterone administration adversely affects the normal prostate. This idea is not supported by the medical literature. A 2002 study indicates that testosterone is actually beneficial for the prostate gland in the vast majority of cases. In this study, researchers looked at multiple parameters, including prostate volume, prostate-specific antigen (PSA) levels, and lower urinary tract symptoms in a group of men with low or low-normal testosterone levels. Of the 207 men studied, 187 responded favorably to testosterone treatment. These positive responders all showed improvement in almost every parameter measured: their prostate glands all decreased in size, PSA was lower, and urinary symptoms such as frequency, urgency, dribbling, and getting up at night to urinate all improved.

WHAT YOU NEED TO KNOW: OPTIMIZING TESTOSTERONE LEVELS IN EN

More than just SEXY TESTOSTERONE

Testosterone, the chief male hormone, is essential for libido and erectile function, and plays a crucial role in mood, energy, bone health, and lean body composition. Here are some more facts;

* Testosterone levels decline with age, usually beginning in a man’s mid-30s.

* Diminishing testosterone levels have been linked with disorders such as depression, fatigue, obesity, and cognitive decline.

* Low testosterone levels increase the risk of coronary heart disease as well as all-cause and cardiac mortality.

* Restoring testosterone to youthful levels offers men a wealth of health benefits, including benefits for heart health, body composition, mood, and memory.

* Bio-identical testosterone has not been found to have adverse effects on the healthy prostate gland—in fact, it may help improve prostate symptoms in men with low-normal testosterone levels. Today Testosterone therapy is contraindicated in men with prostate cancer.

* Regular blood testing can help you and your physician decide if testosterone therapy is right for you. Optimizing testosterone levels requires a multi-pronged approach that includes optimal diet, proper nutrition, nutritional supplements, exercise, and bio-identical testosterone, if necessary.

In a separate recent study that looked at a similar group of men, the authors observed that “No treatment-related change was observed in prostate histology, tissue biomarkers, gene expression, or cancer incidence or severity. Treatment-related changes in prostate volume, serum PSA, voiding symptoms, and urinary flow were minor.

On the question of whether testosterone therapy causes prostate cancer, the answer clearly appears to be no. In a landmark review article published in 2004 in the New England Journal of Medicine, the authors report “there appears to be no compelling evidence at present to suggest that men with higher testosterone levels are at greater risk of prostate cancer or that treating men who have hypogonadism [low testosterone] with exogenous androgens increases this risk.” However, since testosterone stimulates cell growth, it is possible that it can accelerate the growth of an existing prostate cancer. Cancer screeningtests such as a PSA test are necessary before replacement therapy. Testosterone-replacement therapy is contraindicated in men with known prostate cancer.

LACK of TESTOSTERONE on MOOD & DEPRESSION

Depression is a leading cause of disability worldwide. In a recent study of 3,987 older men in Australia, researchers found that those with depression had significantly lower testosterone concentrations than men without depression.

The authors suggested that older men with depression may benefit from systematic screening of testosterone levels and testosterone supplementation.

In my own practice, I have seen both younger and older men with low testosterone levels and depression improve remarkably after testosterone supplementation. Other studies have shown an improvement in depression scores with testosterone therapy in patients with depression who are unresponsive to conventional treatments. Further research in this

area is ongoing.

TESTOSTERONE IMPROVES COGNITIVE – MEMORY & many more BRAIN ABILITIES

Testosterone supplementation clearly seems to be beneficial for proper male mental and verbal function. Several studies have shown that decreased serum testosterone levels appear to adversely affect verbal memory in healthy young men. Short-term testosterone administration exerts a beneficial effect on spatial and verbal memory and enhances cognitive function in healthy men.

MANAGEMENT OF LOW TESTOSTERONE LEVELS

Optimizing testosterone levels in men requires a multi-faceted approach that includes:

* Proper lifestyle.

