Category Archives: Testosterone

Hypogonadism is a common condition in the male population, with a higher prevalence in older men, obese men, and men with type 2 diabetes. It is estimated that approximately 35% of men older than 45 years of age and 30-50% of men with obesity or type 2 diabetes have hypogonadism.

Testosterone is an important sex hormone in men. It is secreted by the testes and is responsible for the typical male characteristics, such as facial, pubic, and body hair as well as muscle. This hormone also helps maintain sex drive, sperm production, and bone health. The brain and pituitary gland (a small gland at the base of the brain) control the production of testosterone by the testes.

Be open with your doctor about your medical history, all prescription and nonprescription drugs you are now taking, sexual problems, and any major changes in your life. Your doctor will take a thorough history of your symptoms and then complete a physical exam, including your body hair, breast tissue, and the size and consistency of the testes and scrotum.

Your doctor will also use blood tests to see if your total testosterone level is low. The normal range depends on the lab that conducts the test. To get a diagnosis of hypogonadism, you need at least two early morning (710 AM) blood tests that reveal low testosterone in addition to signs and symptoms typical of low testosterone. The cause of hypogonadism can be investigated further by your doctor. This might include additional blood tests, and sometimes imaging such as a pituitary MRI.

Male hypogonadism is a combination of low testosterone levels and the presence of any of these symptoms:

Over time, low testosterone may cause a man to lose body hair, muscle bulk, cause weak bones (osteoporosis), low red blood cells and smaller testes. Signs and symptoms (what you see and feel) vary from person to person.

There are many causes of hypogonadism. They may involve a problem with the testes or with the signal from the brain that controls testosterone secretion. Low testosterone can result from:

Improvement of testosterone levels can improve sexual concerns, bone health, muscle and anemia (low red cells in the blood). Hypogonadism can be treated with the use of doctor-prescribed testosterone replacement therapy. This treatment is safe and can be effective for men who are diagnosed with consistently abnormal low testosterone production and symptoms that are associated with this type of androgen (hormone) deficiency.

Although testosterone replacement therapy is the primary treatment option, some conditions that cause hypogonadism, such as obesity, can be reversible without testosterone therapy. These should be addressed before testosterone therapy is contemplated. If testosterone therapy is needed, goals of treatment are to improve symptoms associated with testosterone deficiency and maintain sex characteristics.

There are many different types of testosterone therapy. Method of treatment depends on the cause of low testosterone, the patients preferences, cost, tolerance, and concern about fertility. You should discuss the different options with your physician "your partner in care" to find out which therapy is right for you.

Injections: Self or doctor administered in a muscle every 12 weeks; administered at a clinic every 10 weeks for longer-acting. Side effects: uncomfortable, fluctuating symptoms.

Gels/Solutions: Applied to upper arm, shoulder, inner thigh, armpit. Side effects: may transfer to others via skin contact must wait to absorb completely into skin.

Patches: Adhere to skin every day to back, abdomen, upper arm, thigh; rotate locations to lessen skin reaction. Side effects: skin redness and rashes.

Buccal Tablets: Sticky pill applied to gums twice a day, absorbs quickly into bloodstream through gums. Side effects: gum irritation.

Pellets: Implanted under skin surgically every 36 months for consistent and long-term dosages. Side effects: pellet coming out through skin, site infection/ bleeding (rare), dose decreasing over time and hypogonadism symptoms possibly returning towards the end of dose period.

Nasal Gel: Applied by pump into each nostril 3x a day. Side effects: nasal irritation or congestion.

Sometimes a medication called clomiphene citrate is used to treat hypogonadism, but this is not FDA approved for this indication. A thorough discussion is needed with your doctor.

You should discuss with your physician how to monitor for prostate cancer and other risks to your prostate. Men with known or suspected prostate or breast cancer should not receive testosterone therapy. You should also talk to your doctor about the risks of testosterone therapy if you have, or are at risk for, heart disease or stroke. In addition, if you are planning fertility, you should not use testosterone therapy.

You should not receive testosterone therapy if you have:

Possible risks of testosterone treatment include:

If you are treated with testosterone, your doctor will need to see you regularly, along with blood tests.Testosterone therapy is only recommended for hypogonadism patients. Boosting testosterone is NOT approved by the US Food and Drug Administration (FDA) to help improve your strength, athletic performance, physical appearance, or to treat or prevent problems associated with aging. Using testosterone for these purposes may be harmful to your health.

