*Male Hormones

Treatment with Testosterone Therapy

Testosterone levels gradually decline at a rate of about 1-2% per year starting your late 20’s. Because this happens so slow, men often do not notice the symptoms associated with hormonal imbalance and do not realize how low their Testosterone actually is until years later. Most men in their late 30s and older are operating at about 50% of their optimal range. We usually treat males who are over 35 years of age but there are some exceptions.

Many men suffer needlessly because their hormone levels are either never checked, they are in the “range”, or the wrong test is ordered. Men as young as 25 to 30 years in age are presenting low levels of testosterone, which was not the case 10 or 20 years ago. This can be the result of environmental toxins, plastics, pesticides, pollutants and/or xenoestrogens in the environment. A large percentage of men who have been told their hormone levels are fine actually have Low T. Often the total amount of testosterone is read as adequate, but the amount of usable testosterone (or free testosterone) is low. Men with Low T may have subtle to profound symptoms, ranging form poor motivation, anxiety, weight gain, a lost sense of well being to profound depression, and loss of sex drive. Men with low testosterone cannot only enjoy an improved quality of life with testosterone supplementation, but will also benefit from a significant decrease in the risk for heart disease, cancer, diabetes and death.

Low T (Hypogonadism) in men can result in:

  • Fatigue, tiredness or loss of energy
  • Depression, low or negative mood
  • Irritability, anger or bad temper
  • Anxiety or nervousness
  • Loss of memory or concentration
  • Relationship problem with partner
  • Loss of sex drive or libido
  • Erection problems during sex
  • Loss of morning erections
  • Decreased intensity of orgasms
  • Backache, joint pain or stiffness
  • Loss of fitness
  • Feeling over-stressed
  • Loss of drive and competitive edge
  • Stiffness and pain in muscles and joints
  • Falling level of fitness
  • Decreased effectiveness of workouts

Testosterone replacement and optimization can result in:

  • Decreased aging of heart and better circulation
  • Protection against heart disease
  • Lower cholesterol levels
  • Decreased risk of heart attacks and strokes
  • Decreased risk of diabetes
  • Decreased body fat
  • Increased lean muscle
  • Increased blood flow to brain
  • Decreased brain aging
  • Improved memory, mental functioning and ability
  • Improved concentration and focus
  • Decreased risk of dementia and Alzheimer’s
  • Increased sense of well being and mood
  • Increased energy, stamina and endurance
  • Increased sexual potency and frequency
  • Decreased osteoporosis (bone loss)
  • Decreased risk of prostate cancer

Average testosterone levels in older vs. younger men

 

Male Testosterone Levels Throughout the Day

Testosterone serum levels graph by time of the day in old and young men

Low T linked to long-term risk of death in relatively healthy adult men
ENDO 2007: The Endocrine Society Research Summaries Book June 5, 2007

This study is another major report linking deficiency of testosterone in relatively healthy men with increased death from all causes, over time . “We have followed these men for an average of 18 years and our study strongly suggests that the association between testosterone levels and death is not simply due to some acute illness, ” said Gail Laughlin, Ph.D., assistant professor and study author.

In the study, Laughlin and co-workers looked at death, no matter the cause, in nearly 800 men, ages 50 to 91 years, who were living in California since 1970. At the beginning of the 1980s, almost one-third of these men had suboptimal blood testosterone levels for men their age.

The group with low testosterone levels had a 33 percent greater risk of death during the next 18 years than the men with higher testosterone. This difference was not explained by smoking, drinking, physical activity level or pre-existing diseases (such as diabetes or heart disease). Men with Low T were more likely to have elevated markers of inflammation, called inflammatory cytokines, which contribute to many diseases. Men with low testosterone were also shown to be three times more likely to have a waist measurement more than 40 inches, low HDL (good) cholesterol, high triglycerides (levels of fat in the blood), high blood pressure, or high blood glucose (blood sugar).

This study is further confirmation of previous studies that demonstrate an increased risk of morbidity and mortality with low or low normal testosterone:

  • In a study of male veterans, low serum testosterone levels were shown to increase the risk of death in the next few years by 88%, according to a report in the Archives of Internal Medicine.
  • In an earlier study, Dr. Molly M. Shores and colleagues from the University of Washington in Seattle showed an increase in 6-month mortality among men with low testosterone levels.
  • Another study published in a 2006 edition of the Archives of Internal Medicine involved 858 male veterans who were at least 40 years of age, prostate cancer-free, and had repeated testosterone levels taken between 1994 and 1999 and were followed for an average of 4.3 years. It was found that men with low or low normal testosterone had a 23-75% increased risk of dying.

