Bio-identical Hormone Replacement (BHRT) for Men

Integrative Clinical Pharmacist Scott Berliner, RPh

Low hormone levels in men seem to be just as prevalent as in women, although it seems that fewer men seek help with this issue. Available treatments have become diverse. Yet no pharmaceutical company has found a way to produce individualized, custom therapy for all the different imbalances that can appear in today’s world of toxins, many of which have endocrine disruptive properties. A fine compounding laboratory, in conjunction with an integrative physician, can recognize these imbalances from a symptom history and extensive blood work and then create the proper formula to address any imbalance.

Testosterone is the most common hormone we replace but the formulas can address deficiencies of DHEA, sometimes called the “Mother Hormone” and progesterone as well. It is important to understand that you cannot just replace a single hormone without looking at what happens once the deficient hormone is introduced. Testosterone can aromatize, or change form in the body, to other substances like estrogen or dihydrotestosterone. These are not desirable metabolites so we often add Chrysin or diindolylmethane (DIM). Chrysin is an extract from the plant Passiflora Incarnata, or passionflower. This extract is a flavonoid-rich substance that contains polyphenols which have been used in the past as natural aromatase inhibitors. Bodybuilders took it orally under the name “Flavone X”. The literature on Chrysin is quite good and the studies on it were fairly solid, but were done on an “in vitro” sample. This type of sample is created by re-creating the body fluids and then putting the substance to be tested into the fluid and watching how it behaves. Unfortunately when these studies were applied directly to men the same result did not occur. It turns out that Chrysin is difficult to digest and absorb and incredibly high doses of 6 to 8 capsules a day would be required to replicate the result.

In a fine compounding laboratory we can reduce the particle size of the Chrysin sufficiently to administer it transdermally which is a topical application to the skin. DIM or diindolylmethane is a natural substance formed from the breakdown of plant cells from the Brassica family of vegetables. This family includes broccoli, kale, brussel sprouts and cauliflower. DIM is a fat-soluble substance and is ideal as an addition to these topical formulas. DIM can prevent the conversion of testosterone to estrogen, thus freeing up more of the bound estrogen and allowing lower doses and less negative metabolites. In addition, DIM can aid in preventing the conversion of the estrogen that is formed into undesirable metabolites that can cause problems in long-term use. BHRT in men is usually done long term.

So the pharmaceutical dynamics of the created formula is based on correcting the deficiencies as well as the prevention of negative metabolites. An integrative compounding pharmacist is aware of these possibilities and looks for them in formulating the appropriate combination of ingredients.

Transdermal administration of hormones is not the only way these deficiencies can be addressed but it is the most common. When these formulas are prepared properly, absorption through the skin is an ideal method of administration. Since all hormones are fat-soluble the vehicle is created as an oil-in-water emulsion. This “cream” can then carry the hormones through the fat cells in the skin and then the water component continues the journey through the semi-permeable membranes in the capillaries thus bringing the hormones into the blood.

I have had some experiences where despite adequate doses of the hormones, blood levels did not rise adequately or symptoms were not being controlled as expected. There is a small percentage of the population that does not absorb well through this pathway and for those men we can create a similar formula in a lozenge that can be dissolved in the mouth and then absorbed through the sublingual route under the tongue. This route has a faster onset but the levels can drop more rapidly than when the hormones are allowed to deposit in the skin, where they can be absorbed as needed on a more consistent basis.

Some men have levels so low that the physician, upon diagnosis, may opt to give an intramuscular injection. The injection route is the fastest acting, usually causing a fairly dramatic rise in levels in a relatively short period of time. This is not the preferred method as it can also cause dramatic drops in levels if therapy is not continued. It is usually reserved for severely low levels accompanied with symptoms that need to be addressed immediately, like severe depression, a common symptom of low testosterone.

Testosterone deficiency in men, known as andropause, is becoming more common, but with a good team comprised of the “Triad” (the patient, the integrative physician, and the integrative pharmacist) wonderful, non-invasive solutions are becoming readily available and affordable. For some men this may make a huge difference in the quality of life.