* Nutrition modification, “ Lean and green”

* Nutritional supplements with lignans. Foods rich with lignanas are flax seed and sesame seed, oat, barley, pumpkin seed, soybean, broccoli, beans and berries.

* Exercise

* Testosterone supplementation (under strict qualified and experienced medical supervision).

A thorough medical history and physical examination should be performed, along with a blood and urine testing panel that includes not only testosterone levels, but also other important parameters such as fasting glucose, PSA, estradiol, and complete blood counts (CBC) liver function tests, and blood lipid panel (cholesterol, triglycerides HDL, LDL).

It is important to work closely with an experienced physician who is readily accessible and who can adjust treatment as needed.

Careful, thoughtful optimization of testosterone levels with a comprehensive evaluation and treatment plan can result in dramatic improvements in one’s overall health and well-being.

For men who no longer produce enough testosterone, an experienced doctor can prescribe a topically applied cream to restore testosterone to youthful ranges. These testosterone creams usually come in delivery systems that enable the precise amount of this hormone to be applied to the skin each day for absorption into the bloodstream.

The most efficient way is to prescribe the proper dose of low-cost individually compounded testosterone cream.

The reason testosterone cream is used as opposed to tablets is that the oral ingestion of testosterone can result in rapid absorption and excretion.

ORTANCE OF BLOOD TESTING

A testosterone cream, on the other hand, gradually releases into the bloodstream, which is more analogous to the way testosterone is naturally secreted each day by the testicles of younger men.

Compared with brand name testosterone topical drugs, consumers can save more than 85% by using natural testosterone cream made by a compounding pharmacy.

For example, the name brand Androgel® cream costs around $225 for a month’s supply. The identical amount of natural testosterone can be obtained from a compounding pharmacy for less than $25 a month. For those patients in whom a cream is not the best choice, testosterone injections can be prescribed.

Follow-up blood testing 30-60 days later is important to ensure that PSA, estradiol, and other blood markers stay in normal ranges. Some men will aromatize (or convert) testosterone into estrogen, which necessitates the use of a drug like Arimidex® or nutrient-lifestyle changes to inhibit excess aromatase activity.

Note: Whether supplementing with natural testosterone or not, aging men may consider using the prescription drug Avodart® to reduce levels of DHT (dihydrotestosterone), a normal (yet undesirable if in high levels) metabolite of testosterone. Studies show that men using agents that lower dihydrotestosterone have reduced rates of both benign and malignant prostate disorders.

The information provided on this site is for educational and informational purposes only and is not intended as a substitute for advice from your physician or other health care professional or any information contained on or in any product label or packaging. You should not use the information on this site for diagnosis or treatment of any health problem or for prescription of any medication or other treatment. You should consult with a healthcare professional before starting any diet, exercise or supplementation program, before taking any medication, or if you have or suspect you might have a health problem. You should not stop taking any medication without first consulting your physician.

REFERENCES

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8. Jones RD, Nettleship JE, Kapoor D, Jones HT, Channer KS. Testosterone and atherosclerosis in aging men: purported association and clinical implications. Am J Cardiovasc Drugs. 2005;5(3):141-54.

9. Dobrzycki S, Serwatka W, Nadlewski S, et al. An assessment of correlations between endogenous sex hormone levels and the extensiveness of coronary heart disease and the ejection fraction of the left ventricle in males. J Med Invest. 2003 Aug;50(3-4):162-9.

10. Hak AE, Witteman JC, de Jong FH, et al. Low levels of endogenous androgens increase the risk of atherosclerosis in elderly men: the Rotterdam study. J Clin Endocrinol Metab. 2002 Aug;87(8):3632-9.

11. Malkin CJ, Pugh PJ, Morris PD, et al. Testosterone replacement in hypogonadal men with angina improves ischaemic threshold and quality of life. Heart. 2004 Aug;90(8):871-6.

12. Kang SM, Jang Y, Kim JY, et al. Effect of oral administration of testosterone on brachial arterial vasoreactivity in men with coronary artery disease. Am J Cardiol. 2002 Apr 1;89(7):862-4.

