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Hormone Replacement Therapy: Guide for Men


If you are familiar with the term hormone replacement therapy, it is probably in reference to women who are experiencing menopause. Then why are we talking about it? Because it is a recent category in men’s health and that studies are showing benefits. This hormone replacement therapy guide will teach you everything you need to know relating to this solution for men. Some benefits are:

  • Increases sex drive
  • Improves erections and reproductive functions
  • Builds muscle bulk
  • Maintains healthy levels of red blood cells
  • Maintains bone density
  • Increases body and facial hair
  • Improves energy level

Hormone replacement therapy clinics are popping up all over the country and the demand is increasing. Let’s talk about the ins and outs and if it is for you.

What is hormone replacement therapy?

A hormonal imbalance can occur at any point in your life. It can also be the only state of existence you have ever known. Male hormone imbalance can be brought on by stress, an acute injury or illness, poor nutrition, inadequate exercise, and many other things.

The glands that make up the endocrine system are involved in an intricate balance with each other. Just one gland at one juncture can set things awry throughout your whole body with symptoms that are difficult to diagnose.

Low testosterone can also make things difficult. Just because you have been told your hormones are normal, that does not mean they are optimized. Testosterone is needed for:

  • Male sexual development
  • Reproductive function
  • Building muscle bulk
  • Maintaining healthy levels of red blood cells
  • Maintaining bone density

The symptoms of hormone imbalance are vague and often misdiagnosed and ignored. The only way to know is by getting your hormones checked through a blood test. This can be done in a doctor office through saliva testing, blood testing, blood serum testing, or urine testing.

The most common symptoms of hormonal imbalance in men are often disregarded until they impact the quality of life so severely that treatment is aggressively needed. Some of the symptoms of hormone imbalance in men include:

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  • Fatigue
  • Insomnia
  • Weight Gain
  • Brain Fog
  • Decrease Sexual Performance
  • Inability to Maintain Muscle Mass
  • Depression
  • Anxiety
  • Diabetes
  • Heart Disease
  • Osteoporosis

What does it mean to have low testosterone?

Natural testosterone production decreases with age. The American Urological Association estimates that about two out of 10 men older than 60 years have low testosterone and about three out of 10 in their 70s and 80s. A male’s highest testosterone level usually peaks at about age 20, and then it decreases slowly with age. It has been suggested that a 1.5 percent decrease in testosterone level per year is normal for middle-aged (30 to 50 years old) and older males. While this decrease may not be noticeable in some men, others may experience significant changes starting in their middle-aged years or more commonly at age 60 and above.

The measurement used to determine low testosterone is diagnosed as levels less than 300 nanograms per deciliter (ng/dL). A normal range is between 300 and 1,000 ng/dL and a level of 679 ng/dL is about average. Some research indicates that the healthiest men have a range between 400 to 600 ng/dL.  A blood test known as a serum testosterone test is used to determine your level of circulating testosterone.

You can start monitoring your testosterone at age 35 and then have it checked every five years. If your levels fall too low or if you start to have some of the symptoms of low testosterone, you can begin HRT. Once you start the therapy your levels should be closely monitored in order to make sure the levels don’t become too high, because that’s a problem, too.

What are the benefits of hormone replacement therapy?

Hormone replacement therapy can help anyone whose hormones are out of balance at any time. However, as much as a third of the population may experience hormonal imbalance as they age. We also encounter circumstances in which a man has never experienced balanced hormones, as evidenced by symptoms including exhaustion, irritability, and extreme mood swings.

You will also gain:

A healthy heart and blood – testosterone helps red blood cell production through bone marrow so having a healthy heart that pumps blood and provides plenty of oxygen to muscles and organs is important for training performance. A study of 83,000 men whose testosterone levels were returned to normal after therapy were 24 percent less likely to have a heart attack and 36 percent less likely to have a stroke.

Decrease fat and increase muscle – testosterone increases muscle mass but not necessarily strength. You will need to combine therapy with strength training and exercise.

Stronger bones – Testosterone plays a huge role in bone mineral density. Bone density decreases as men age and testosterone levels drop. This raises the risk of weak bones and osteoporosis. Strong bones help support your muscles and internal organs, which can boost athletic performance. Research shows that bone density increases with testosterone treatment as long as the dose is high enough. Clinical trials on the effect of testosterone on bone density found increases in spinal and hip bone density.

