{"id":58,"date":"2011-06-07T06:12:55","date_gmt":"2011-06-07T12:12:55","guid":{"rendered":"http:\/\/www.maledoc.com\/blog\/?p=58"},"modified":"2019-08-16T07:42:17","modified_gmt":"2019-08-16T13:42:17","slug":"more-pills-and-testosterone","status":"publish","type":"post","link":"https:\/\/www.maledoc.com\/blog\/2011\/06\/07\/more-pills-and-testosterone\/","title":{"rendered":"More Pills and Testosterone"},"content":{"rendered":"

May blew by, and I didn’t manage a single new post.\u00a0 The annual meeting of the American Urological Association<\/a> and a big burst of research activity in my bioengineering lab did keep me busy, but really, there’s no good excuse, and it’s time to blog again.<\/p>\n

One very active area of this blog is How Clomid Works in Men<\/a>, with over a hundred comments to date.\u00a0 I’m grateful to Robert for inspiring this post<\/a>. \u00a0His question is, are there medications that decrease estrogen?<\/p>\n

To review how the pituitary controls the making of testosterone in the testis<\/a>, testosterone is converted to the female hormone estrogen, and rising levels of estrogen tell the pituitary to make less\u00a0luteinizing hormone (\u201cLH\u201d). \u00a0The role of LH in a man is to stimulate the testis to make testosterone, and as the pituitary sees more testosterone in the blood through the lens of estrogen, it tells the testis to make less testosterone by reducing LH. \u00a0I likened this negative feedback system to a thermostat and a heater: as the room becomes hotter, the thermostat turns down the heater. \u00a0Clomiphene binds tightly to the pituitary<\/a>, (and hypothalamus for you biological sticklers), and tricks the pituitary into thinking less estrogen is bouncing around in the bloodstream. \u00a0The pituitary labors to make more LH as a result, and the testis makes more testosterone. \u00a0The drug tamoxifen<\/a> works in a similar way.<\/p>\n

But Robert’s question<\/a> hinted at another way to trick the pituitary: there is a way to decrease estrogen directly so that the pituitary sees less of it and makes more LH.<\/p>\n

The enzyme aromatase<\/a> turns testosterone into estrogen. \u00a0Drugs like anastrozole<\/a> and testolactone<\/a> block aromatase, causing estrogen to decrease in the blood. \u00a0The pituitary makes more LH as a result, and the testis produces more testosterone. \u00a0If a man has low testosterone and high estrogen, these drugs can simultaneously increase testosterone and decrease estrogen. In a study published in the Journal of Urology in 2002<\/a>, doctors Raman and Schlegel report evidence that anastrozole seems to work a little better than testolactone, at least in terms of increasing sperm production. \u00a0In that study, the doctors also suggest that these drugs are best used if the ratio of testosterone is less than ten to one.<\/p>\n

As I wrote in my post on How Clomid Works in Men<\/a>, all of these drugs are off-label for use in the male, meaning that the Food and Drug Administration<\/a> didn’t approve their use in men. \u00a0That doesn’t mean that they can’t be used. \u00a0It means that doctors need to tell patients what we know about these drugs, allowing for an informed decision on their use. \u00a0It also means that many of the questions we have about these drugs don’t have answers. \u00a0A good question about aromatase inhibitors in men is whether estrogen plays an important role in some health concerns in men, and if it is decreased for a long period of time, can other health problems occur? \u00a0We don’t know. \u00a0My current practice for prescribing aromatase inhibitors is mostly to limit their use to male fertility, and to stop the medication as soon as possible.<\/p>\n

So there you have the two basic ways that pills can trick the pituitary into telling the testis to make more testosterone. \u00a0Thanks, Robert!<\/p>\n","protected":false},"excerpt":{"rendered":"

May blew by, and I didn’t manage a single new post.\u00a0 The annual meeting of the American Urological Association and a big burst of research activity in my bioengineering lab did keep me busy, but really, there’s no good excuse, and it’s time to blog again. One very active area of this blog is How […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,9],"tags":[131,132,14,13,129,130,137,124,136,135,134,12,133,10],"class_list":["post-58","post","type-post","status-publish","format-standard","hentry","category-fertility","category-male-hormones","tag-anastrozole","tag-arimidex","tag-clomid","tag-clomiphene","tag-estradiol","tag-estrogen","tag-nolvadex","tag-pituitary","tag-soltamox","tag-tamoxifen","tag-teslac","tag-testis","tag-testolactone","tag-testosterone"],"_links":{"self":[{"href":"https:\/\/www.maledoc.com\/blog\/wp-json\/wp\/v2\/posts\/58","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.maledoc.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.maledoc.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.maledoc.com\/blog\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.maledoc.com\/blog\/wp-json\/wp\/v2\/comments?post=58"}],"version-history":[{"count":0,"href":"https:\/\/www.maledoc.com\/blog\/wp-json\/wp\/v2\/posts\/58\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.maledoc.com\/blog\/wp-json\/wp\/v2\/media?parent=58"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.maledoc.com\/blog\/wp-json\/wp\/v2\/categories?post=58"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.maledoc.com\/blog\/wp-json\/wp\/v2\/tags?post=58"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}