13. Zou B, Sasaki H, Kumagai S. Association between Relative Hypogonadism and Metabolic Syndrome in Newly Diagnosed Adult Male Patients with Impaired Glucose Tolerance or Type 2 Diabetes Mellitus. Metab Syndr Relat Disord. 2004 Spring;2 (1):39-48.

14. Spark RF. Testosterone, diabetes mellitus, and the metabolic syndrome. Curr Urol Rep. 2007 Nov;8(6):467-71.

15. Kalyani RR, Dobs AS. Androgen deficiency, diabetes, and the metabolic syndrome in men. Curr Opin Endocrinol Diabetes Obes. 2007 Jun;14(3):226-34.

16. Fukui M, Kitagawa Y, Ose H, Hasegawa G, Yoshikawa T, Nakamura N. Role of endogenous androgen against insulin resistance and athero- sclerosis in men with type 2 diabetes. Curr Diabetes Rev. 2007 Feb;3(1):25-31.

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18. Naharci MI, Pinar M, Bolu E, Olgun A. Effect of testosterone on insulin sensitivity in men with idiopathic hypogonadotropic hypogonadism. Endocr Pract. 2007 Oct;13(6):629-35.

19. Saad F, Gooren LJ, Haider A, Yassin A. A dose-response study of testosterone on sexual dysfunction and features of the metabolic syndrome using testosterone gel and parenteral testosterone undecanoate. J Androl. 2008 Jan-Feb;29(1):102-5.

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CO2 Laser Skin Resurfacing

Dr. Leon Tcheupdjian MD began CO2 laser skin resurfacing in 1988 and since then he has successfully treated large number of patients from wrinkles to acne scars including brow lifts, lower and upper eyelid wrinkles (LASER blepharoplasty). “Satisfaction among my patients were very high. Unfortunately the down time was from three to seven days”.

Soon after the new ERBIUM LASER arrived into the scene, even though the down time was cut to half so were the results. Now more and more patients elect to accept the extra few days down time for better results.

University of Michigan researchers looked at 47 patients, with an average age of 52, who received the treatment between 1996 and 2004 and have published a study that gives the thumbs-up to CO2-based laser resurfacing when it comes to smoothing wrinkles. The surgery has previously been linked to side effects including hypo-pigmentation. After 2 years, patients see an average 45% reduction in the number of wrinkles and fine lines on their face, according to the study. This is excellent.

The finding is not entirely new. However, "The point is basically that carbon dioxide is still a very good treatment. It does have a downtime and some side effects, but it does cause a dramatic improvement in many patients that we can't achieve with anything else out there now," says Leon Tcheupdjian MD, director of the liposuction and Cosmetic Surgery Institute, with four Chicago and suburban offices in Illinois. He can be reached at 1-847-259-1000.

Whereas around half of the patients developed either acne or darkening or lightning of the skin as a result of the procedure, most of the side effects had cleared up within months.

At that point, the volunteers were measured according to an agreed score to determine the reduction in the number of wrinkles.

On average, patients had 45% fewer lines and wrinkles across all areas of their face than before the laser surgery, although some had up to 50% fewer, the findings, published in the Archives of Facial Plastic Surgery, show.

The surgery, called carbon dioxide laser resurfacing, has previously been linked to side effects including scarring and acne.

But new research suggests that the treatment is safe and that after two years patients see an average 45 per cent reduction in the number of wrinkles and fine lines on their face.

It works by removing layers of damaged skin as well as stimulating the face to produce more collagen, the elastic material which helps give skin its shape, filling in the wrinkles.

Thousands of the procedures are carried out in the US and all over the world every year and can cost up to $3500 to treat the full face.

The treatment is commonly used to remove fine lines and wrinkles from the whole face or can be used to target certain areas, such as crow's feet around the eyes.

It can also be used to tighten the skin, especially in the jowl area.

