Eric G. was a 39-year-old married man and father of two who worked rotating shifts. He found himself gaining weight; losing muscle; and struggling with decreased drive, stamina, and energy. When he entered a hormone replacement therapy (HRT) program, his body fat was 32 percent, his lean muscle mass was 61,339 grams, and he was in the 99th percentile for his age. Within six months, his body fat was 15 percent, his lean muscle mass increased to 72,679 grams, and he was in the 10th percentile for his age. He said, “Now that my transformation is complete, I’m able to work without limitations, have boundless energy and stamina, and approach all aspects of my life with newfound confidence.”
Explore This IssueACEP Now: Vol 33 – No 05 – May 2014
A successful HRT program must be in the hands of a skilled physician who acknowledges patients’ symptoms and utilizes evidence-based objective measurements to develop a treatment plan that will minimize risk while providing benefit.
Is HRT a Danger or a Miracle Cure?
HRT, like all medical treatments, has benefits and risks. The endocrine system is complex, and hormones are powerful. In the hands of an unskilled practitioner, HRT can be disastrous and should absolutely be avoided. However, under the careful supervision of an experienced physician, HRT is extremely safe and effective, with benefits far outweighing any risks.
Scientific studies have shown that by age 40, most adults have significantly altered levels of several essential hormones. Patients complain of fatigue, decreased motivation, decreased sex drive, decreased energy, and changes in body composition with decreased muscle mass and increased body fat. These symptoms often lead to high cholesterol and high blood pressure and become more noticeable as time marches on. Patients often chalk them up to simple aging or depression or, worse, attribute them to career burnout or even a failing relationship.
Unfortunately, the medical community reinforces these interpretations and, in fact, erroneously publishes information warning against HRT entirely. Most physicians are familiar with the problems associated with the National Institutes of Health study warning women against HRT and know that the pendulum has already begun to swing back in favor of prudent HRT for menopause.
A study recently published in JAMA warned that testosterone replacement was associated with increased risk of stroke and heart attack. However, the men in this study were not prescribed an aromatase inhibitor along with their testosterone. When testosterone therapy does not include an aromatase inhibitor, estrogen will also rise, often to harmful levels. High estrogen is definitely associated with increased risk of blood clotting. Furthermore, testosterone can increase Hg and should be monitored. However, high testosterone alone is not a risk factor for stroke or heart attack. If it were, then these conditions would be more common in men between the ages of 18 and 25 rather than older men. Furthermore, the Kaplan-Meier methodology utilized in this study was less than ideal, skewing the data even more.