Better verbal memory, spatial abilities, and mathematical reasoning – maybe your days of SAT prep are long gone, but research indicates that men with higher ratios of total testosterone have a reduced incidence of Alzheimer’s. There is also evidence that thinking abilities and processing speed are correlated with testosterone levels. Treatment for men ages 34 to 70 has also shown an improvement in spatial memory.

Better libido – this one is a little tricky. Testosterone levels naturally rise in response to sexual arousal and activity so men with higher levels of testosterone usually have greater sexual activity. Older men need more testosterone for libido and erectile function. There is a maximum level of testosterone before there’s no increased response, so taking more won’t increase response and for men who don’t have hypogonadism, your libido may not increase with testosterone treatment.

Improved mood – Lower testosterone levels are associated with poorer quality of life. Some of the symptoms of low testosterone levels include depression, fatigue, and irritability. But some research shows that this may only be for men with hypogonadism. Men whose bodies follow the normal decrease of testosterone over time didn’t show an increase in depression. The effects of testosterone replacement therapy on mood can vary. Men with hypogonadism reported improved mood and well-being and reduced fatigue and irritability. Research suggests that this treatment may also be an effective anti-depressant treatment.

Different forms of hormone replacement therapy

Depending on what you need and your tolerances, there are a few ways to take HRT:

  • Injections – if done by a doctor or clinician, you will get a deep intramuscular injection and can be high or low levels. There is no daily regimen and can cause mood fluctuations. The DIY kind is another story and we will cover it later.

Hormone replacement doctors

  • Implants – a subdermal implant has about 5-10 gms of hormones and is a nonsurgical procedure to place it. There is a slight risk of the implant migrating. It should last three to six months.
  • Skin Patch – there are either skin patches or scrotal patches that you can use, with doses varying between 2.5 mg/day and 6 mg/day. If you use the scrotal patch, you will have to shave daily and the absorption is variable. For all other skin patches, the skin can welt at the patch site.
  • Gels (Androgel, Testim) – these are the most popular choice of patients, with 70 percent choosing gels. They are the most convenient but can transfer to others. So, if you have children and it gets on them, they can actually go into early puberty.
  • Pill – these are a 30mg buccal tablet taken twice a day. You can experience mouth or gum irritation and even a change in our taste.
  • BHRT pellets are inserted subcutaneously in the hip area in a quick in-office visit. Within seven to ten days after your pellet insertion, Bio-identical Hormone Replacement Therapy (BHRT) begins to work and patients are back to their active lifestyles.

Does it really work?

So, here we go with some science on how this works. Testosterone is tricky because it exists in several different forms in the blood and each form has its own hormonal activity. “Free” or unbound testosterone is a fully active hormone, but protein-bound testosterone is only partly active, or sometimes completely inactive. What is usually measured in a blood draw is the total testosterone, which is a combination of the free and protein-bound forms.

An analogy to explain this is to think of the total testosterone as all of the cars in a parking lot. Only the cars that can start or drive are useful and free testosterone is all the cars that can start and be driven away, but the protein-bound are the cars that may or may not start, and the ones that may or may not be driven away.

Aging is fewer cars in the lot (lower total production) and higher levels of certain proteins that bind testosterone so that even fewer cars start and run. This combination is what leads to declining testosterone activity with age.

Testosterone replacement therapy can have some pretty good benefits, such as:

Better bones – testosterone can improve bone mineral density and reduce fractures, just as found in postmenopausal women on estrogen. Hip fractures are two to three times as likely to kill an older man as a woman of the same age, and 40 percent of older male patients with hip fractures die within a year of the injury.

Leaner body – this is probably what you’re here for. It results in an increase in lean body mass, possibly increases strength, and can decrease fat mass. HRT Stimulates erythropoietin and therefore increases blood count. It has been shown to improve lipid profiles and dilate blood vessels but it’s not known if this reduces heart attacks and strokes. It does not seem to alter LDL or total cholesterol. Recent testing has shown that men with chronically low testosterone levels have two to three-FOLD higher risk of developing metabolic syndrome and have a 40 percent greater risk of death than men with normal testosterone levels.

Better sexual health – and oh yeah, this too. Sexual function improves with testosterone. Most research agrees that sexual drive is improved by testosterone but penile erections may only be improved in men who have low testosterone levels. Low testosterone is actually an unusual cause of erectile problems in older men (like six percent unusual) because lower sex drive and age-related changes to the penis are more common.