There is no firm scientific evidence that long-term testosterone replacement is associated with either prostate cancer or cardiovascular events. The FDA requires that you are made aware that the possibility of cardiovascular events may exist during treatment. Prostate cells are stimulated by testosterone, so be extra vigilant about cancer screenings. African American men over age 45 especially those with family history of cancer are already at risk for prostate cancer.

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Hypogonadism in Men | Endocrine Society

In the United States, approximately 43 percent of women and 31 percent of men experience sexual dysfunction.1 It is not surprising that testosterone, primarily used to treat sexual problems, is being prescribed more often than in the past; a 500 percent increase in sales has been documented from 1993 to 2001.2 However, testosterone therapy is controversial, particularly for use in women. The safety and effectiveness of testosterone supplementation have not been clearly defined, although there is an extensive review3 by the Institute of Medicine outlining what is known about testosterone therapy in older men.

Testosterone levels in adult men decline at an average rate of 1 to 2 percent per year.4 This change can be caused by the normal physiologic changes of aging, testicular dysfunction, or hypothalamicpituitary dysfunction.5 By 80 years of age, more than 50 percent of men have testosterone levels in the hypogonadal range.6 Hypogonadism is defined as a low serum testosterone level coupled with any of the signs and symptoms outlined in Table 1.7 The presentation varies from person to person.

Laboratory measures of testosterone include total testosterone, free testosterone, and steroid hormone-binding globulin. In addition, luteinizing hormone and folliclestimulating hormone levels can be used to differentiate primary from secondary hypogonadism (Table 28). Approximately 98 percent of the circulating testosterone is bound to steroid hormonebinding globulin or albumin.9 The amount of bioavailable testosterone is the sum of the free testosterone and a portion of the bound testosterone. Total testosterone (normal range, 300 to 1,000 ng per dL [10.4 to 34.7 nmol per L]) is the most commonly used measure of testosterone in research studies and in clinical practice.4 Changes in steroid hormonebinding globulin can affect the bioavailable testosterone. Because measures of bioavailable testosterone are not standardized, they are not used routinely. There are no consistent guidelines for the level of total testosterone that defines hypogonadism; however, many studies use the American Association of Clinical Endocrinologists (AACE) definition of a total testosterone level less than 200 ng per dL (6.9 nmol per L).8

Table 31024 lists the possible benefits of testosterone therapy in men.

Men with low testosterone levels commonly complain of decreased sex drive or erectile dysfunction. Treatment with testosterone gel, transdermal patch, or intramuscular injection is indicated for men with low total testosterone levels who have these symptoms. Regardless of the route of administration, studies have shown improvement in libido and sexual function in hypogonadal men.1013 Other small, short-term trials of sexual function in men, including some with men who have normal testosterone levels, show mixed results. The optimal delivery method has not been determined.

The bone mineral density of hypogonadal men decreases as testosterone levels decrease, potentially increasing the risk of fractures.25 Bioavailable testosterone and estrogen levels are more correlated with density changes than total testosterone. Testosterone replacement may stop bone loss and increase bone density14; however, many studies demonstrate equivocal results, and none have shown a decreased rate of fractures with testosterone therapy.15,16 Lean body mass increases consistently occur with testosterone treatment in healthy men; however, muscle strength does not significantly increase.15,17

The indications for the use of testosterone in cognitive and psychological impairment are still unclear; however, studies of healthy older men with testosterone deficiency have yielded interesting results. Neuropsychological testing has revealed improvements in spatial cognition26 and spatial and verbal memory27 with testosterone replacement. No positive effects on mood or depression have been clearly demonstrated for hypogonadal men.10,18 Two trials19,20 (not placebo controlled) have demonstrated improvements in quality of life.

Most men with human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) have decreased androgen levels, although the levels may remain in the low-normal range.21 Testosterone replacement has been shown to increase mood and sense of well-being in this population.22,23 Improvements in libido, energy, and muscle strength also have been demonstrated.23,24

Most studies of testosterone therapy in hypogonadal men have been on men younger than 65 years, but the Institute of Medicine examined the effectiveness and safety of testosterone treatment in older men.3 The committee found no compelling evidence of major adverse side effects resulting from testosterone therapy (Table 411,19,2836). However, because of the lack of well-done, long-term studies, the report3 states that its use is appropriate only for those conditions approved by the U.S. Food and Drug Administration (FDA), and that it is inappropriate for wide-scale use of testosterone therapy to prevent possible future disease or to enhance strength or mood in otherwise healthy older men. Because of safety concerns, the Institute of Medicine recommended that well-constructed, short-term studies of testosterone in older men be conducted for conditions that do not already have effective therapies. If effective, they recommended that long-term studies be conducted to determine safety.3