Scientific Review of Testosterone Replacement in Men

  • Bringing testosterone from low normal to high normal lowers the risk for heart disease by 60%
  • The Journal of Clinical Endocrinology & Metabolism. Aug 2002. Vol. 87, No. 8 3632-3639
  • 2 year study of low dose testosterone on libido in men Clin Endocrinol Metab 1997
  • Testosterone levels and high libido or low sex drive

Dihydrotestoerone reduces prostate size
Ann Med 1993 Jun;25(3):235-41
Testosterone Improves Sexual Function, Mood, Muscle Strength, and Body Composition Parameters in Hypogonadal Men Improved:
J Clin Endocrinol Metab 85: 2839-2853, 2000

  • Sexual function
  • mood
  • muscle strength
  • Subjects did not exercise
  • Improved lean body mass and fat mass
  • Correlated with serum level of T obtained

Studies show that these benefits were not obtained with testosterone patches (hormone patches are too weak for most patients)

  • Testosterone supplementation increased working memory in men.
  • Janowsky J et al. Sex steroids modify working memory. J Cogn Neurosci 2000 May;12(3):407-14
  • Testosterone replacement reduces the risk of Alzheimer’s disease by preventing the production of beta amyloid precursor protein.
  • Gouras GK et al. Proc Natl Acad Sci U S A 2000 Feb 1;97(3):1202-5
  • Testosterone levels correlates with and testosterone replacement improves cognitive function.
  • Hormones and Behavior 1998; 33(2):85-94.
  • J Clin Endocrinol Metab 1999 Oct;84(10):3681-5
  • Testosterone replacement is more effective than antidepressants for depression.
  • Am J Psychiatry 157:1884, November 2000
  • Androl 1992 Jul-Aug;13(4):297-304
  • Low testosterone is associated with fatigue and testosterone replacement will give an increased sense of well being.
  • Many patients are able to stop Antidepressants after being treated with testosterone
  • Geriatr Psychiatry Neurol 2000 Summer;13(2):93-101
  • The lower the active testosterone the higher the risk for heart attack.
  • Circulation 1999 Apr 6;99(13):1666-70
    • – Acute anti-ischemic effect of testosterone in men with coronary artery disease
    • – Testosterone replacement improves exercise
    • – Low testosterone induces shirt term depression
    • – Dilates coronary arteries
  • “Short-term administration of testosterone induces a beneficial effect on exercise- induced myocardial ischemia in men with coronary artery disease. This effect may be related to a direct coronary-relaxing effect.”
  • Men with heart disease have significantly lower:
    • – Total testosterone
    • – Free testosterone
    • – Bioavailability testosterone
    • -Men with coronary artery disease have lower levels of androgens than men with normal coronary angiograms.
  • Eur Heart J 2000 Jun;21(11):890-4
  • Low testosterone increases the risk of heart disease and more optimal levels decrease the risk of heart disease.
  • Int J Obes Relat Metab Disord, July 2003
  • Low testosterone levels increase the risk of prostate cancer and testosterone replacement therapy reduces the risk of prostate cancer.
  • Dihydrotestosterone and testosterone levels in men screened for prostate cancer: a study of a randomized population.Br J Urol 1996 Mar;77(3):433-40
    • – DHT is lower in prostate cancer patients
    • – DHT is lower in more advanced tumors
    • – PSA and DHT have an inverse relationship (high DHT lower PSA)
  • Testosterone replacement is better than exercise to reduce body fat, gain lean muscle and improve strength, and works synergistic with exercise.

How Testosterone Levels can affect men's health

  • J Endocrinol 2001 Jul;170(1):27-38
  • Testosterone serum levels and muscle mass and muscle strength
  • Testosterone replacement reduces risk of diabetes.
    • – Testosterone replacement therapy decreases insulin resistance
    • – Low levels of testosterone play a role in the development of type 2 diabetes
    • – Elevated insulin decreases testosterone levels resulting in a vicious cycle of worsening insulin resistance and reduced testosterone levels
    • – Testosterone replacement therapy breaks this cycle
    • – Low testosterone is associated with Syndrome X, hypertension, type 2 diabetes and heart disease.
  • Journal of American Epidemiology 1996
  • Int J Obes Relat Metab Disord 2000
  • Mayo Clin Proc 2000 Jan;75 Suppl:S61-4
  • Diabetes Care. 2000 Apr;23(4):490-4
  • Metabolism 1997 May;46(5):526-9
  • Dihydrotestoterone with NSAIDS kills prostate cancer cells.
  • Cancer Chemother Pharmacol, 2002; 49(3):179-86
  • Using HCG to boost testosterone levels results in significant improvement in prostate enlargement and symptoms
  • Journal of Urology 2003
  • Bio-Identical testosterone replacement therapy decreases fat and increases lean muscle.
  • Bhasin et al. journal of Endocrinology and Metabolism, 2003
  • Testosterone replacement therapy speeds healing and results in the shortening of hospital stays.
  • Journal Am Geriatr Soc, 2002
  • Pesticides reduce testosterone production in men.
  • Biology and Reproduction, 2003