Both our medical doctor and the staff naturopathic doctors have done extensive training in natural (bioidentical) hormone replacement. Dr. Steve Parcell is board certified in anti-aging medicine through the American Academy for Anti-aging Medicine (A4M). We offer all types; from hCG to testosterone injections, creams and pellets. * These prescriptions may be covered by insurance.
NatureMed has been in the Denver/Boulder area for 16 years. We spend the time it takes to get your hormones right. We don’t feel it should be expensive and do not charge membership fees. Testosterone should be bioidentical not synthetic. NatureMed has a medical doctor on staff to meet all of your natural testosterone replacement needs in Boulder. Testosterone can apply to women too.
Testosterone assists the male body in building protein and is crucial for normal sexual drive and stamina, and in producing erections. Testosterone also has positive effects on mood, cognitive ability and behavior. Several published studies have shown the beneficial effects on quality of life by normalizing testosterone levels with testosterone replacement therapy. Most importantly, normalizing testosterone levels may reduce the risks of developing serious medical conditions. There is mounting evidence linking low testosterone levels to long-term medical conditions.
Bioidentical testosterone replacement therapy for men
NatureMed is an integrative, naturopathic medical clinic located in the Greater Denver area. One of our offerings is bio-identical hormone replacement therapy. As men age testosterone levels naturally decline starting at around 30 years of age, declining at 1% per year. Though this is a normal process it sometimes occurs too early. The term bioidentical hormones refers to hormones in their natural state, the type made by the body naturally. We never use synthetic hormones.
When is bioidentical testosterone replacement therapy indicated in men?
Certain drugs, medical conditions and treatments can cause low testosterone. We have seen many men come in with normal testosterone which goes much lower when cholesterol lowering therapy is started. This is because cholesterol is a precursor for testosterone.
Patients who have been on narcotic-based pain medications commonly experience a dramatic drop in testosterone as well. Endurance athletes may also experience low testosterone as a consequence of excessive training. There is a normal reference range for testosterone in men of all ages. A man may have a normal testosterone level his whole life until he is 70 years old when it finally drops below what is normal for a 70-year-old. Conversely, some men experience significant decreases in testosterone in their 30’s, 40s or 50s. Hypogonadism is a clinical condition in which low levels of serum testosterone are found in association with specific signs and symptoms. There are two types of hypogonadism; primary, meaning the testes are not working and secondary, meaning the signals from the brain are not working. In older men above the age of 65 or 70 years, the changes in total testosterone are overshadowed by a more significant decline in free testosterone levels. This is a consequence of the age-associated increase of the levels of sex hormone binding globulin (SHBG). SHBG is the protein that binds up serum testosterone and makes it unavailable for use. Only free testosterone has a major physiologic effect.
LOW TESTOSTERONE IS A MEDICAL CONDITION THAT SHOULD BE TREATED
Signs and symptoms of low testosterone (low T)
- A decrease in muscle mass and strength
- A decrease in bone mass and osteoporosis
- An increase in central body fat
- Loss of energy and drive
- Other symptoms such as a decreased libido, erectile dysfunction, forgetfulness, anemia, difficulty concentrating, insomnia, and a decreased sense of well-being are also sometimes present.
Hypogonadism (Low T) may result in significant decrease in quality of life and adversely affect the function of multiple organ systems. Population-based studies done in the last 10 years indicate that low testosterone levels are associated with an increase in the risk for developing type 2 diabetes, metabolic syndrome, heart disease and even a reduction in longevity. In men, testosterone concentrations are inversely related to mortality due to cardiovascular disease and all causes. Low testosterone may be a predictive marker for those at high risk of cardiovascular disease.
Diagnosing low testosterone in men in the Denver/Boulder area
The diagnosis of hypogonadism includes demonstration of a low total or free testosterone and clinical symptoms such as erectile dysfunction, decreased muscle mass and strength, increased body fat, decreased bone mineral density and osteoporosis, mild anemia, breast discomfort and gynecomastia, hot flashes, sleep disturbance, body hair and skin alterations, decreased vitality, and decreased intellectual capacity (poor concentration, depression, fatigue). In the presence of many symptoms of testosterone deficiency and borderline serum testosterone levels, a short therapeutic trial may be tried. An inadequate response to testosterone treatment requires reassessment.
Testosterone Deficiency Questionnaire
- Do you have a decrease in libido or sex drive?