Prostate cancer and benign prostate enlargement are thought to be stimulated by testosterone. Because treatments for both conditions include androgen suppression, the possibility of increased risk of these conditions with testosterone supplementation is of great concern. Testosterone treatment has been associated with increased prostate volume, although not necessarily above high-normal levels.28 Multiple studies have not shown signs or symptoms of benign prostatic hypertrophy during testosterone treatment. In short-term studies,18,29,30 there is no convincing evidence of an increased risk of prostate cancer from testosterone replacement treatment, as measured by prostate-specific antigen levels. Long-term studies need to be completed before it is reasonable to make a final determination.

Few data show that testosterone replacement increases the incidence of cardiovascular disease. Most studies have focused on the effect on cardiovascular risk factors such as lipid levels, insulin sensitivity, and C-reactive protein. Although some studies have suggested that testosterone reduces high-density lipoprotein (HDL) cholesterol levels, there are many studies showing no effect on HDL cholesterol. No effect on C-reactive protein or insulin sensitivity occurs with replacement to normal levels.37 A meta-analysis31 of the effect of testosterone replacement on cholesterol levels showed mixed results, indicating that the effect is unclear.

Because high levels stimulate erythropoiesis, testosterone can be beneficial for men with anemia. However, polycythemia can be an issue for nonanemic men who are at risk of vascular disease. Most studies of cardiovascular risks associated with testosterone demonstrate increases in hematocrit levels.11,19

Testosterone, an essential precursor of estrogen in women, is made in the ovaries and adrenal glands. There is a steady decline in testosterone levels from the 20s through menopause. With surgical menopause, the level of testosterone drops precipitously. No clear lower limit of testosterone has been established; however 15 ng per dL (0.5 nmol per L) commonly is used. One study38 found that women with 0 to 10 ng per dL (0 to 0.3 nmol per L) had markedly decreased sexual desire in all situations and absent or markedly decreased orgasms. Because of studies like this, supplemented with anecdotal evidence, many women have been started on testosterone therapy.

In December 2004, the FDA voted against approving a new testosterone patch for women because of safety issues. The advisory panel had concerns about the low numbers of women studied and the length of the studies. However, many physicians are prescribing testosterone in other forms. Oral esterified estrogen with methyltestosterone (Estratest) has been used extensively since the 1970s, though it has not been FDA approved. It is marketed for treatment of hot flashes, although there is marginal evidence to support its use for this.32

Most women can expect to spend one third of their lives in the postmenopausal stage. With the new evidence that traditional hormone therapy using estrogen and progesterone can increase the risk of cardiovascular disease as well as uterine and breast cancer,39 women with post-menopausal complaints of hot flashes, mood changes, and poor sexual functioning have been more interested in testosterone therapy as an option. Clinical guidelines for the use of androgens for female sexual dysfunction are being developed by the Endocrine Society.40 There is little evidence in the literature for the benefit of estrogen plus testosterone over estrogen alone for the treatment of hot flashes.

Depression, anger, moodiness, insomnia, and lack of well-being are common complaints of postmenopausal women. A limited number of studies33,41 have shown that psychological symptoms and memory are improved with the addition of testosterone to estrogen.

Testosterone replacement is prescribed most commonly to treat problems with libido, sexual enjoyment, and orgasm in patients who are postmenopausal or who have had an oophorectomy. As many as 50 percent of post-menopausal women have sexual dysfunction,42 and a low testosterone level has been correlated with reduced coital frequency in these women.43 A number of small studies done in postmenopausal women demonstrate effectiveness for sexual dysfunction; however, all used testosterone combined with estrogen (Table 5).32,36,4348

Osteoporosis is a leading cause of morbidity and mortality in older women. Low circulating testosterone is correlated with hip fracture and height loss in postmenopausal women.49 Estrogen alone has been used to prevent loss of bone mass, but other studies have shown that oral estrogen-androgen hormone therapy promotes bone formation.32,43,45 It is not known, however, if this prevents fractures or prolongs life.

Women with diminished sex drive have been shown to have lower free testosterone levels.50 However, physicians are reluctant to use testosterone in premenopausal women because of concerns about masculinization. In a 12-week trial51 of 34 women, testosterone therapy (1% cream, 10 mg per day applied to the thigh) improved well-being, mood, and sexual function in premenopausal women with low libido and low testosterone levels. No increase in hirsutism, acne, or voice change occurred.

