[mtex]

For men who get poor results from the above methods, the next alternative is prescription testosterone. There are three methods of delivery -- injectible, patches and gels.

The most often used injectible was testosterone cypionate which was inexpensive both to manufacture and purchase. Unfortunately in the early summer of 2002, Upjohn stopped manufacturing this product. The best guess as to why this occurred is that the government may have simply placed too much red tape record keeping on Upjohn to make something with such a low profit margin worthwhile. Though this is an unproven supposition, it is a generally held belief in medical circles.

That leaves testosterone enthanate manufactured by Bristol-Myers Squibb. This is a much more expensive product although it is slightly more advantageous because it does not cause as much water retention, one of the side effects of testosterone supplementation.

The problem with injectibles is that men either have to show up at their doctor's offices every two weeks (the usual protocol) when weekly injections are better, or inject themselves. It's not that people can't learn to give themselves shots; diabetics do it daily. But this is intramuscular in an oil based suspension, so you need to know what you're doing. In addition testosterone levels are highest after the shot and then decline as time passes. Although this does suffice, it is not the way that the body naturally releases this hormone.

Most men opt for the convenience of patches or gels. Patches are often very problematic, producing skin rashes from the adhesive, falling off due to perspiration or showering, and ugly to look at. They have been pretty much bypassed in favor of AndroGelâ„¢.

AndroGelâ„¢ is a much better product as far as delivery because when put on twice a day, it mimics the normal rise and fall of blood levels of natural testosterone. It's very easy to apply and leaves no telltale residue. The downside is that a man should definitely not rub it on, then a few minutes later hug a child or a pregnant woman.

The same holds true for the prohormone sprays. Dr. Ullis cautions that these products "in the suggested doses . . . may boost your testosterone levels much higher than AndroGelâ„¢. The recommended dose of AndroGelâ„¢ is only 50 to 150 mgs/day, while the prohormone sprays list the upper range dose as high as 800 mgs/day." If you're using these sprays for HRT, then you would need to adjust the dose accordingly.

Side Effects of Testosterone

Like all other medications, testosterone can cause a lot of problems if not used properly. The athletic community often has a "more is better" mentality, but shooting up more testosterone is not like eating a couple of extra helpings of broccoli.

In pubescent males, testosterone levels are sky high. Although they often cause oily skin and acne, these young guys don't have problems with prostate enlargement and hair loss. Of course this might be simply because it hasn't been coursing through their systems long enough. Maybe it's the same reason these kids can also eat an extra large pizza and not get indigestion. Eventually one's system finally says, "Enough already!"

However, what seems to be happening is that as men age and their testosterone levels fall, they start to experience what was once thought to be the bane of high testosterone levels, i.e. heart disease, prostate enlargement and male pattern baldness. It is now believed by many doctors that estrogen is a greater culprit in this story, at least in men with testosterone deficiencies.

Even so, it pays to proceed with caution. Dr. Ullis insists his male patients be regularly tested for prostate problems as well as placing them on various prostate-protecting supplements that include "saw palmetto, quercetin, and lycopene" in order to help "prevent prostate enlargement and inflammation," and possibly prevent cancer as well.

The bottom line for men is that HRT can "have powerful anti-aging effects if the proper treatments are used." Many can actually "find a new lease on life and sexuality" after their hormones are restored to youthful levels. "The key . . . is finding the right treatment option."

What About the Girls?

Many women are taking supplemental estrogen. Often this is handed out whether it's needed or not. During a routine office visit some years ago, my doctor flipped through my chart and stated, "Let's see, you're 52. You should be taking estrogen." My question was "Why? I'm not having any problems." I got the usual lecture about osteoporosis, never mind that I was working out like a madwoman four days a week in the gym. My response was that if he wished to prescribe a hormone, I'd prefer to have testosterone. He laughed although he did agree that for my goals, it would be the better choice.

Because I was so entrenched in the physique community, which is often several years ahead of the mainstream, I had become aware that Premarinâ„¢ and Proveraâ„¢, synthetic estrogen and progesterone, respectively were possible causes of breast and cervical cancers. Several women I knew who were undergoing treatment for these conditions had taken these medications.

The present thinking in the up-to-date medical community has changed toward the use Premarinâ„¢ or Proveraâ„¢ and doctors have become more cautious or often seek other alternatives.

The problems with these synthetic estrogens are that they are manufactured from the urine of pregnant horses. Even though human estrogen is close, it's not quite the same. Natural human estrogen as we think of it, is not one compound, but three, i.e. estrone, estradiol and estriol. Horses have a different ratio than humans, not to mention some hormones that humans don't even have in the first place. It is this difference, used over a period of time, that is thought to be the a possible cause of cancer.

