“Tom” was only 37 years old when he started experiencing symptoms more often experienced by men 10 or even 20 years older. Always a healthy weight, he had suddenly gained some extra belly fat, though he’d changed nothing about his diet or routine. He was losing muscle and experiencing joint pain, fatigue, and erectile dysfunction. He told his physician that he’d also been feeling burned out, anxious, irritable, and emotional.
After testing Tom’s testosterone levels, the physician prescribed a commercially available testosterone gel, but it brought no relief. So Tom’s physician recommended he get a specially compounded prescription from Jennifer Burch, PharmD, at Central Compounding Center in Durham, NC.
The bulk of Burch’s patients come to her for compounded hormone replacement therapy. About 15% of them are men experiencing andropause, also known as “male menopause.” What qualifies as low testosterone, and when it is simply a part of aging versus a condition that warrants treatment, are widely debated. But estimates say that as many as 25 million American men experience some symptoms of andropause.
“Male menopause may not be erectile dysfunction,” Burch explained. “Men come in with low sex drive, fatigue, and just lack of desire to get off the couch and do the things they used to. And if they don’t have enough testosterone, and they have a little more estrogen, all of a sudden this guy is more emotional, too.”
Physicians often refer men to Burch when in-office hormone injections or commercially available testosterone therapies are ineffective.
“The products on the market provide more testosterone than patients need, so the products lose their benefits over time,” Burch said.
When the strengths that are available commercially do not provide relief, Burch is able to compound therapies that contain the minimum hormone a patient needs to fit his unique physiology.
“Biochemically we are like snowflakes,” Burch said. “Hormones have to be individualized for people. Not just strengths one, two, and three. We each have many different features, so we need many different versions of hormone replacement therapy.”
Burch also recommends regular saliva tests to check hormone levels and make sure the compound is working.
“Nobody ever checks a woman’s hormone levels,” Burch noted. “They say, ‘You’re having hot flashes? Take some of this and see what happens.’ If you call back and you’re still having hot flashes, they say, ‘Double your dose. Let’s see what happens.’ We use salivary test kits and it’s amazing because then you can use really low doses of hormones.”
Low testosterone isn’t simply a quality-of-life issue, according to Burch. It has been associated with diabetes, obesity, and high blood pressure. If testosterone levels drop significantly too early in life, there could be major health consequences.
“Tom is a young guy, so we need to balance his testosterone to help with his quality of life, but we also don’t want him to be depleted of testosterone for the next 20 years because then you have to wonder what the chronic disease profile will look like,” Burch said.
Thanks to collaboration between Burch and Tom’s physician, Tom’s testosterone levels have risen and his symptoms have all but disappeared.
“The last time I saw him, his joint pain had decreased tremendously,” Burch added. “He was running 4 miles a day, 6 days a week. Pretty good for a guy who was burned out, fatigued, had joint pain, and lack of stamina.”