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*Male Hormones & Testosterone Replacement Therapy (TRT)

What is Testosterone?

Testosterone is the principle male hormone. It appears in men in quantities up to 8 times the amount seen in women. In men, testosterone is a hormone produced mostly by the testes and is responsible for the proper development of male sexual characteristics. Optimal testosterone levels are essential for sexual activity and energy, muscle and bone mass growth, and even the prevention of osteoporosis. It promotes the primary sexual characteristics of men and is responsible for greater health, longer life and general well-being.

When Does Andropause Start?

Low-T, also referred to as low testosterone or andropause, begins occurring in men as early as age 30, though symptoms are usually first noticed closer to age 40. Testosterone levels gradually decline at a rate of about 1-2% per year starting in your late 20’s and continues throughout your life.

Because this happens so slowly, 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.

Do I Have Low Testosterone (Low T)

A large percentage of men who have been told their testosterone is fine actually have Low T. Often the total amount of testosterone is read as adequate, but the amount of usable or “free” testosterone is low. Men suffering from Low T may have subtle to profound symptoms, ranging from poor motivation, anxiety, weight gain, a lost sense of well-being to profound depression, and loss of sex drive. Men with Low T cannot only enjoy an improved quality of life with male hormone replacement therapy or Testosterone Replacement Therapy, but will also benefit from a significant decrease in the risk for heart disease, cancer, diabetes and death.

The US Food and Drug Administration (FDA) estimates 4 to 5 million American men may be suffering from hormonal imbalance, but only 5% are currently treated. This translates into approximately 250,000 men being treated. This means that there is over 4,750,000 men who are untreated. If you are reading this you could be one of them.

The only accurate way to detect this condition is to measure the amount of testosterone in your blood. 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 hormone levels associated with andropause, 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.

Signs and Symptoms of Hormonal Imbalance in Men

The earliest Symptoms of Testosterone Deficiency involve physical, mental, sexual and general health.

    • PHYSICAL – Fatigue and decrease in energy levels, physical weakness & decrease in muscle mass, decreased body hair, increase in body fat (especially stomach fat), Sleep Issues, Weak and Fragile Bones, backache, joint pain & stiffness, decreased effectiveness of workouts,  Rapid weight loss, Breast enlargement, Water retention, Adult acne, Headaches/Migraines
    • MENTAL – The onset of depression, unexplained anxiety or panic attacks, muddled thinking, and a loss of self-confidence and self-esteem are common early symptoms of the progressive loss of testosterone. Other mental symptoms include being less effective at work, grumpiness, irritability, decreased sense of well-being, loss of drive & competitive edge and lack of concentration. The quality of life deteriorates, even to the point that studies have shown that TD depression can be so severe that it can lead to suicide.
    • SEXUAL – Testosterone is the primary source of sexuality for both men and women, stimulating their desire for sex (libido). The continuing loss of the hormone leads to a progressive disinterest in sexual activity. Men usually start to experience erectile dysfunction or impotence and eventually all interest in sex gradually disappears. They may also notice a decrease in semen production, loss of morning erections and decrease in orgasm intensity.
    • GENERAL – Increased Cholesterol Levels, Anemia (Low Iron Levels), decreased immunity, Relationship problems with your partner, Prostate inflammation, Low thyroid symptoms, Hypoglycemia, Diabetes, Insomnia

Treatment with Testosterone

By undergoing hormone replacement therapy, or HRT, you can increase your testosterone levels and correct the other aspects of your health as you reach an age of maturity. This will reduce your risk of Alzheimer’s, osteoporosis and prostate cancer while simultaneously giving you a renewed vigor in life. Within a matter of weeks from the start of therapy, men experience heightened sexual activity, greater and faster brain responsiveness, reduced fat, a healthier heart and an overall renewed body.

We offer the following procedures and treatments:

Topical Testosterone Creams

The use of creams and gels are very common, requiring daily application once or twice a day. We can also have testosterone cream compounded to a specific dose for a particular patient. The upside to using a topical cream is that there is no injection. However, there are a few important concerns when it comes to using topical hormone creams.

Topical testosterone cream sounds quick and easy, but there are some important concerns which we have to take into account prior to prescribing. Topical testosterone cream can be transferred through the clothes for up to 12 hours after application. What does this means for patients? We do not recommend topical to men with small children because they can transfer it to the kids. Once it is transferred to the kids they will start developing masculinization symptoms.

Not only does testosterone transfer occur up to 12 hours after application, if you are not careful with your hygiene after application will also inadvertently transfer it to others as well. For instance, let’s say you apply your cream a with your right hand and then you use that hand to open the faucet, you will leave some residual testosterone cream on the tap and some who comes along and opens that faucet later will inadvertently absorb the hormone.

Men who are married or involved in a relationship should really consider not using topical testosterone because it can be transferred during intimacy.

On another note, testosterone applied on the skin is quickly converted to DHT because most of the enzymes which convert testosterone to DHT is located in the skin. While on testosterone replacement therapy the DHT levels will monitored on a regular basis.

Testosterone Injections

Interestingly many men who seek hormone replacement therapy prefer injectable therapy. For those who are interested in doing self-injections, our office will schedule a training session in order to teach you how to perform self-injections safely. This session takes about 10-15 minutes. Treatment by injection is often a better option; a shot of testosterone is usually performed 1-2 times a week based on the dose. The down side is the hassle of self-injection and the pain associated with the shot. In addition to the pain associated with the injection there may be some pain from the actual testosterone –which is rare.

Injectable testosterone is in an oil base and can produce some muscle soreness after injections. The oil base allows for the hormone to be time released for 7-10 days. With hormone injections, the injection sites can be rotated between injections. There is also the potential to develop a skin infection at the injections site-which is why we do an injection training session. This is extremely rare if you follow the injection technique as taught.

Many men prefer this option and it is the most popular option. This is a good option for men who are married or are involved in a relationship, men with small kids and single guys.

Testosterone Replacement Therapy 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 wellbeing 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

Ten Biggest Myths and Misconceptions About Testosterone

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 levels had a 33 percent greater risk of death during the next 18 years than the men with higher levels. 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 levels 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 levels:

  • In a study of male veterans, low serum 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 hormone 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 Therapy in Men

  • Bringing testosterone from low normal to high normal levels 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


  • 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 hormone patches (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
  • TRT 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 hormone replacement therapy improves cognitive function. Hormones and Behavior 1998; 33(2):85-94.J Clin Endocrinol Metab 1999 Oct;84(10):3681-5
  • Male Hormone Replacement Therapy is more effective than antidepressants for depression. Am J Psychiatry 157:1884, November 2000Androl 1992 Jul-Aug;13(4):297-304
  • Low T is associated with fatigue and TRT 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
  • Low T induces short term depression
  • 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
    • TRT improves exercise
  • 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 T 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 T levels increase the risk of prostate cancer and TRT 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)

TRT is better than exercise to reduce body fat, gain lean muscle and improve strength, and works synergistic with exercise. J Endocrinol 2001 Jul;170(1):27-38