Understanding Men’s Issues: Testosterone & Andropause, Part 3

Testosterone, the Hormone of “Desire” by Tom White, RPh, PhC

Testosterone (T) is considered the hormone of “DESIRE” for both women and men. As I mentioned in the last article, it only takes a small amount of T in women to have an adequate response, but it takes a much larger amount of T to have a beneficial effect in men.

THIS ARTICLE WILL DISCUSS SOME OF THE DIFFERENT DOSAGE FORMS USED TO DELIVER TESTOSTERONE TO BOTH MEN AND WOMEN.

The difference between “total” and “free” testosterone is as follows: Total testosterone from a laboratory report represents free (or unbound) and bound hormone, or hormone that is usually bound to protein. Total T tells us how much potential a person has to produce T. But it is only “free” T that is available to combine with a receptor site to elicit or generate a response in the body. We can be very capable of producing a hormone such as T but unless it is in the “free” state, no positive response will be observed.       

Although free T levels in men generally range from 7ng/dl to 25ng/dl to be in the normal range, it is well understood and documented that the effective range for “free” T is between 20-25ng/dl. Women’s “free” T levels generally fall in the range of 1.0-8.5 pg/ml.

COMMON DOSAGE FORMS TO DELIVER TESTOSTERONE TO THE BODY:

• Oral
• Topical (apply to upper outer arm for both men and women, or applied lightly to vulva area in women as instructed)
• Injectable
• Troche (Lozenge)
• Topical oil drops
• Subcutaneous Pellets
• Sublingual

Oral dosage forms of natural bio-identical testosterone are considered to be ineffective since oral T is metabolized by the liver so quickly. But many women take oral T with some degree of success. I have never seen a man respond favorably to oral T. There are no commercially available oral T products; only compounded preparations.

One of the methods the drug manufacturers have improvised to make testosterone more effective orally is to produce methyl-testosterone. The problem with methyl-testosterone is the potential for liver damage and negative effects on lipid profiles. Example: Estratest®

Topical administration of T is generally considered to be the most accepted means to deliver T. It is usually dosed once a day in the morning. Example: Androgel®, Compounded preparations.

THE TOPICAL PREPARATIONS PROVIDED BY TW WELLNESS ARE UNIQUE TO US. WE USE NO PRESERVATIVES AND NO DENATURANTS. WE USE SPECIAL PENETRATION ENHANCERS TO IMPROVE ABSORPTION AND DECREASE CROSS CONTAMINATION TO OTHER INDIVIDUALS AND PETS. ALL OF OUR TOPICAL HORMONAL PREPARATIONS ARE CONSIDERED TO BE HYPOALLERGENIC. All of our formulations are proprietary.

The injectable route of administration is very popular with men, but much too strong for women in general. The injectable method is usually dosed once a week every week, using deep IM injections. Example: DepoTestosterone®, (compounded testosterone cypionate).

The troche and sublingual dosage forms attempt to get T absorbed in the mouth, thereby avoiding the first pass effect of the liver. But this route of administration is generally recognized to be short acting and multiple dosing is sometimes required to produce the best results. Example: Striant® for men, compounded preparations.

Topical oil dosage forms are not well recognized but can deliver T very effectively. Example: TMO® found only and exclusively at TW Wellness.

The implanted T pellets are not uncommon, but correct dosage is very hard to predict. A patient may receive either too much or not enough. Once implanted, you’re stuck with it for 3-4 months.

By far, the topical administration of T is the most popular for both men and women. T is generally dosed in the morning to minimize the negative effects on the body’s own ability to produce testosterone. We want to augment – not interfere with T production. T should be applied to a non-fatty area. Fatty areas of the body contain more of the enzyme aromatase which converts testosterone to estrogen. The upper outer arm is generally recognized to be the best area to apply topical T preparations, because this is a more muscular area of the body. Some practitioners suggest a special T cream for women that may be applied very lightly to the vulva area 2-3 times a week. This is a very popular method of administering T to women.

TW Wellness utilizes a new pump delivery system developed in France to deliver very consistently an 1/8 teaspoonful per pump actuation. This new pump is available for most of our hormonal products. It takes the mess out of dosing with little spoons and a jar. This delivery system is extremely accurate and consistent. With this consistency, the patient will actually receive more doses per unit than with the jar and spoon method.

As a reminder: always wash your hands after applying your topical hormonal preparations.

TW Wellness Compounding Pharmacy and Clinic is a “ONE-STOP-SHOP”. We can take care of all your hormonal requirements. Please contact us to inquire about fees and an appointment with Tom White. 505-717-2342.