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bhrt for men

Recognizing Symptoms of Hormonal Imbalance in Men

Let’s talk about the things men don’t say out loud. The things that drive them through that office door while claiming “nothing’s wrong” until you ask the right questions. You know them all too well.

For many, it’s low sex drive. Less vitality, more fatigue. Some notice indifference or low-level depression settling in. Isn’t confidence and motivation a younger man’s game? Sure, declining muscle tone is frustrating, but if erectile dysfunction shows up uninvited, it can feel like the party’s over.

Low Testosterone and Hormone Replacement Therapy for Men

Decreasing androgens often result in disruptive symptoms like mood changes, sexual problems, and sleep issues. While these concerns are often attributed to aging, they may reflect underlying hormonal shifts that warrant further evaluation. Low testosterone or hypogonadism can occur at any age and may call for hormone replacement therapy in the form of testosterone and/or DHEA. When in decline, these signaling molecules affect multiple organ systems prompting a range of physical, emotional, and sexual symptoms.

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What Is BHRT for Men?

If hormone replacement therapy has been decided upon, provider and patient choice matter. Bioidentical hormone replacement therapy (BHRT) is not only a critical component of a larger therapeutic strategy, but a customizable physiologic opportunity for men unlike any other.

Testosterone and DHEA in Bioidentical Hormone Replacement Therapy

BHRT involves the use of hormones predominantly isolated from plant materials, that have the exact chemical and molecular structure as hormones made in the human body. Bioidentical hormones, like testosterone and DHEA, are designed to bind to the same receptors in the body and undergo similar enzymatic breakdown:

  • Testosterone is a sex hormone important for mental and physical vitality, affecting sexual function, mood, body composition, and metabolic health.
  • DHEA is a precursor hormone that can support overall hormonal balance by converting to testosterone and estradiol, benefiting the brain, muscle, and bone.

Potential Benefits of BHRT for Men

BHRT is not simply about normalizing lab values, it is about addressing symptoms through a personalized, clinically guided strategy that supports overall health and function. Implications of male hormone deficiency extensively researched and targeted by BHRT include:

  • Energy, motivation, and sleep: Patients with testosterone deficiency can feel disinterested in their surroundings. Limited energy coupled with restlessness can make it difficult to achieve proper sleep hygiene.
  • Sex drive: Testosterone is a driver of libido, directly related to desire. Low levels of free testosterone have been associated with diminished sexual interest and receptivity.
  • Body composition: Testosterone deficiency is connected to mid-section weight gain. Testosterone replacement therapy (TRT) and DHEA therapy can impact lean body mass, fat mass, and sugar cravings. 
  • Cognition and mood: Low levels of testosterone and DHEA can negatively affect well-being and even mimic depression. Addressing these hormonal deficiencies have been shown to improve mood and cognitive performance. 

Andropause, Testosterone, and DHEA Decline

During andropause, testosterone and adrenal androgen tend to decline in parallel, but separately. Many men may experience broader adrenal related symptoms, because DHEA tends to decline earlier and more steeply than testosterone. 

Combining Testosterone and DHEA Therapy

After DHEA converts to DHEA-S in the liver, it undergoes further enzymatic transformation in peripheral tissues, where it contributes to the synthesis of active estrogens and androgens like estradiol and testosterone. Patients with low DHEA-S can experience persistent symptoms like fatigue or poor exercise recovery, which is why compounded injectable testosterone blends like testosterone cypionate/DHEA may help patients struggling to optimally benefit from testosterone therapy alone.

Compounded BHRT Options for Men

Multiple mechanisms of action working together can provide more complete symptom management. And it’s no secret intramuscular or subcutaneous injections offer less frequent, more convenient dosing at one to two times per week. Injectable preparations bypass bodily roadblocks, like liver digestive enzymes, that can negatively impact drug bioavailability. Dose and delivery route are essential to activity, which is why compounded BHRT also offers distinctive options like topical testosterone creams and fast-burst sublingual tablets that maximize therapeutic utility.

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A Personalized Approach to BHRT for Men

It is not uncommon for inconsistent sleep, chronic stress, declining energy, and hormonal changes to converge, creating symptoms that take a toll on your patients’ body and mind long before they recognize the cause. The goal of BHRT for men is to help patients regain vitality, improve function, reduce symptoms, and feel more like themselves again.

How Belmar Can Help

If you are a man who is experiencing or concerned about any of the symptoms on this page, start a conversation with your doctor. Together, you can decide if a compounded prescription might be a good option for you.

If you are a clinician interested in prescribing compound medications to your patients, contact us for information on how to get started and how to access all of our clinical resources. If you are new to compounding, you may find our page on How to Write a Compounding Prescription helpful. You can also visit our Medication Options page to find a formulary and learn more about all the medication solutions available from Belmar.

References

  1. Biundo B. Hormone Treatment Options for Males: What to do for Men with Low Testosterone. Int J Pharm Compd. 2024 Jan-Feb;28(1):28-32.
  2. Biundo B. Treatment Options for Male Hypogonadism.6 Int J Pharm Compd. 2024 Jan-Feb;28(1):6-14.
  3. Mauvais-Jarvis F, Lindsey SH. Metabolic benefits afforded by estradiol and testosterone in both sexes: clinical considerations. J Clin Invest. 2024 Sep 3;134(17):e180073. 
  4. Sumii K, Miyake H, Enatsu N, Matsushita K, Fujisawa M.  Prospective assessment of health-related quality of life in men with late-onset hypogonadism who received testosterone replacement therapy.  Andrologia, 2016; 48(2):198-202.
  5. Walther A, Breidenstein J, Miller R. Association of Testosterone Treatment With Alleviation of Depressive Symptoms in Men: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2019 Jan 1;76(1):31-40.
  6. Zitzmann M. Testosterone, mood, behaviour and quality of life. Andrology. 2020 Nov;8(6):1598-1605. doi: 10.1111/andr.12867. Epub 2020 Jul 30.