There are women who have taken Premarinâ„¢ and Proveraâ„¢ for years, like 20 or 30! - and are doing fine. Currently most doctors will not give these drugs to women who have a family history of reproductive cancers.

Dr. Ullis has a contrary opinion to much of the mainstream. "Believe it or not, there are actually more women who need testosterone replacement therapy than men." The reason for this is that even in peri-menopause (the period before actual menopause) women "stop producing testosterone almost completely or have very low levels of free testosterone and precursors such as DHEA and androstenedione."

When women's testosterone levels get low, they suffer from the same complaints as men, thus it should be considered "as a front line treatment." Dr. Ullis states that small amounts (usually a gel needs to be made specifically for each woman by a compounding pharmacy) can turn women's lives around. They perk up, lose fat, have an interest in sex and even make rather dramatic improvements in their exercise programs.

Like men, women shouldn't just go willy-nilly slapping on dabs of their man's AndroGelâ„¢! They also need a blood panel and cancer screening tests.

Dr. Ullis has also recommended prohormones for some female patients, albeit in very small doses. However, with these over-the-counter prohormones, unlike a pharmaceutical grade cream, there is no controlled regulation as to quality, ingredients and dosage in the supplement industry. (They can also cause very unsightly skin problems.)

After the recent problems with athletes testing positive because 19-norandrostenedione was being surreptitiously slipped into protein powder without anything being put on the label and without the purchaser being any the wiser, one can also wonder what else is in the unlabeled prohormone bottle.

So What About Big E?

Dr. Ullis does not prescribe Premarinâ„¢ for two reasons. The first is that not every woman needs estrogen replacement, and secondly he is of the mind that it definitely can increase the risk of breast cancer. It can also lead to unnecessary weight gain in a population that already has enough problems in this regard.

If women are experiencing uncomfortable symptoms such as hot flashes, natural plant phytoestrogens may help in this regard "and may actually lower the risk of breast cancer and do not lead to weight gain." This is particularly fortuitious because many women have problems that interfere with their lives at a time when they can least afford it. Many are at the epicenter of a circle that includes an employer, older children and elderly parents. A middle aged woman is trying to juggle these while still trying to find time for her husband or significant other and herself. She needs all the energy she can get!

So what if you're one of these women whose body just does a number on you and you wake up every night drenched to the skin, cry at the drop of a hat, get angry for no good reason, have no interest in sex, etc.? If phytoestrogens don't solve your problems, Dr. Ullis would probably prescribe a natural "bio-identical estrogen" cream or gel, favoring "estradiol over estrone and estriol since these latter two forms of estrogen are possibly transformed into more toxic metabolites." He always encourages his patients to discontinue Premarinâ„¢. In fact he feels that some problems women encounter, i.e. the inability to lose fat, may be "due to the excess estrogen" they have been ingesting.

Hormone No. 3 - Progesterone

We hear about this constantly, but what is it? In young women, progesterone is the primary hormone that prepares the lining of the uterus to receive and accept a fertilized ovum. Is this something that's necessary for a woman past childbearing age? Nature obviously doesn't think so, but Nature shuts down other hormones as well.

Proveraâ„¢, which is a synthetic compound that doesn't quite match the natural human hormone, is "somewhat androgenic . . . women can become irritable and agitated from using it [as well as] experience other side effects such as acne." Natural progesterone, on the other hand, "can have a calming, relaxing effect on women."

The combination of synthetic estrogen and progesterone is usually the weight gain culprit because while estrogen encourages fat storage, progesterone increases appetite. Natural compounds have the opposite effect, or at least a neutral effect.

If you, as an over-fat woman wish to lose weight, Dr. Ullis recommends you forget progesterone, and especially Proveraâ„¢. On the other hand, for a woman who might be at risk for endometrial cancer, he will often recommend very small doses of a natural gel. Dr. Ullis' final statement is that he believes the combination of Premarinâ„¢ and Proveraâ„¢ to be "a travesty against women and may be one of the major factors behind the obesity epidemic in America." Strong words, but worth heeding.

Human Growth Hormone (hGH)

If you've picked up a muscle glossy at any time over the past few years, you're bound to come across some article discussing the fabulous success of those who have used hGH. The supplement industry has rushed out a bunch of products they claim will boost your natural production. These products are scams and a complete waste of money.

Prescription Growth Hormone is ghastly expensive and must be injected, like insulin, just under the skin and at the proper time of the day to coincide with the body's release. Most people find this extremely inconvenient not to mention that unless someone has been medically tested and shown to be deficient, like the supplements, it's a total waste of time and money. Dr. Ullis reports that he does have patients who have been screened and have come up short. If that's the case then he will prescribe it for them, but only if they do not respond to other therapies first.