- Do you have a lack of energy?
- Do you have a decrease in strength and/or endurance?
- Have you lost weight?
- Have you noticed a decreased “enjoyment of life”?
- Are you sad and/or grumpy?
- Are your erections less strong?
- Have you noticed a recent deterioration in your ability to play sports?
- Are you falling asleep after dinner?
- Has there been a recent deterioration in your work performance?
A positive ADAM questionnaire is defined as “yes” for question 1 and 7, or yes for questions 2-4 (but not the others).
Benefits of testosterone replacement therapy:
- Improved sexual desire and function
- Increased bone mineral density
- Improved mood, energy and quality of life
- Change in body composition and improve muscle mass and strength
- Improved cognitive function
- Improved fat and sugar metabolism (improvement in metabolic syndrome)
- Increases in coronary blood flow in patients with coronary heart disease and beneficial effects on blood vessel function and coagulation. The net effect is a reduction in risk of clotting and improvement in circulation.
- Testosterone has also been shown to increase the ejection fraction of the heart, meaning more blood is pumped with each beat.
Risks of testosterone replacement therapy
Though rare, risks relating to testosterone replacement therapy in men do exist.
- Stimulate growth of already existing prostate cancer and male breast cancer
- Worsen symptoms of benign prostatic hypertrophy
- Cause gynecomastia (increase in breast tissue secondary to elevations and estrogen). This can be prevented.
- Cause elevated red blood cell count
- Cause testicular atrophy and infertility (not a problem if you already had all the kids you want to have)
- Cause or exacerbate sleep apnea
- Liver cancer if used at super physiologic levels (e.g bodybuilders) it has not been convincingly proved that testosterone replacement can cause development of cancer when used in the usual therapeutic doses.
- Testosterone does not cause prostate cancer!
Testosterone replacement therapy, if done correctly, provides more benefits than risks!
See this article on testosterone replacement in older men.
*In the state of Colorado testosterone replacement must be approved and prescribed by our medical doctor.
1. Nieschlag E, Swerdloff R, Behre HM, et al. Investigation, treatment and monitoring of late-onset hypogonadism in males. Aging Male. 2005;8:56-58. [PubMed]
2. Morales A, Schulman CC, Tostain J, Wu FCW. Testosterone deficiency syndrome (TDS) needs to be named appropriately – the importance of accurate terminology. Eur Urol. 2006;50:407-409. [PubMed]
3. Rhoden EL, Morgentaler A. Risks of testosterone-replacement therapy and recommendations for monitoring. N Engl J Med. 2004;350(5):482-492. [PubMed]
4. Harman SM, Metter EJ, Tobin JD, Pearson J, Blackman MR. Baltimore Longitudinal Study of Aging. Longitudinal effects of aging on serum total and free testosterone levels in healthy men. J Clin Endocrinol Metab. 2001;86:724-731. [PubMed]
5. Ding EL, Song Y, Malik VS, Liu S. Sex differences of endogenous sex hormones and risk of type 2 diabetes: a systematic review and meta-analysis. JAMA. 2006;295:1288-1299. [PubMed]
6. Laughlin GA, Barrett-Connor E, Bergstrom J. Low serum testosterone and mortality in older men. J Clin Endocrinol Metab. 2008;93:68-75. [PubMed]
7. Laaksonen DE, Niskanen L, Punnonen K, et al. Testosterone and sex hormone binding globulin predict the metabolic syndrome and diabetes in middle-aged men. Diabetes Care. 2004;27:1036-1041. [PubMed]
8. Khaw KT, Dowsett M, Folkerd E, et al. Endogenous testosterone and mortality due to all causes, cardiovascular disease, and cancer in men: European prospective investigation into cancer in Norfolk (EPIC-Norfolk) Prospective Population Study Circulation 2007. 4116232694-2701. [PubMed]
9. Shores MM, Matsumoto AM, Sloan KL, Kivlahan DR. Low serum testosterone and mortality in male veterans. Arch Intern Med. 2006;166:1660-1665. [PubMed]
