Over the last few weeks, I’ve covered progesterone, estrogen, DHEA, and pregnenolone (access all past emails via link at bottom of this email). Today I will outline some key considerations on evaluation of and treatment with testosterone.
An outline of today's email:
- Testosterone FYI
- Testosterone “Nevers”
- Prescribing Tips
1: Testosterone FYI
- Blood testing of testosterone may not adequately reflect a need for TRT or determine dosing adjustments (saliva preferred) (study)
- OCPs always reduce testosterone levels (e.g. OCPs increase SHBG, which lowers active testosterone)
- TRT in post-menopausal women can lower Lp(a) by up to 65%
2: Testosterone “Nevers”
- Never prescribe methyltestosterone (associated with an increased risk of liver cancer)
- Only replace testosterone in women with adequate estrogen (or if replacing estrogen), otherwise there is an increased risk of heart disease and plaque formation (since we need estrogen to protect the heart), and testosterone cannot attach to brain receptors without adequate estrogen
- Never prescribe testosterone to someone with a history of breast cancer (due to aromatization of testosterone into estrogen)
3: Testosterone Prescribing Tips
- Prioritize use of transdermal testosterone, apply to top of foot or inner thigh, and know that transference can occur for up to 12 hours
- Always assess serum and RBC zinc status (zinc is needed to metabolize testosterone), and increase if needed
- Max dose should be 2mg (transdermal)
- As with other hormones, my personal belief is that if we are prescribing this, there should be a symptomatic response (and that we aren't just treating lab levels): does the patient have more energy, better memory/cognition/mood, less pain, weight loss....within 12-16 weeks of use?
Thank you for reading, and stay tuned....going to have more live Zoom calls coming up in the new year, workshops, and the mentorship is launching!
Best in health,
Meg
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