Who is hormone replacement therapy designed for and who can it benefit?

  • Men in their 30s
  • Men in their 40s
  • Men in their 50s and 60s
  • Men in their 70s and beyond
  • Professional athletes
  • Gym-goers and non-professional athletes

What are peptides and how do they work?

Peptides are a compound of two or more amino acids where a carboxyl group of one is united with an amino in another group. Eliminate a molecule of water and a peptide bond is formed. They are kind of small proteins. Anything with fewer than 50 amino acids is considered a peptide. A dipeptide is two amino acids joined by one peptide bond. A polypeptide is a long, un-branched chain of amino acids joined by peptide bonds but isn’t complex enough to be considered a protein.


Intake and production of all the amino acids are necessary for the production of all the peptides that are needed for your body to work efficiently. As we age and go through different stages with different diets, stress, and physical changes, some essential amino acids and peptide production is down-regulated.

Peptides have a lot of functions in your body and some act like neurotransmitters and some act like hormones. Several amino acids are necessary for sufficient amounts to produce hormones such as human growth hormone (HGH). If you can’t absorb or make enough of these amino acids, your production of that hormone will be low. If you have athletic or fitness goals you want to make sure you can perform and recover as quickly as possible.

Amino acid supplementation is pretty common among fitness folks. However, peptide supplementation is becoming more common. What’s the advantage? First, peptides are digested and used more readily by the body as they are smaller and your body doesn’t have to break down a larger protein molecule. Also, peptides are thought to be more stable in the body and therefore more beneficial than the more unstable, un-bonded amino acids.

These might be familiar to you in the form of glutamine or creatine and have quicker absorption and fewer side effects. You could also take them in pill or powder form and are referred to as “pre-digested” proteins or peptides. Injectable peptides are banned by most athletic governing bodies. They are taken to increase lean body mass, lower body fat, and improve recovery speed after a workout. Examples are IGF-1, GHRP-6, and Ipamorelin.

Potential risks associated with hormone replacement therapy

There are, of course, risks associated with taking hormones.


  • Decreased sperm count – this is due to the decrease in testicle size, as described below.
  • Breast enlargement – some testosterone is converted into estradiol, a form of estrogen, whether you take the hormone or not. In men who have more breast tissue naturally, the testosterone that they are taking is naturally converted into estradiol. This could stimulate breast tissue to grow. It’s pretty uncommon but if it does happen, your doctor will probably stop treatment for a couple of months to let the tissue go back to normal then when you resume treatment you will add a drug that blocks the conversion of testosterone to estradiol.
  • Decreased testicle size – this is the most common side effect of testosterone replacement therapy. Normally your pituitary gland senses that there isn’t enough testosterone in the bloodstream and it sends a luteinizing hormone to signal to your testicles to produce more testosterone and a follicle stimulating hormone to produce sperm. If you take supplemental hormones, your pituitary gland gets the message that there’s enough testosterone in your system so it stops sending the signals. Your testicles pretty much go to sleep. This means it can hamper fertility so if you are planning on having kids, you can’t really have this as an option. Your production might not go back to normal after you stop treatment, either.
  • Acne – your skin type can change by increasing oil production. If there is too much you will have breakouts. It’s not common but if you had acne as a teenager you might be susceptible to it again.

Other reasons someone may need hormone replacement therapy

There are many other hormone replacement therapies available and they are used by many different kinds of people. If you have spent time searching you know that there is a whole lot of information out there. Not all of it pertains to what you are looking for, but should be included in our guide for the sake of completeness.

  • Hormonal therapy for cancer – is a cancer treatment that slows or stops the growth of cancer that uses hormones to grow. It is also called hormonal therapy, hormone treatment, or endocrine therapy. It can make a tumor smaller before surgery or radiation therapy, lower risk that cancer will return, and destroy cancer cells that have returned or spread to other parts of your body. Used for prostate and breast cancer.
  • Transgender hormone therapy – this is used on those who are seeking to transition from their birth gender to the one that more closely aligns with their gender identity.

The information on this website has not been evaluated by the Food & Drug Administration or any other medical body. Information is provided for educational purposes. You should consult your doctor before acting on any content on this website.

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