10. Araujo A, Kupelian V, Page ST, Handelsman DJ, Bremner WJ, McKinlay JB. Sex steroids and all-cause mortality and cause-specific mortality in men. Arch Intern Med. 2007;167:1252-1260. [PubMed]
11. Lindeman RD, Yau CL, Baumgartner RN, Morley JE, Garry PJ. New Mexico Aging Process Study. Longitudinal study of fasting serum glucose concentrations in healthy elderly. The New Mexico Aging Process Study. J Nutr Health Aging. 2003;7(3):172-177. [PubMed]
12. Vermeulen A. Androgen replacement therapy in the aging male – a critical evaluation. J Clin Endocrinol Metab. 2001;86:2380-390. [PubMed]
13. Bhasin S, Buckwalter JG. Testosterone supplementation in older men: a rational idea whose time has not yet come. J Androl. 2001;22:718-731. [PubMed]
14. Feldman HA, Longcope C, Derby CA, et al. Age trends in the level of serum testosterone and other hormones in middle-aged men: longitudinal results from the Massachusetts Male Aging Study. J Clin Endocrinol Metab. 2002;87:589-598. [PubMed]
15. Liu PY, Beilin J, Meier C, Nguyen TV, Center JR, Leedman PJ, et al. Age-related changes in serum testosterone and sex hormone binding globulin in Australian men: longitudinal analyses of two geographically separate regional cohorts. J Clin Endocrinol Metab. 2007;92:3599-3603. [PubMed]
16. Orwoll E, Lambert LC, Marshall LM, et al. Testosterone and estradiol in older men. J Clin Endocrinol Metab. 2006;91:1336-1344. [PubMed]
17. Yeap BB, Almeida OP, Hyde Z, et al. In men older than 70 years, total testosterone remains stable while free testosterone declines with age. The Health in Men Study. Eur J Endocrinol. 2007;156:585-594. [PubMed]
18. Krithivas K, Yurgalevitch SM, Mohr BA, et al. Evidence that the CAG repeat in the androgen receptor is associated with age related decline in serum androgens levels in men. J Endocrinol. 1999;162:137-142. [PubMed]
19. Zmuda JM, Cauley JA, Kriska A, Glynn NW, Gutai JP, Kuller LH. Longitudinal relation between endogenous testosterone and cardiovascular disease risk factors in middle age men: a 13 year follow-up of former Multiple Risk Factors Intervention Trial participants. Am J Epidemiol. 1997;46:609-617.
20. Gray A, Feldman HA, McKinlay JB, Longcope C. Age, disease, and changing sex hormone levels in middle-aged men: results of the Massachusetts Male Aging Study. J Clin Endocrinol Metab. 1991;73:1016-1025. [PubMed]
21. Araujo AB, Esche GR, Kupelian V, et al. Prevalence of symptomatic androgen deficiency in men. J Clin Endocrinol Metab. 2007;92:4241-4247. [PubMed]
22. Wu FCW, Tajar A, Pye SR, et al. Hypothalamic-pituitary-testicular axis disruptions in older men are differentially linked to age and modifiable risk factors: The European Male Aging Study. J Clin Endocrinol Metab. 2008;93:2737-2745. [PubMed]
23. Veldhuis JD. Aging and hormones of the hypothalamo-pituitary axis: gonadotropic axis in men and somatotropic axes in men and women. Ageing Res Rev. 2008;7:189-208. [PubMed]
24. Kaufman JM, Vermeulen A. The decline of androgen levels in elderly men and its clinical and therapeutic implications. Endocr Rev. 2005;26:833-876. [PubMed]
25. Morales A, Spevack M, Emerson L, et al. Adding to the controversy: pitfalls in the diagnosis of testosterone deficiency syndromes with questionnaires and biochemistry. Aging Male. 2007;10:57-65. [PubMed]
26. Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2006;91:1995-2010. [PubMed]
27. Schiavi RC, Schreiner-Engel P, White D, Mandeli J. The relationship between pituitary-gonadal function and sexual behavior in healthy aging men. Psychosom Med. 1991;53:363-374. [PubMed]
28. Travison TG, Morley JE, Araujo AB, O’Donnell AB, McKinlay JB. The relationship between libido and testosterone levels in aging men. J Clin Endocrinol Metab. 2006;91:2509-2513. [PubMed]
29. Morley JE, Kim MJ, Haren MT, Kevorkian R, Banks WA. Frailty and the aging male. Aging Male. 2005;8:135-140. [PubMed]
30. Baum N, Candace A, Crespi CA. Testosterone replacement in elderly men. Testosterone replacement in elderly men. Geriatrics. 2007;62:15-18.