Testosterone is used for women with premature ovarian failure, Turner's syndrome, HIV infection, or chronic corticosteroid use. More research in the area of chronic illness has been completed in men than in women. Other uses such as the prevention of dementia and depression have been postulated.

The controversy over using testosterone has primarily come from issues involving safety (Table 411,19,2836). The typical side effects related to the estrogentestosterone preparations are alopecia, acne, and hirsutism, although these are dose and duration dependent and are not common.34 Controlled studies32,35,48,51 have found low incidence of deep voice, oily skin, acne, and male-pattern hair loss. Virilization is not common, usually is reversible, and typically occurs only with supraphysiologic dosages. Reduced total cholesterol and HDL cholesterol levels have been demonstrated when used in women in addition to estrogen, although the long-term effects on heart disease are not known. Testosterone use in the short term has not been associated with an increase in cardiovascular disease or symptoms. Usual estrogen-testosterone doses in women have not been linked to hepatic damage.35

Anabolic steroids are testosterone compounds used by male and female athletes to improve performance and by others to treat depression and increase a sense of well-being. Their use has had a significant affect on international sports since the mid-20th century.52 More recently, supplements such as dehydroepiandrosterone, a testosterone precursor, have gained popularity. A recent study53 supports its use for depression in men and women. These substances can raise testosterone levels. Some athletes believe this will enhance performance, but no clear benefits have been demonstrated.54,55 However, side effects such as gynecomastia, acne, and lowered HDL cholesterol levels have been noted. Over-the-counter supplements are not regulated, and wide variability exists in quality and content.56 Testosterone precursors such as dehydroepiandrosterone may pose serious health risks.

The AACE has issued guidelines for testosterone supplementation in men, and guidelines for women are being developed.8,40 Table 6 lists the indications and Table 757 shows the available forms of testosterone and their various costs. The goal in men is to restore the testosterone concentration to the normal range. Oral preparations should be avoided because of first-pass metabolism and the association of hepatotoxicity with the higher doses used for men. Injections of testosterone last 10 to 14 days, requiring frequent visits to the doctor or training in self-injection techniques. Pellets and transbuccal troches are the newest methods of delivery but have not been as well studied.

Given the lack of long-term safety information, women who are interested in being treated with testosterone must understand the potential risks involved in using a powerful hormone. Clinical status of the patient is the best way to follow the effectiveness of testosterone therapy because normal levels are not well established. Oral treatment in combination with estrogen is the most readily available method of treatment for women, although some physicians prescribe the topical gel. Patients usually notice an improvement in libido and energy within days or weeks.

Because of the uncertain safety of testosterone, monitoring patients during therapy is recommended (Table 88,40). The AACE guidelines suggest routine monitoring of male patients by history and physical examination including a digital rectal examination and measuring prostate-specific antigen levels, testosterone levels in patients receiving injections, hematocrit, and lipid profiles.7 Generally, women are watched for side effects rather than checking testosterone levels. It is recommended that physicians monitor women taking testosterone for virilization and do baseline and semiannual breast examinations, complete blood cell count, lipid levels, annual mammography, and endometrial ultrasonography.40

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Testosterone Treatments: Why, When, and How? | AAFP

Testosterone is a hormone found in humans, as well as in other animals. In men, the testicles primarily make testosterone. Womens ovaries also make testosterone, though in much smaller amounts.

The production of testosterone starts to increase significantly during puberty and begins to dip after age 30 or so.

Testosterone is most often associated with sex drive and plays a vital role in sperm production. It also affects bone and muscle mass, the way men store fat in the body, and even red blood cell production.

A mans testosterone levels can also affect his mood.

Low levels of testosterone, also called low T levels, can produce a variety of symptoms in men, including:

While testosterone production naturally tapers off as a man ages, other factors can cause hormone levels to drop.

Injury to the testicles and cancer treatments such as chemotherapy or radiation can negatively affect testosterone production.

Chronic health conditions and stress can also reduce testosterone production. Some of these include:

Testosterone levels decline steadily in adult women, however, low T levels can also produce a variety of symptoms, including:

Low T levels in women can be caused by removal of the ovaries as well as diseases of the pituitary, hypothalamus, or adrenal glands.

Testosterone therapy may be prescribed for women with low T levels, however, the treatments effectiveness on improving sexual function or cognitive function among postmenopausal women is unclear.

A simple blood test can determine testosterone levels. Theres a wide range of normal or healthy levels of testosterone circulating in the bloodstream.

