Andropause is this gradual decline in hormone production experienced by middle-aged men. Declining testosterone production--hormonally similar to fall of estrogen in women going through menopause--usually causes a reduction in sex drive and poor erections. It may also cause fatigue and depresion.

While the effects of declining testosterone are relatively benign, the rising estrogen that accompanies it can be quite discomforting, and potentially deadly. Chronic “estrogen dominance” is responsible for benign prostatic hypertrophy and prostate cancer. Since testosterone blocks the adverse effects of rising estrogen levels, testosterone replacement therapy is a powerful strategy for restoring hormonal balance and reversing undesirable estrogen dominance.

Transdermal testosterone, applied either through patch or cream, is the preferred method of administration. Why? Because orally administered sex steroid hormones are taken directly to the liver and wrapped in a protein coat. Protein bound testosterone is inactive, but still shows up in serum testing. Transdermally applied testosterone (as a cream or gel), on the other hand, does not go directly to the liver, is not bound with protein, and stays in the biologically acitive “free” form. Less than 10% of orally administered hormones reach their target tissues intact as the effective, free (or non-bound) form, whereas about 90% of the transdermally applied form gets to testosterone receptors as the active form. Transdermal dosing is at least 10 times more efficient than oral dosing.

If the decision is made to use testosterone, testing is necessary to get the dose right.

Conventional medicine makes several common errors in managing andropause. These problems in using hormones can be solved by understanding the four principles of hormone replacement therapy, summarized below:

1. Don’t take testosterone without testing. Use testing to determine the correct dose.

2. Based on the results of tests, use physiologic doses (those that the body would be making if it still were capable of making enough) rather than pharmacologic doses.

3. When treating someone with a hormone deficiency, Use only bio-identical hormones: natural testoterone as transdermal cream or gel. Altered, synthetic versions of our natural hormones are not acceptable. They not only lack the same benefits as the real hormone, but can also cause side effects because they are foreign to the body.

4. Look at the “big picture” in Natural Hormone Replacement Therapy. No single hormone works in isolation; they work in concert, like individual members of a large orchestra. In men, therefore, the ideal approach consists of testing and replacing shortfalls of not just testosterone, but also of the other anti-aging hormones: estrogen, progesterone, DHEA, pregnenolone, and thyroid hormone.