Dr. Jonathan Brajtbord, one of our board-certified urologists, is passionate about integrative medicine and helping patients optimize their health so they can thrive.
He recently hosted a webinar about Biote testosterone replacement therapy for men. (Note: hormone replacement therapy is also available for women, but we're focusing on men in this blog post.)
Below, we've compiled the key points from Dr. Brajtbord's webinar. We've also embedded the webinar video at the end of the article.
As with all content on our blog, the following is educational only, not medical advice. Always consult your physician about your specific healthcare needs.
Here's Dr. Brajtbord in his own words.
Hormones are chemical messengers that tell our body how to function. They regulate the activity of cells and organs, as well as our growth, metabolism, and sexual development and function. The hormones and the tissues and glands that release them comprise the endocrine system.
When hormones are out of balance, disease can develop.
Things that can cause hormonal imbalances include:
Scientists have found over 50 hormones (so far!) in the human body. The one we'll be talking about today is testosterone in men.
We have testosterone receptors all over our body—from the brain and the eyes down to our skin, bone marrow, lymphoid tissues, blood, and male and female reproductive systems. In men, this includes the prostate, the seminal vesicles, and the testicles.
The concept of a "normal" level brings up the debate between "normal" and "optimal." Most urologists would say that the normal range is between 300 and 1000, with 300 considered the low end of normal.
The problem? Some men might be in the normal range, and yet they're experiencing clinical symptoms of having low testosterone. For that reason, we tend to say that low T is a clinical diagnosis, not just a laboratory diagnosis.
Testosterone deficiency in the adult man (sometimes referred to as hypogonadism or "low T") is a clinical and biochemical syndrome associated with a low level of testosterone, which may adversely affect multiple organ functions and quality of life.
Symptoms can include fatigue, weight gain, muscle loss, brain fog, joint pain, low energy, and low sex drive. (This isn't an exhaustive list, either).
Here's the thing, though: low testosterone is not the only thing that can cause these symptoms. Poor diet, exercise, sleep quality, and stress levels can also contribute to these symptoms.
Keep in mind that low T has been associated with an increased risk for diabetes, high blood pressure, sleep apnea, cardiovascular disease, and other chronic diseases.
Even more troubling, studies suggest that more and more men in their late thirties and early forties are experiencing low T. Our testosterone levels are dropping.
The question is, what do we do about that? How can we avoid low T so that we don't develop chronic diseases and so that we can protect our brains, our bones, our hearts, and our relationships?
One of the solutions is testosterone replacement therapy.
Just as the name suggests, the goal is to deliver testosterone to the patient to help boost his diminished levels. (More on delivery modes later.)
The benefits of a balanced hormone system run the gamut:
Other benefits include heart protection, bone protection, increased bone strength, reduced body fat, and lowered cholesterol. (This isn't an exhaustive list, either.)
Keep in mind that testosterone replacement likely won't be enough to truly optimize most men's lives. If we raise a man's testosterone levels to normal (or even optimal) levels, but they're not changing their diet, exercising, or engaging in relevant lifestyle changes, then we're really fighting an uphill battle.
Bottom line: You might not see the benefits of just having higher testosterone—you need to make lifestyle changes as well, like eating healthier, getting regular exercise, practicing good sleep hygiene, and paying attention to your mental health.
How does testosterone replacement therapy work?
There are "bioidentical" hormones, whose molecular structure is the same as that produced in the body, and then there's synthetic testosterone, which was made synthetically to mimic but not exactly match what your body naturally makes.
There are four ways to deliver testosterone:
1. Oral. There are products that allow men to receive testosterone orally through buccal or sublingual delivery, which are absorbed in the mouth or under the tongue. Because of their short half-life, these products must be dosed two to three times a day, which many patients don't like. There is a new product that allows men to take daily pills of testosterone, but this is a synthetic version of testosterone replacement therapy (TRT) and can cause GI symptoms.
2. Creams, gels, patches. You must put these on the skin once or twice a day. The skin absorbs the medication, but absorption rates vary from patient to patient. Not to mention, creams and gels can transfer from patients to other people, like kids and grandkids, which we don't want. This form of testosterone is bioidentical.