Normal male testosterone levels range between 280 and 1,100 nanograms per deciliter (ng/dL) for adult males, and between 15 and 70 ng/dL for adult females, according to the University of Rochester Medical Center.

Ranges can vary among different labs, so its important to speak with your doctor about your results.

If an adult males testosterone levels are below 300 ng/dL, a doctor may do a workup to determine the cause of low testosterone, according to the American Urological Association.

Low testosterone levels could be a sign of pituitary gland problems. The pituitary gland sends a signaling hormone to the testicles to produce more testosterone.

A low T test result in an adult man could mean the pituitary gland isnt working properly. But a young teen with low testosterone levels might be experiencing delayed puberty.

Moderately elevated testosterone levels in men may produce few noticeable symptoms. Boys with higher levels of testosterone may begin puberty earlier. Women with high testosterone may develop masculine features.

Abnormally high levels of testosterone could be the result of an adrenal gland disorder, or even cancer of the testes.

High testosterone levels may also occur in less serious conditions. For example, congenital adrenal hyperplasia, which can affect males and females, is a rare but natural cause for elevated testosterone production.

If your testosterone levels are extremely high, your doctor may order other tests to find out the cause.

Reduced testosterone production, a condition known as hypogonadism, doesnt always require treatment.

You may be a candidate for testosterone replacement therapy if low T is interfering with your health and quality of life. Artificial testosterone can be administered orally, through injections, or with gels or skin patches.

Replacement therapy may produce desired results, such as greater muscle mass and a stronger sex drive. But the treatment does carry some side effects. These include:

Some studies have found no greater risk of prostate cancer with testosterone replacement therapy, but it continues to be a topic of ongoing research.

One study suggests that theres a lower risk of aggressive prostate cancers for those on testosterone replacement therapy, but more research is needed.

Testosterone is most commonly associated with sex drive in men. It also affects mental health, bone and muscle mass, fat storage, and red blood cell production.

Abnormally low or high levels can affect a mans mental and physical health.

Your doctor can check your testosterone levels with a simple blood test. Testosterone therapy is available to treat men with low levels of testosterone.

If you have low T, ask your doctor if this type of therapy might benefit you.

Link:
Testosterone: What It Is and How It Affects Your Health

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Low testosterone in males is common as they get older. Symptoms can be subtle, but there is treatment available if the symptoms affect your lifestyle.

Testosterone is a hormone produced by the testicles. Testosterone affects your appearance and sexual development, stimulates sperm production and sex drive, and helps build muscle and bone mass.

Testosterone production typically decreases with age. According to the American Urological Association, about 40 percent of males ages 45 and older have low testosterone.

If your testosterone production drastically drops, you may experience a range of symptoms. Signs of low testosterone are often subtle and can include:

Testosterone plays a key role in sex drive, also known as libido. Some people may experience a decline in sex drive as they get older, but those with low testosterone will likely experience a more drastic drop.

Testosterone aids in achieving and maintaining an erection. It tells brain receptors to produce nitric oxide, which is a molecule that helps trigger a series of chemical reactions necessary for an erection to occur.

When testosterone levels are too low, you may have difficulty achieving an erection before sex or having spontaneous erections, such as during sleep.

However, research is inconclusive on whether testosterone replacement therapy can successfully treat erectile dysfunction. In a 2016 review of studies that looked at the benefit of testosterone in men with erection difficulties, nearly half showed no improvement with testosterone treatment.

Other health conditions can often cause erectile difficulties. These include:

Smoking and alcohol use can also contribute.

Experiencing hot flashes can be a sign of low testosterone. This can feel like a sudden sensation of warmth. You may also experience heavy sweating, reddening of the skin, and night sweats.

Testosterone plays a role in several body functions, including hair production. Balding is a natural part of growing older for many men, and while it can be hereditary, those with low testosterone may lose body and facial hair as well.

Males with low testosterone may report extreme fatigue and decreased energy. You may have low testosterone if youre consistently tired despite getting plenty of sleep or if you find it harder to get motivated to exercise.

Males with low testosterone may notice a decrease in muscle mass, as testosterone contributes to building muscle. A 2016 review found that testosterone affects muscle mass but not necessarily strength or function.

Males with low testosterone may experience increased body fat or develop gynecomastia, which is enlarged breast tissue. Gynecomastia can occur when there is an imbalance of testosterone and estrogen in the body.

Osteoporosis is a condition many people often associate with females, but males with low testosterone can also experience bone loss. Testosterone helps produce and strengthen bone, so males with low testosterone, especially older men, may have lower bone volume and be more susceptible to bone fractures.