31. Shores MM, Moceri VM, Sloan KL, Matsumoto AM, Kivlahan DR. Low testosterone levels predict incident depressive illness in older men: effects of age and medical morbidity. J Clin Pyschiatry. 2005;66:7-14.
32. Lunenfeld B, Saad F, Hoesl CE. ISA, ISSAM and EAU recommendations for the investigation, treatment and monitoring of late-onset hypogonadism in males: scientific background and rationale. Aging Male. 2005;8:59-74. [PubMed]
33. Morley JE, Baumgartner RN, Roubenoff R, Mayer J, Nair KS. Sarcopenia. J Lab Clin Med. 2001;137:231-243. [PubMed]
34. Zitzmann M, Faber S, Nieschlag E. Association of specific symptoms and metabolic risks with serum testosterone in older men. J Clin Endocrinol Metab. 2006;91:4335-4343. [PubMed]
35. Morley JE, Charlton E, Patrick P, et al. Validation of a screening questionnaire for androgen deficiency in aging males. Metabolism. 2000;49:1239-1242. [PubMed]
36. Morley JE, Perry HM, III, Kevorkian RT, Patrick P. Comparison of screening questionnaires for the diagnosis of hypogonadism. Maturitas. 2006;53:424-429. [PubMed]
37. Heinemann LA, Saad F, Heinemann K, Thai DM. Can results of the Aging Males’ Symptoms (AMS) scale predict those of screening scales for androgen deficiency. Aging Male. 2004;7:211-218. [PubMed]
38. Moore C, Huebler D, Zimmermann T, Heinemann LA, Saad F, Thai DM. The Aging Males’ Symptoms scale (AMS) as outcome measure for treatment of androgen deficiency. Eur Urol. 2004;46:80-87. [PubMed]
39. T’Sjoen G, Goemaere S, De Meyere M, Kaufman JM. Perception of males’ aging symptoms, health and well-being in elderly community-dwelling men is not related to circulating androgen levels. Psychoneuroendocrinology. 2004;29:201-214. [PubMed]
40. Kelleher S, Conway AJ, Handelsman DJ. Blood testosterone threshold for androgen deficiency symptoms. J Clin Endocrinol Metab. 2004;89:3813-3817. [PubMed]
41. Isidori AM, Giannetta E, Gianfrilli D, et al. Effects of testosterone on sexual function in men: results of a meta-analysis. Clin Endocrinol. 2005;63:601-602.
42. Morley JE, Melmed S. Gonadal dysfunction in systematic disorders. Metabolism. 1979;28:1051-1073. [PubMed]
43. Matsumoto AM. Andropause: Clinical implications of the decline in serum testosterone levels with aging in men. J Gerontol Med Sci. 2002;57:76-99.
44. Diver MJ, Imtiaz KE, Ahmad AM, Vora JP, Fraser WD. Diurnal rhythms of serum total, free and bioavailable testosterone and of SHBG in middle-aged men compared with those in young men. Clin Endocrinol (Oxf). 2003;58:710-717. [PubMed]
45. Wang C, Nieschlag E, Swerdloff R, et al. Investigation, treatment and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA and ASA recommendations. Eur J Endocrinol. 2008;159:507-514. [PubMed]
46. Citron JT, Ettinger B, Rubinoff H, et al. Prevalence of hypothalamic-pituitary imaging abnormalities in impotent men with secondary hypogonadism. J Urol. 1996;155:529-533. [PubMed]
47. Bunch TJ, Abraham D, Wang S, Meikle AW. Pituitary radiographic abnormalities and clinical correlates of hypogonadism in elderly males presenting with erectile dysfunction. Aging Male. 2002;5:38-46. [PubMed]
48. Rhoden EL, Estrada C, Levine L, Morgentaler A. The value of pituitary magnetic resonance imaging in men with hypogonadism. J Urol. 2003;170:795-798. [PubMed]
49. Buvat J, Lemaire A. Endocrine screening in 1, 022 men with erectile dysfunction clinical significance and cost effective strategy. J Urol. 1997;158:1764-1767. [PubMed]
50. Araujo AB, O’Donnell A, Brambilla DJ, et al. Prevalence and incidence of androgen deficiency in middle-aged and older men: estimates from the Massachusetts Male Aging Study. J Clin Endocrinol Metab. 2004;89:5920-5926. [PubMed]