In the United States, testosterone is available from any pharmacy as an intramuscular injection. Two of the common forms are the shorter acting testosterone propionate and longer acting testosterone cypionate. The former is given two or three times a week and the latter every one to three weeks. The only oral or sublingual testosterone preparation available commercially in the U.S. is methyl testosterone. However, because of the extra methyl group, this is not a natural testosterone. Methyl testosterone has been removed from the market in Europe because of its potential liver toxicity and possible carcinogenic potential. A transdermal patch of natural testosterone applied to the scrotum was recently approved by the FDA.

A variety of natural testosterone preparations are available from compounding pharmacies. These include oral capsules, sublingual lozenges, topical creams and topical gels. The dosage must be highly individualized because of different levels of absorption and because considerable amounts of testosterone taken orally may be lost through liver detoxification mechanisms. The male testes produce about 15 mg of testosterone daily. This fact should be utilized in determining appropriate dosage, since we are simply trying to supplement a shortage of testosterone production.

Dr. Debled’s therapy focuses almost completely on testosterone replacement to treat andropause. My view is that this treatment should be incorporated into a comprehensive treatment approach which emphasizes lifestyle, including an optimal diet, nutritional supplements, exercise, stress management, detoxification procedures and energy balancing. Part of this program would involve attention to cleaning up the environment. In addition to replacing testosterone if it is deficient, the rest of the endocrine system should also be balanced. This may involve the administration of thyroid hormone, DHEA or physiologic doses of cortisol. Some recent studies on aging indicate that the administration of optimal doses of human growth hormone may also be extremely useful when it is deficient. Male andropause is largely a preventable and treatable condition.