Males with low testosterone can experience mood changes. Since testosterone influences many of the bodys physical processes, it can also influence mood and mental capacity.

Both testosterone levels and cognitive functions, particularly memory, decline with age. As a result, doctors have theorized that lower testosterone levels could contribute to affected memory.

According to a 2019 review of studies, testosterone supplementation is linked with improved memory in older men with low testosterone though the effect may be small.

However, a 2017 study on testosterone supplementation did not find memory improvements in 493 men with low testosterone levels who took testosterone or a placebo.

The body requires testosterone to develop the penis and testicles, so low testosterone levels could contribute to a disproportionately smaller penis or testicles. There are other conditions and circumstances that can cause a smaller penis and testicles, as well.

These include:

Doctors have linked low testosterone with an increased risk for anemia, according to a 2017 study. When the researchers administered testosterone gel to anemic men with low testosterone, they saw improved blood counts compared to men who used a placebo.

Some symptoms of anemia include:

Testosterone levels naturally decrease as males get older, but other conditions or circumstances may also cause low testosterone. These may include:

Having low testosterone may increase your risk of developing other health conditions.

These conditions include:

Testosterone levels are typically 300 to 1,000 nanograms per deciliter (ng/dL). Low testosterone is when testosterone levels fall below 300 ng/dL. A blood test called a serum testosterone test can determine your testosterone level.

Other tests may be performed to determine the cause of low testosterone.

Tests to diagnose low testosterone and its causes include:

Testosterone replacement therapy is a common treatment for low testosterone.

If you have low testosterone symptoms that are bothering you, you can talk with a doctor to determine if testosterone replacement therapy is right for you. Testosterone replacement therapy comes in a variety of forms, including:

Testosterone replacement therapy is a lifelong treatment. If you stop treatment, your testosterone levels will also drop.

Side effects of testosterone replacement therapy can include:

Testosterone replacement therapy may not be right for you if you:

Males experience a gradual decrease in testosterone as they get older. The older you are, the more likely that youll have low testosterone.

A variety of factors can cause low testosterone. Males with testosterone levels below 300 ng/dL may experience some symptoms. A doctor can check your testosterone level with a simple blood test.

If you have low testosterone and the symptoms bother you, testosterone replacement therapy is a common treatment.

If you would like to know your testosterone levels, LetsGetChecked offers male hormone tests at home at various price points.

Read this article in Spanish.

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Low Testosterone: 12 Signs in Men - Healthline

Testosterone Replacement Therapy is a life-changing treatment for men with low levels of testosterone. Optimale is the top-rated TRT clinic in the UK, using experienced doctors and advanced systems to ensure you get the best service and care available.

Established over 5 years ago, we have lots of experience helping men recover from low testosterone and realise their full potential in life. Our medical director, Dr Chris Airey, also used to suffer from low testosterone. Now he uses his personal experience and his degree in Endocrinology to ensure men get the best treatment possible.

Unlike other clinics, Optimale is flexible to your needs, providing protocols and medication options that are convenient and effective for your own personal circumstances. We provide a 5-star service which is why we are the top-rated clinic in the UK for Testosterone Replacement Therapy.

We only use experienced, GMC registered doctors in our clinics. We are CQC registered and regulated a legal requirement for any legitimate medical clinic in the UK.

If you are interested in learning more then visit our page on TRT in the UK, order a blood test, or complete our ADAM Questionnaire to find out if you are suffering from low testosterone.

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Testosterone Replacement Therapy (TRT) Experts | Optimale

Testosterone is the hormone that gives men their manliness. Produced by the testicles, it is responsible for male characteristics like a deep voice, muscular build, and facial hair. Testosterone also fosters the production of red blood cells, boosts mood, keeps bones strong, and aids thinking ability. Lack of testosterone, often nicknamed, low-t, can cause unwanted symptoms.

Testosterone levels peak by early adulthood and drop as you ageabout 1% to 2% a year beginning in the 40s. As men reach their 50s and beyond, this may lead to signs and symptoms, such as impotence or changes in sexual desire, depression or anxiety, reduced muscle mass, less energy, weight gain, anemia, and hot flashes. While falling testosterone levels are a normal part of aging, certain conditions can hasten the decline. Low t risk factors include:

Millions of men usetestosterone replacement therapyto restore low levels and feel more alert, energetic, mentally sharp, and sexually functional. But it's not that simple. A man's general health also affects his testosterone levels. For instance, being overweight, having diabetes or thyroid problems, and taking certain medications, such as glucocorticoids and other steroids, can affect levels. Therefore, simply having low-t levels does not always call for taking extra testosterone.

