Dr. Huber started with bio-identical hormone treatment using progesterone in women and was influenced by many teachers, including Dr. John R. Lee, who was a big proponent of the use of micronized progesterone only for female health problems. He notes the landmark article by Chang et al.(read also) regarding the use of radio-labeledtopical progesterone being given to women two weeks before removal of their breast biopsy and the fact that large quantities of radio-labeled progesterone were found in the breast tissue removed, but there was little rise in serum levels, suggesting the progesterone was absorbed but that serum levels weren't reflective of topical application. Dr. Huber sites the specific work of David Zava, PhD, owner of ZRT Laboratories, who is an expert on hormone testing for topically applied hormones (read article) helping to clarify this debate regarding the best way to assess topical hormone therapy with saliva testing versus traditional serum testing.
Topical Testosterone Using Physiologic Doses and Saliva Over Serum Testing
In men the use of supra-physiologic doses of topical testosterone cream is many times administered at 50, 100 or 150 mg per day (the male only produces 5-12 mg of testosterone per day). These doses will create a "tachyphylaxis" or attenuation of the hormone's ability to activate the hormone receptor sight due to supra-physiologic doses of topical testosterone in the attempt to raise serum levels. More and more testosterone is used with less and less benefit while serum levels rise slowly and moderately (sometimes not at all) over time.
Dr. Huber has found that by using physiologic doses of testosterone in the 5-10 mg range, endogenous testosterone production is not suppressed as much or at all, and there is a better long-term clinical effect from the testosterone and can be followed nicely using saliva testing. The goal is to enhance the body's own ability to increase or maintain physiologic testosterone levels, not suppress them or replace them if possible with supra-physiologic doses.
When Dr. Huber uses these physiologic doses of topical testosterone between 5-12 mg per day he doesn't see the side effects of rising PSA (prostate specific antigen) and DHT (dehydrotestosterone) levels, aromatization (conversion to estrogen) or increased red blood cell production (sometime wrongly called polycythemia). In younger men between the ages of 20-40 it is even more important if testosterone is used to use lower non-supressing, but supportive doses of testosterone at 2.5-5 mg per day of topical testosterone. He follows his testosterone patients on topical creams with saliva testing which immediately and accurately shows absorption of adequate amounts of testosterone.
When asking two large drug companies who manufacture prescription topical testosterone products where their absorption studies are that show the "10% absorption" rule from their topically applied products there was no absorption studies available from these companies.
Many integrative medicine hormone training programs still teach using topical testosterone in 25-100 mg doses to start off with because they still are using serum testing when using topical testosterone creams or gels.
Injectable Testosterone and Serum Levels
With the use of injectable testosterone serum levels of testosterone are more reflective of a more physiologic dose. Dr. Huber will start of with 35 mg of testosterone injected subcutaneously (most people are still trained to give it intramuscularly, but SQ works as well, is less painful and easier to give a smaller, more exact dose) twice weekly. Sometimes he may taper the dose up to 50 mg SQ twice weekly. His goals is not to get to "youthful" levels of testosterone in the 900-1100 ng/dl range but more in the 400-600 mg range with the patient feeling clinically well.
Testosterone Levels Are Lower Now Than in the 1980s
Testosterone levels in males have declined over the last 30-40 years.
- Reasons include: exposures to plastics with compounds such as BPA (Bisphenol A), environmental toxins, pesticides, herbicides, chemicals, etc. These compounds can reduce testicular size; their production of testosterone; reduce the activity of the Leydig cells which produce testosterone in the testicles; reduce sperm cell count and sperm motility; and reduce sex drive.
- Polypharmacy - many of the drugs which men take for cholesterol lowering, blood pressure, depression/mood, diabetes, etc. can reduce testosterone production.
- Stress effects the HPA axis (hypothalamic pituitary axis) which sends the chemical messages to the testicles that produce testosterone.
- Lack of sleep can reduce testosterone levels. Testosterone is produced in 4-5 "pulses" throughout the day with the biggest being in the morning (peak 0530 and 0800 h).
- Sugar consumption can reduce testosterone levels (Americans are consuming 150 pounds per person per year).
- Past or current head trauma.
- Mercury exposure from amalgams.
Clomid and HCG to Increase Testosterone Production
Clomid (clomiphene) is a drug which blocks estrogen receptors on the hypothalamus which causes a release of lutenizing (LH) and follicle stimulating hormone (FSH) which stimulates the testicles to produce testosterone and sperm respectively. It is used for infertility treatment in men and women. It can be beneficial in stimulating one's own production of testosterone at a dose of 50 mg by mouth two to three times per week over 6-12 month period, with lifestyle change, to see if a man can increase his own testosterone production. Sometimes men can get off the Clomid, and if they have corrected their lifestyle enough, they have good testosterone production and symptom improvement without any more drug therapy. HCG (human chorionic gonadotropin) hormone can sometimes be pulsed with the Clomid at 100-200 mcg 2-3 time per week SQ to directly stimulate testicular production of testosterone. But Dr. Huber has good results using lifestyle and Clomid by itself usually.
Lifestyle approaches include taking Agnus Castus in the morning and pituitary complex (support) at night; reducing heavy metals; enhancing gut health and liver detoxification; avoiding plastics; removing amalgams and sources of metals; taking chlorella and probiotics; exercise, stress reduction and getting adequate sleep (7-8 hours per night).
Side effects with Clomid are minimal and reversible such as mood swings and some vision changes.
Testosterone Therapy and Prostate Cancer and Heart Disease Risk
Testosterone therapy does not cause prostate cancer. Those with higher levels of testosterone get less prostate cancer and less aggressive forms.
Testosterone therapy does not increase cardiovascular risk. It reduces plaque; increases coronary artery dilation; reduces CRP; is associated with a reduction in diabetes; belly fat; and decreases hypertension. Dr. Huber feels the research on testosterone's cardiovascular protective effects is overwhelming and some the of recent research showing some risk is severely flawed.
Dr. Huber share his personal experience with his 85 year old father who's health, quality of life and ability to function were failing until he gave him testosterone by pellet insertion, since his dad wouldn't comply with a topical cream. Immediately his attitude, mood, cognition, strength, demeanor and cardiovascular health improved. Dr. Huber believes his father is alive today with a good quality of life because of the testosterone therapy.
Dr. Huber's message is do lifestyle first and add hormones at physiologic doses second (and measure topical hormone creams with saliva testing...). Or, hormones are the "Sprinkle" on the cupcake. They should be given after improving gut health; immune system stabilization, cortisol/adrenal normalization and thyroid balancing.
Dr. Gary Huber spent 20 years as an emergency medicine physician before evolving his practice to integrative care. Dr. Huber lectures on hormone replacement therapies, cardiovascular care, sports medicine and other integrative medicine topics to physician groups. He has developed the highly successful Huber Personalized Weight Loss Program, which not only promotes healthy weight loss but works to reverse issues of metabolic syndrome.
Dr. Huber earned his medical degree from the Ohio University College of Osteopathic Medicine and did his residency at Doctors Hospital, Columbus, Ohio and is Board Certified in Emergency Medicine.
Gary Huber, D.O., AOBEM Huber Personalized Medicine, 8170 Corporate Park Drive, Suite 150, Cincinnati, Ohio 45242, Cellular phone# (513) 284‐3785, E‐Mail: firstname.lastname@example.org Website: www.huberpm.com
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