Researchers looked at 47 patients, with an average age of 52, who received the treatment between 1996 and 2004.

They found that while around half of the patients developed either acne or darkening of the skin as a result of the procedure most of the side effects had cleared up within two years.

At that stage the volunteers were measured according to an agreed score to determine the reduction in the number of wrinkles.

On average patients had 45 per cent fewer lines and wrinkles across all areas of their face than before the laser surgery, although some had up to 50 per cent fewer, the findings, published in the Archives of Facial Plastic Surgery journal, show.

Patients who undergo the treatment can often go home the same day, although they are advised to stay out of the sun for at least a few weeks as their faces are left extremely susceptible to sun damage.

“Carbon dioxide lasers are the gold standard treatment, with fantastic long term results in wrinkle treatment skin tightening lifting and deep acne scars”

Although different laser treatments had been designed in recent years to reduce the number of side effects, none have been as successful at tackling wrinkles, he added

Why Mesotherapy / Meso-Glow?

The philosophy explained by Dr. Tcheupdjian

Who wants to live to be 150?!

The human body is in a constant state of flux always changing, minute by minute. Our cells are never the same. They are always under attack, being altered, or defected by free radicals (produced by extra electrons of unstable molecules from oxidation and reduction by-products).

I find it rather mind-boggling and ironic that 20 % of the oxygen we breathe converts into destructive and dangerous free radicals. The very thing that we cannot live without “oxygen” in order to breathe has turned out to be very destructive and highly volatile. We implement healthy aerobic and deep breathing exercises to increase oxygen flow to our bodies only to be the recipients of own mitochondrial and nuclear DNA destruction.

The “unstable” oxygen we intake ignites a slow inflammatory response throughout the entire body creating DNA and RNA degradation, cell membrane destruction, and cellular degeneration leading to the creation of waste products (lipofuscins) disturbing our body’s ability to repair itself. Inflammation also interferes with the synthesis of proteins; enzymes and vital hormones, while reducing the counts of vital T-cells causing harm to the immune system.

Free radicals attack the collagen, elastin and connective tissue causing inflexibility and damage to the skin. This process known as “aging” accompanied with the creation of mutant cells eventually leads to cancer and death. It’s almost as if we are providing truth to Shakespeare’s statement, “We owe God death.” My practice believes aging is preventable and “the war on aging has just begun,” so says the slogan of the American Academy of Anti-aging medicine.

Together with Mother Nature, medical scientists have created a powerful cure for preventing and counteracting the harmful oxidation process: The miracle of antioxidants, working to combat free radicals (or free radical scavengers). They actually seek out free radicals and bind them before they can attach themselves to other molecules and cause cross-linking. The key is learning how to maximize their effects, and our practice has done just that by means of medical treatments, oral supplementation, topicals, and through the miraculous healing effects of mesotherapy dermal penetration.

About Dr. Tcheupdjian...

Leon Forrester Tcheupdjian, M.D. (Dr. T.) Founder / Medical Director Liposuction and Cosmetic Surgery Institute, Chicago

World renowned cosmetic & plastic surgeon, Dr. Leon Forrester Tcheupdjian (Dr. T.), has specialized in Liposuction/ Lipotherapy and related procedures since 1981.

He has performed or supervised probably more Liposuction / Lipotherapy procedures than any other American plastic surgeon. He teaches other physicians the art and science of Liposuction / Lipotherapy and fat transplantation.

The Pioneer of Liposuction / Lipotherapy

The Preeminent plastic surgeon, Chicago based Doctor Tcheupdjian (Dr. T.) is the author of one of the most respected reference textbooks on Liposuction. He is recognized as a pioneer in the development and practice of new techniques in current use. He has designed several of the modern surgical instruments currently used in Liposuction and fat transfer.

With full passion, Dr. Leon Forrester Tcheupdjian, travels the world, sparing nothing, to bring the latest innovations and technology to his practice. As a noted authority, the doctor has appeared on television, radio, and in print publications.