Testosterone

From: Traumatic Brain Injury, Panhypopituitarism and Hormonal Evaluations as a Standard of Care
<a id="null" class="null" href="http://www.nevadaosteopathic.org/attachments/article/33/Clearfield%20Panhypopituitarism%20and%20TBI.pdf">http://www.nevadaosteopathic.org/attachments/article/33/Clearfield%20Panhypopituitarism%20and%20TBI.pdf</a>

Major Depressive Disorder is Most Prevalent Post TBI • Growth Hormone Deficiency • Testosterone Deficiency is a Major Cause of Depression – Anxiety, aggression, Mood Disorder, Arousal, Sexual Dysfunction, Suicidal Ideation • Androgen Receptors are Present Throughout the Brain – Androgens have ongoing effects in mature brain – Androgens impact cognitive function.

Testosterone and Depression Post TBI
Testosterone Effects the CNS
• Free testosterone in lowest quartile=highest incidence of depression
Male
– At Risk: 295 ng/dL Free T 6.0 ng/ml (Median 12-14 ng/ml)
– Depression: 147.5 ng/dL Free T 3.0 pg/ml
Female
– At Risk: 22 ng/dL (median 44 ng/dL) ; Free T 1.0 ng/dL (median 2-4 ng/dL)
– Depression: 11 ng/dL ; Free 0.5 ng/dL

Case study: Olivia G.
Diagnosis: Treatment Resistant Depression

Olivia            Median

Total Testosterone    12.72 ng/ml  44 ng/ml

Free Testosterone     0.08 ng/ml    2-4 ng/ml

DHEA-S                     49.2 ug/dL    235 ug/dL

DHT                           4 ng/dL       <30 ng/dL

The Word on 5 Alpha Reductase is “Goldilocks”
DHT makes androgens (testosterone) more potent
Activity:
Metabolizes progesterone into a-Pregnanediol
Metabolizes cortisol into a-THF (b-metabolites of both through 5β activity)

Upregulated leads to high androgen symptoms:
Men (thinning hair, prostate issues)
Women (PCOS, thinning hair, acne, facial hair growth)

Increased enzyme activity:
High insulin and obesity
Edinger, KL; Frye, CA, Testosterone’s analgesic, anxiolytic and cognitive-enhancing effect may be due in part to
actions of its’ 5 alpha-reduced metabolites in the hippocampus; Behav Neuroscie; 2004 Dec;118(6):1352-64.
Albany, NY

Testosterone and DHT Elevation
• Finasteride and Dutasteride block conversion centrally

– Cross BBB resulting in depression, fatigue, and sexual dysfunction
– Recommend Saw Palmetto, Pygeum, Pumpkin Seeds, Pomegranate Juice to
control conversion of T to DHT

Testosterone Metabolizes into Estradiol
• S/S Estrogen Excess in Men
• Breast Enlargement
• Prostate Enlargement
• Difficulty Urinating
• Increased Emotional Lability
• Tearfulness

Testosterone and Anxiety
Testosterone reduces anxiety, enhances cognitive performance.
Analgesic, anxiolytic, and cognitive effects are due to action on
5 alpha reductase metabolites in hippocampus effect
Edinger, KL; Frye, CA, Testosterone’s analgesic, anxiolytic and cognitive-enhancing effect may be due in part to
actions of its’ 5 alpha-reduced metabolites in the hippocampus; Behav Neuroscie; 2004 Dec;118(6):1352-64. Albany, NY

The presence of a LOW Prolactin level can be a tip-off in a patient with treatment resistant anxiety. Having a high dopamine (Prolactin inhibiting factor) will suppress the production of Prolactin from the Anterior Pituitary.

pg 18 of 33 medmedium avoid hormones for cfs, not tbi

Laboratory Evaluation in TBI
“The Optimal Physiological Level”
Major National Lab
Total Testosterone Range (264-916)=1180/2 = 590 Median
(Prior to July 17, 2017 Range (348-1197)= 772.5 Median Range lowered due to obesity crisis showing improvement w low testosterone levels

Clomiphene Citrate
• Three year study (2014-2016) on the use of Clomid in two groups: Less than 40 and greater than 40.
• 2016 study: Less than 40 with a Free T of 5-10 get one tablet every 3rd day. Blood work in 12 weeks.
• Older than 40 get UL-Testosterone protocol (20mg)
every 3rd day with 25/50mg tablet of Clomid or no clomid. Blood work in 8-12 weeks.

Outcomes of Clomiphene Citrate Treatment in Young Hypogonadal Men.
Long-term follow-up of CC treatment for HG shows that it is a effective and safe alternative to
testosterone supplementation in men wishing to preserve their fertility.
Katz DJ1, Nabulsi O, Tal R, Mulhall JP. BJU Int. 2012 Aug;110(4):573-8. doi: 10.1111/j.1464-410X.2011.10702.x. Epub 2011 Nov 1.