Doctors diagnose low testosterone based on a physical exam, a review of symptoms, and the results of multiple blood tests since levels can fluctuate daily.

If your doctor diagnoses low testosterone, other tests may be considered before therapy. For example, low-t can speed bone loss, so your doctor may recommend a bone density test to see whether you also need treatment for osteoporosis.

Prostate cancer is another concern, as testosterone can fuel its growth. As a result, the Endocrine Society recommends against testosterone supplementation for men in certain situations, including those who:

Other circumstances in which testosterone supplementation is not recommended include:

In most cases, men need to have both low levels of testosterone in their blood and several symptoms of low testosterone to go on therapy.

It is possible to have low levels and not experience symptoms. But if you do not have any key symptoms, especially fatigue and sexual dysfunction, which are the most common, it is not recommended you go on the therapy given the uncertainty about long-term safety.

Even if your levels are low and you have symptoms, low-t therapy is not always the first course of action. If your doctor can identify the source for declining levelsfor instance, weight gain or a particular medicationhe or she may first address that problem.

If you and your doctor think testosterone replacement therapy is right for you, there are a variety of delivery methods to consider, as found in the Harvard Special Health ReportMen's Health: Fifty and Forward.

Most men feel improvement in symptoms within four to six weeks of taking testosterone replacement therapy, although changes like increases in muscle mass may take from three to six months.

By Matthew SolanExecutive Editor, Harvard Men's Health Watch

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Treating low testosterone levels - Harvard Health

When you think of testosterone, what comes to mind? Macho men? Aggressive, impatient, type A behavior? Road rage? Violence?

Testosterone's role in bad behavior is largely a myth. What's more, testosterone plays other important roles in health and disease that may surprise you. For example, did you know that testosterone is a key player in prostate cancer? Or, that women need testosterone, too? There's more to testosterone than guys behaving badly.

Testosterone is the major sex hormone in males and plays a number of important roles, such as:

Adolescent boys with too little testosterone may not experience normal masculinization. For example, the genitals may not enlarge, facial and body hair may be scant and the voice may not deepen normally.

Testosterone may also help maintain normal mood. There may be other important functions of this hormone that have not yet been discovered.

Signals sent from the brain to the pituitary gland at the base of the brain control the production of testosterone in men. The pituitary gland then relays signals to the testes to produce testosterone. A "feedback loop" closely regulates the amount of hormone in the blood. When testosterone levels rise too high, the brain sends signals to the pituitary to reduce production.

If you thought testosterone was only important in men, you'd be mistaken. Testosterone is produced in the ovaries and adrenal gland. It's one of several androgens (male sex hormones) in females. These hormones are thought to have important effects on:

The proper balance between testosterone (along with other androgens) and estrogen is important for the ovaries to work normally. While the specifics are uncertain, it's possible that androgens also play an important role in normal brain function (including mood, sex drive and cognitive function).

Testosterone is synthesized in the body from cholesterol. But having high cholesterol doesn't mean your testosterone will be high. Testosterone levels are too carefully controlled by the pituitary gland in the brain for that to occur.

Having too much naturally-occurring testosterone is not a common problem among men. That may surprise you given what people might consider obvious evidence of testosterone excess: road rage, fighting among fathers at Little League games and sexual promiscuity.

Part of this may be due to the difficulty defining "normal" testosterone levels and "normal" behavior. Blood levels of testosterone vary dramatically over time and even during the course of a day. In addition, what may seem like a symptom of testosterone excess (see below) may actually be unrelated to this hormone.

In fact, most of what we know about abnormally high testosterone levels in men comes from athletes who use anabolic steroids, testosterone or related hormones to increase muscle mass and athletic performance.

Problems associated with abnormally high testosterone levels in men include:

Among women, perhaps the most common cause of a high testosterone level is polycystic ovary syndrome (PCOS). This disease is common. It affects 6% to 10% of premenopausal women.

The ovaries of women with PCOS contain multiple cysts. Symptoms include irregular periods, reduced fertility, excess or coarse hair on the face, extremities, trunk and pubic area, male-pattern baldness, darkened, thick skin, weight gain, depression and anxiety. One treatment available for many of these problems is spironolactone, a diuretic (water pill) that blocks the action of male sex hormones.

