Selecting the Right Doctor for Male Hormone Replacement Therapy

Aside from its findings on the safety and efficacy of various forms of HRT in men, Renew Man provided a valuable service to the public by describing the caution a male patient must exercise in selecting a physician to prescribe HRT initially and monitor his progress throughout the course of treatment. According to Renew Man, because of relatively lax medical laws and regulations in the state of Florida in the United States, many subpar providers of HRT operate out of that state. Among the many errors committed by these subpar providers were using the same HRT protocol for all patients, rather than an individualized approach; failing to test thyroid hormone and DHEA levels; failing to monitor and control hematocrit thereby increasing the risk of stroke some men experience from taking therapeutic doses of testosterone; inconsistent or even nonexistent follow-up biometric testing; and “stacking hormones,” which is the use of several synthetic versions of testosterone rather than a bioidentical hormone product, such as (generic) compounded testosterone.14

Family doctors “though well intentioned,” have woefully inadequate training to begin HRT for male patients. They frequently will attempt to boost testosterone with a synthetic FDA-approved prescription drug without realizing that any increase in testosterone will alter the male patient’s entire hormone cascade. It never dawns on many of these providers that they need to check and prescribe drugs to control the patient’s estradiol, dihydrotestoserone, and even thyroid hormone levels. According to Renew Man, the errors committed by inadequately trained family medicine practitioners include incorrect initial diagnosis, e.g., treating depression and lethargy with an antidepressant rather than recognizing it as a symptom of the larger andropause condition; treating all male patients with the exact same protocol; failing to periodically retest estradiol – which is known to cause myocardial infarctions, prostate cancer, and gynocomastia when elevated in men; failing to test for DHEA and thyroid hormones compounded by failure to recognize low-normal readings on Free T3 reflect hypothyroidism, another medical condition often present with andropause; and inconsistent or nonexistent biometric testing of male patients on HRT.14

“Urologists often have the knowledge base necessary to treat andropause, but will not take the time to provide safe, quality treatment. Urologists are often high-production doctors, and their practices see a high volume of patients. Hormone replacement therapy and treatment (if done correctly) takes time, patience, and follow-up. 14 An award-winning, board certified urologist in Tennessee advised me that he was unfamiliar with and uncomfortable prescribing CC and bioidentical testosterone needed in male HRT.

As to endocrinologists, “hormones are their specialty. However, 90+% of their clients are usually women and diabetics. Endocrinologists may know a lot about hormones, but they treat few if any andropausal men, and surprisingly, they usually lack the knowledge to do so effectively.” 14 My own research confirms these statements from Renew Man. An endocrinologist affiliated with a medical research foundation told me that male patients seeking HRT would be better served with a primary care physician who took the time to learn about male HRT through continuing medical education, rather than the typical endocrinologist. In addition, a board-certified endocrinologist in East Tennessee gave me a list of blood tests he would order for a male patient on HRT, but he failed to check for serum dihydrotestosterone levels – an obvious error.

 

Reference

14.  http://www.renewman.com/male-hormones/ [accessed on Sept. 2, 2014].

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