3. Injectable treatments. Most of the time, these are injected weekly or every other week. These injections deliver synthetic testosterone. The testosterone is not bioidentical. Often, when we put men on these injections, their T levels will go up and then down. So you have this roller coaster effect, which isn't ideal. Some men will actually become more irritable with these peaks and valleys. This type of treatment also can increase your risk of having your blood become too thick, which can lead to an increased risk of blood clots and strokes.
4. Pellet therapy. Small pellets that look like small pieces of rice are delivered under the skin, allowing for more consistent absorption by the body leading to more consistent blood levels. The testosterone delivered in these pellets is bioidentical, meaning it's the same molecular structure that your body naturally produces. This allows the testosterone to optimally bind to their receptors throughout the body. The procedure is done in the office under local anesthesia and usually takes 25-30 minutes. It needs to be repeated every four to five months for men. Like any procedure, side effects exist, such as pain and discomfort from the procedure; however, this is minimal, and the procedure is very well tolerated.
Your doctor can work with you to choose the right delivery.
I've become a big advocate of pellet therapy since it offers more consistent testosterone levels, it doesn't require daily or weekly delivery of the hormone, and the testosterone is bioidentical instead of synthetic.
When I was going through medical school and residency, which wasn't that long ago, relatively speaking, we weren't taught much about hormone replacement therapy. We were told to stay away from it. This was because of earlier studies in the nineties that suggested hormone replacement therapy can cause cardiovascular events.
Since then, researchers have scrutinized the data. In 2023, a study was published in The New England Journal of Medicine called "Cardiovascular Safety of Testosterone-Replacement Therapy."
This important study found that men do not have an increased risk of cardiac events while on testosterone replacement therapy.
However, several factors require further study and clarification. While this study did demonstrate an increased risk of blood clots, other larger studies did not show an association between these events and TRT. Additionally, men in this study on TRT had an increased risk of atrial fibrillation; however, other studies suggested that normalization of low testosterone levels by TRT decreased the rates of men developing atrial fibrillation.
While more research will continue to uncover these risk factors, TRT is safe for men when performed properly and with the appropriate monitoring and follow-up.
Not all testosterone pellet therapy is created equal. The quality of the pellets that providers can use varies dramatically. I'm excited to partner with Biote because I believe in its commitment to investing in the highest-quality products and its overall philosophy regarding hormone replacement therapy.
The Biote Method of bioidentical hormone replacement therapy (BHRT) using pellet therapy is tailored to each individual man's unique physiology, determined through a consultation and comprehensive lab tests.
With Biote, we individualize and personalize your therapy dose based on the labs we draw. We also consider your age, weight, and activity level along with these labs. This objective data helps produce personalized dosing for you that we can then tinker with over time. We're not just throwing a dart against the wall and hoping that we land on the right dose.
We also discuss those lifestyle changes I mentioned: Make sure you're exercising, eating well, and sleeping enough, all of which will help you see the maximum benefit of testosterone replacement.
One area that I want to be clear about is that the Biote procedure is not FDA-approved. Why is this? Pellet therapy is approved by the FDA; however, the FDA required Biote to settle on a specific dose for men. The Biote method is a personalized, individual dosing program that allows for the provider to specifically administer a dose for you as an individual patient. Because of this individualization approach, the procedure was never approved by the FDA.
Biote pellet therapy isn't covered by commercial insurance or Medicare. It is a cash procedure that costs $800 for men. Again, it needs to be repeated every 4 to 5 months, so I recommend that my male patients budget between $2000 and $2400 annually. Men can use their health savings account or similar products to cover the cost of this procedure.
However, we run the initial lab work through insurance, and most insurance plans cover the labs. This can be a good way for patients to get started. You can discuss options with your doctor.
If you're in Massachusetts, you can make an appointment with me at our Dedham Care Center to run the blood work. Insurance will typically cover the blood work, so you have nothing to lose by taking this first step. (If you're outside Massachusetts, check out the Biote website to find a provider.)