The concept of multi-hormone optimization is based on trying to optimize the level of many hormones in a man's body at the same time.  These hormones include testosterone, DHEA, melatonin, thyroid hormones and human growth hormone.

As we get older there is an age related decrease in the production of DHEA, testosterone, melatonin, thyroid hormones and HGH.  At the same time there is usually an age related increase in cortisol, insulin and estrogen.  These changes often cause fatigue, loss of muscle mass, cardiovascular disease, weight gain, insulin resistance, weaker immunity and in general a sense of malaise.

These changes are strongly associated with aging.

While it is quite controversial, some physicians believe that by optimizing a man's various hormone levels through hormone modulation, his quality of life can be improved.  

There is a good deal of evidence that by adjusting a man's hormone levels, that his quality of life will be improved.  However, while some physicians believe that hormone modulation can actually increase a man's lifespan, there is currently no scientific basis for this.

Hormone supplementation for menopausal women with estrogen was once thought to be completely safe.  Why not take estrogen if it cured or treated a woman's osteoporosis, heart disease and hot flashes?  It is now known that estrogen may cause cancer, liver damage, stroke and other cardiovascular disease.

Multi-hormone optimization is in its infancy.  The responsible way to initiate any hormone replacement therapy is to fully inform the patient of the currently known side effects and the anticipated benefits.

Many men will decide that the risks outweigh the rewards.  Others want a drink from the fountain of youth and will dive in head first.  Some men will want just testosterone supplementation and others will want more.


Testosterone is a hormone that is made by a man's testicles. 

Many men discover that by the time they are in their late 30's or early 40's that they have less energy, are often tired, are slower physically and mentally, are often grumpy, and have lost a lot of the sex drive that they had when they were younger.

A normal part of the aging process? - maybe.  Or maybe it is caused by a low testosterone level.

Testosterone is responsible for the proper development of a man's secondary sexual characteristics like the growth of his penis, muscle mass, facial and body hair and a deeper voice.  Most men have a normal amount of testosterone as a teenager and they develop normally because of this.

Testosterone is also responsible for the maintenance of a man's muscles, his libido or sexual desire, keeping red blood cells and boneS healthy and in general plays a large part in a man's sense of well-being.


Decreased libido or sex drive
Erectile Dysfunction
Decrease in muscle mass
Increase in body fat
Increased cholesterol
Decrease in body hair
Decreased energy level
Less effective at work
Decreased semen volume
Decreased orgasm intensity
Problems sleeping
Decreased immunity
Decreased sense of well-being
Difficulty concentrating
Fragile bones

As a man ages his testosterone level gradually decreases.  This usually begins at around age 30.  Other causes of testosterone deficiency include:


Testicular injury or infection
Many medications
Chronic illness
Chemotherapy for cancer
Radiation for Cancer
Pituitary dysfunction
Liver cirrhosis
Kidney failure
Genetic & congenital conditions

A simple blood test will determine if a man has a normal level of testosterone.  This test is more accurate if the blood is drawn in the early morning hours.


Intramuscular injections


Increased sense of well-being
Increased muscle mass
Decreased body fat
Increased sex drive
Improved erections
Higher energy level
More productive at work
Happier in general
Increased immunity
Improved mood
Improved concentration
Increased semen volume
Increased orgasm intensity
Stronger bones

Testosterone replacement therapy has been and remains controversial because of the possible side effects of its use and because the long-term effects of testosterone replacement are largely unknown. 

Testosterone supplementation or therapy should not be confused with the super-physiologic and large doses of testosterone and other anabolic steroids that have been abused by some bodybuilders and athletes.  These large doses of steroids are almost always not needed or indicated in the first place, are often unmonitored by a physician and are dangerous and unwise.

The goal of physician directed testosterone replacement therapy is to bring a man who has a low or borderline testosterone level into the middle of the normal therapeutic range.

Before a man is started on testosterone replacement therapy he should have, at a minimum,  certain laboratory tests and a thorough physical exam including his prostate.  Men should then be monitored at regular intervals by both blood tests and physical exams to make sure that there are no adverse effects of the testosterone therapy.  Notwithstanding any physician's best efforts to prevent side effects of testosterone replacement therapy, there are occasionally side effects, including:


Acne or oily skin
Increased red blood cell count
Increase in size of prostate
Increase in PSA
Decreased sperm count
Fluid retention
High blood pressure
Breast enlargement
Sleep apnea
Testicular atrophy
Increased lipid levels

Some men should not use testosterone therapy.  They include men who have or who have ever had prostate or breast cancer, men who have an enlarged prostate or a high PSA. 

All men get tired occasionally, but prolonged fatigue is not normal at any age.  Your doctor will determine if you are a candidate for testosterone replacement therapy.

DHEA (Dehydroepiandrosterone)

DHEA is mostly made by the adrenal glands.  It is converted to testosterone in the body.  DHEA is produced from cholesterol.

DHEA is thought to have many beneficial effects, including, anti-depressant effects, improved memory, immune system, sexual appetite and muscle mass, decreased cardiovascular disease, increased testosterone levels and lower levels of LDL cholesterol.

It has been suggested the higher levels of DHEA, as long as they are not too high, are associated with a longer lifespan in men. 

DHEA has some side effects.  They include all of the side effects of too much testosterone - lipid abnormalities, high blood pressure, prostate growth or cancer, acne, hair loss, breast cancer, breast enlargement and can cause a rise in a man's estrogen level.

Regular exercise has been known to increase a man's levels of DHEA.

DHEA is available in capsule and pill form. The normal daily dosage ranges from 25-200 mg/day.


Melatonin is made by the pineal gland in the brain.

Melatonin is an antioxidant.  It has been somewhat successful in treating jet lag and insomnia.

Melatonin has been most used in regulating sleep and as an antioxidant to strengthen the immune system.

It has also been suggested that Melatonin may be helpful in regulating certain age related changes in the body including, temperature regulation, inflammation, anxiety and macular degeneration.  There is also some evidence, although not compelling, that Melatonin may be helpful with chronic fatigue syndrome, cognitive enhancement, diabetes control, headache prevention, menopause and smoking cessation.

Melatonin is usually taken in pill form by mouth. The usual dosage is between 0.3 and 5.0 mg/day.  While side effects are rare, they include, fatigue, dizziness, headache, irritability and sleepiness, confusion, seizures, giddiness and dysphoria, increased cholesterol, arrhythmias, high blood pressure and high blood sugar.  Melatonin may make some high blood pressure and anti-depressant medication less effective.

Melatonin should not be taken by anyone with a seizure disorder, glaucoma, depression or psychosis or who is taking blood thinners such as warfarin or coumadin.  As it induces sleepiness, it should not be taken within 6 hours of anyone who needs to operate machinery or who needs to drive. Melatonin should not be taken along with other medications that are intended to cause sleepiness or sedation such as klonopin, ativan and ambien.


HGH is made by the pituitary gland in the brain and is the most controversial of all of the hormones than physicians try to modulate.  HGH has been touted to increase muscle mass, strengthen immunity, increase libido and make older men feel younger.  HGH has failed to live up to its expectations and has been shown to have significant negative side effects.  The most significant side effect is cancer, but HGH also causes weight gain, high blood pressure, carpal tunnel syndrome, joint and muscle pain, male breast enlargement and diabetes.

We do not offer testosterone replacement therapy or other hormone replacement therapy in our practice.  If we determine that you may benefit from testosterone replacement therapy or other hormone replacement therapy, you will be referred to an endocrinologist for this treatment.





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