At Great Alchemy, we individualize all of our anti-aging (low testosterone) programs to fit the needs of each patient. We also thoroughly evaluate all laboratory tests and blood work to develop a deeper understanding of the unique biochemical and metabolic pathways that exist in every man.
We are not affiliated with any particular pharmacy (or pharmaceutical manufacturer). We do, however, prefer to work with pharmacies that specialize in bio-identical hormone replacement therapy (BHRT). Bio-identical hormones are completely natural and identical to the ones your body produces.
All of the BHRT delivery systems we prescribe bypass the liver. Why? Because the liver metabolizes these hormones before they reach their intended targets in the body, rendering them useless. This process (known as the “first pass effect”) also damages the liver.
The following is a brief discussion of the different low testosterone treatment methods we offer at Great Alchemy.
Testosterone is broken down quickly by the liver when it is given orally (first pass effect). Pharmaceutical researchers have attempted to bioengineer the testosterone molecule so that the liver doesn’t metabolize it; however, to date, all attempts alter this important human hormone have turned it into a liver toxin.
In an effort to avoid this liver toxicity problem, Belmar Pharmacy developed it’s own proprietary delivery method for bio-identical hormones called Bio-available Lymphatic Absorption (BLA) Lipid Matrix System. These oral lipid capsules avoid the first-pass effect because they are absorbed by the lymphatic system in the villi of the intestine — instead of the normal metabolic pathway that runs from the villi’s capillaries to the portal veins and on to the liver.
Bypassing the first pass effect allows testosterone and other androgens to be delivered by mouth, which many patients prefer.
Troches are cough-drop like lozenges that are placed underneath the tongue (sublingual), where the hormones within them are absorbed directly into blood. The advantages of using troches for testosterone replacement therapy include a rapid peak in testosterone blood levels (which is accompanied by a boost in energy), they are effective at lower does, the troches can be taken before a romantic interlude or a workout, and they are convenient (no gels, patches, or needles).
Unfortunately, not all the male hormones in each lozenge is absorbed directly into the blood stream, as some percentage of it is swallowed and makes its way into the digestive tract and on to the liver (first pass), which can be toxic your liver — especially if your liver is already over taxed by other medications, too much stress, and lifestyle issues (excessive alcohol consumption, sugar intake, and so on).
The other disadvantage of using troches as an androgen delivery system is the rapid rise in testosterone they create often produces a similar spike in estradiol (as this burst of testosterone is converted into estrogen by the aromatase enzyme). This secondary response can be mitigated easily by adding a small amount of estrogen blockers to the troches.
Troches are an ideal male hormone delivery method for men who enjoy the convenience of slipping something underneath their tongue twice a day, dislike needles, or are concerned about a cream rubbing off on their partner. For men who travel frequently or have irregular schedules, troches can simplify hormone replacement significantly.
Testosterone pellets are the oldest form of testosterone replacement therapy. The longevity of this mode of testosterone delivery is a tribute to its safety and efficacy.
Compounded bio-identical pellets are placed just beneath the skin to provide consistent hormone therapy for up to six months — without any of the ups and downs in libido, mood, or energy that can accompany other hormone delivery methods.
The biggest advantage of this type of hormone delivery system is the peace of mind that comes from knowing this hormone therapy is working — without having to take a pill twice a day, apply a gel, put on a patch, or make an appointment for the next injection.
The only drawback to this method of BHRT is that inserting the pellets requires an office visit.
Topical Gels and Creams
Gels and creams are simple and effective ways to combat low testosterone. They avoid the first-pass effect because they are absorbed directly through the skin. Once absorbed into the skin, testosterone and other steroids are released gradually into circulation for several hours.
Gels and creams hold one advantage of over transdermal patches. Men who use gels and creams have a general reduction in their percentage of body fat.
The disadvantage of creams and gels is the possibility of transmission to anyone with whom you have skin-to-skin contact before the gel or cream dries completely, which can take up to 15 minutes.
Because gels and creams are so easy to apply, patients can mimic the body’s natural twice-a-day bump in testosterone production.
Transdermal (Skin) Patches
Like gels and creams, these easy-to-apply patches allow for bio-identical hormones to be absorbed directly through the skin where they are stored and released slowly over the course of 24 hours. The advantage of this delivery method is that peeling off one patch before bed and pressing on another one takes 15 seconds. The disadvantage is the glue used to adhere the patch to your skin can cause irritation, rashes, and hair loss near the patches.
Because of their ease of use, gels and creams have largely replaced transdermal patches as a hormone delivery method.
Unlike old-school testosterone injections where patients received huge doses of hormones that peaked quickly and declined just as fast (putting the poor patient on a hormonal roller coaster that alternated between mania and lethargy), modern hormone injections therapy involves smaller doses of androgens that are injected more frequently (approximately every two weeks).
Today’s androgen injections are supplemented by Human Chorionic Gonadotropin (HCG) therapy on the weeks in between testosterone injections, which helps to balance the patient’s hormone levels, metabolism, and emotional life.
The advantages of androgen injections are cost and convenience. The disadvantages are the injections themselves; some men simply do not like needles.
There really is no way to evaluate which of these male sex hormone delivery methods is best for you without a complete medical history and physical exam.