Category: Bio-Identical Hormones and Testosterone Therapy

Many women and men, feel the changes of hormones as early as their mid-thirties.  The most common symptoms are depression, weight gain, poor libido, skin changes and vaginal dryness (in women).  Women, may experience these symptoms even if they are still getting their monthly cycles.

The first step in figuring out whether your symptoms are related to hormone changes is to have hormone levels tested.  I usually recommend checking some basic bloodwork and thyroid levels in addition to estrogen, progesterone, testosterone and DHEA levels.  Normal hormone levels do not rule out a hormone problem.  Some people with low-normal hormone levels, my develop symptoms of hormone deficiency.

We check hormone levels with bloodwork or saliva tests.  I often start with bloodwork as that is more likely to be covered by insurance.  If the hormone levels are low, I offer patients several alternatives.

Men can use a medication, called Clomid, to increase their testosterone levels.  Clomid is especially useful in young men because it does not reduce sperm count the way testosterone therapy does.  If men choose to start testosterone therapy, I explain the pros and cons of testosterone injections, creams, patches and pellets.  Men choose which of those are best based on their preference.

In women, I recommend bioidentical hormone replacement therapy when natural therapies do not alieve menopausal symptoms.  Bioidentical hormones differ from standard, synthetic hormones because they are the same molecular structure as the hormones your ovaries make.  Bioidentical hormones, have less side effects and less risk of blood clots and stroke than standard hormones.  Less risk does not mean no risk, and I always discuss these pros and cons with my patients prior to prescribing.

Anne Hermann, MD is a board Internal Medicine physician who trained at Columbia University in New York.  She was first author in the study that demonstrated that the bioidentical progesterone cream is absorbed as well as progesterone pills. Over-the-counter progesterone cream produces significant drug exposure compared to a food and drug administration-approved oral progesterone product.  Hermann AC, Nafziger AN, Victory J, Kulawy R, Rocci ML Jr, Bertino JS Jr.J Clin Pharmacol. 2005 Jun;45(6):614-9.

As a research pioneer on bioidentical hormone therapy, Dr. Hermann has been treating men and women for 12 years in Tampa Bay.  For additional information on hormone therapy, please call the office at (813) 902-9559.

Generally, when low testosterone is diagnosed, testosterone replacement therapy is prescribed. It commonly comes in the form of cream, gel, pellet, patch, and injection. While these therapies are effective, there are known side-effects such as testicular shrinkage, prostate enlargement, breast enlargement, low sperm count/sterility, and overproduction of red blood cells. Given the side effect of sterility, testosterone replacement is not the ideal option for men who want to have children. I feel a better option to consider is the use of clomiphene citrate (Clomid).                                                            

Clomiphene citrate is a prescription medication originally used to treat infertility in women. It works by stimulating an increase in the amount of hormones (FSH and LH) that support the growth and release of a mature egg (ovulation). These are the same hormones that increase testosterone, sperm production, and fertility in men.

In a healthy male the pituitary releases LH, the hormone which signals the testes to produce testosterone. After testosterone is produced, some of it is converted to estrogen. Estrogen then signals the pituitary to stop making LH. This is known as a feedback mechanism, where the body communicates with the brain when there is a need for hormone production. With traditional testosterone replacement, the brain gets the message that there is plenty of testosterone being made in the testes. The pituitary stops producing LH and subsequently the natural production of testosterone stops, which leads to the common side effects of testicular shrinkage, low sperm count, and infertility.

Clomiphene citrate on the other hand does not turn off the production of testosterone, it rather stimulates the body’s natural production of it by increasing LH, the hormone responsible for testosterone production. It comes in a pill form and is safe to use with minimal side effects. Some men may require continuous use of clomiphene citrate while others may need it only for 3-6months.

At Hermann Aesthetics & Wellness, we offer our patients Clomid therapy for low testosterone. Please call the office at (813) 902-9559 for more information or to schedule an appointment.