Women with high testosterone levels, due to either disease or drug use, may experience a decrease in breast size and deepening of the voice, in addition to many of the problems men may have.

In recent years, researchers (and pharmaceutical companies) have focused on the effects of testosterone deficiency, especially among men. In fact, as men age, testosterone levels drop very gradually, about 1% to 2% each year unlike the relatively rapid drop in estrogen that causes menopause. The testes produces less testosterone, there are fewer signals from the pituitary telling the testes to make testosterone, and a protein (called sex hormone binding globulin (SHBG) increases with age. All of this reduces the active (free) form of testosterone in the body. More than a third of men over age 45 may have reduced levels of testosterone than might be considered normal (though, as mentioned, defining optimal levels of testosterone is tricky and somewhat controversial).

Symptoms of testosterone deficiency in adult men include:

Some men who have a testosterone deficiency have symptoms or conditions related to their low testosterone that will improve when they take testosterone replacement. For example, a man with osteoporosis and low testosterone can increase bone strength and reduce his fracture risk with testosterone replacement.

As surprising as it may be, women can also be bothered by symptoms of testosterone deficiency. For example, disease in the pituitary gland may lead to reduced testosterone production from the adrenal glands disease. They may experience low libido, reduced bone strength, poor concentration or depression.

There are times when low testosterone is not such a bad thing. The most common example is probably prostate cancer. Testosterone may stimulate the prostate gland and prostate cancer to grow. That's why medications that lower testosterone levels (for example, leuprolide) and castration are common treatments for men with prostate cancer. Men taking testosterone replacement must be carefully monitored for prostate cancer. Although testosterone may make prostate cancer grow, it is not clear that testosterone treatment actually causes cancer.

Men can experience a drop in testosterone due to conditions or diseases affecting the:

Genetic diseases, such as Klinefelter syndrome (in which a man has an extra x-chromosome) and hemochromatosis (in which an abnormal gene causes excessive iron to accumulate throughout the body, including the pituitary gland) can also affect testosterone.

Women may have a testosterone deficiency due to diseases of the pituitary, hypothalamus or adrenal glands, in addition to removal of the ovaries. Estrogen therapy increases sex hormone binding globulin and, like aging men, this reduces the amount of free, active testosterone in the body.

Currently, testosterone therapy is approved primarily for the treatment of delayed male puberty, low production of testosterone (whether due to failure of the testes, pituitary or hypothalamus function) and certain inoperable female breast cancers.

However, it is quite possible that testosterone treatment can improve symptoms in men with significantly low levels of active (free) testosterone, such as:

However, many men with normal testosterone levels have similar symptoms so a direct connection between testosterone levels and symptoms is not always clear. As a result, there is some controversy about which men should be treated with supplemental testosterone.

Testosterone therapy may make sense for women who have low testosterone levelsand symptoms that might be due to testosterone deficiency. (It's not clear if low levelswithout symptoms are meaningful; treatment risks may outweigh benefits.) However, the wisdom and effectiveness of testosterone treatment to improve sexual function or cognitive function among postmenopausal women is unclear.

People with normal testosterone levels are sometimes treated with testosterone at the recommendation of their doctors or they obtain the medication on their own. Some have recommended it as a "remedy" for aging. For example, a study from Harvard Medical School in 2003 found that even among men who started out with normal testosterone results noted loss of fat, increased muscle mass, better mood, and less anxiety when receiving testosterone therapy. Similar observations have been noted among women. However, the risks and side effects of taking testosterone when the body is already making enough still discourages widespread use.

Testosterone is so much more than its reputation would suggest. Men and women need the proper amount of testosterone to develop and function normally. However, the optimal amount of testosterone is far from clear.

Checking testosterone levels is as easy as having a blood test. The difficult part is interpreting the result. Levels vary over the course of the day. A single low level may be meaningless in the absence of symptoms, especially if it was normal at another time. We need more research to know when to measure testosterone, how best to respond to the results and when it's worthwhile to accept the risks of treatment.

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Testosterone What It Does And Doesn't Do - Harvard Health

Background: The aim of testosterone replacement therapy (TRT) is to improve symptoms and signs of testosterone deficiency including decreased libido, erectile dysfunction, depressed mood, anaemia, loss of muscle and bone mass, by increasing serum testosterone levels to physiologic range. TRT has been used in the last 70 years, and overtime, numerous preparations and formulations have been developed to improve pharmacokinetics (PKs) and patient compliance. The routes of delivery approved for use in the Western world include buccal, nasal, subdermal, transdermal and intramuscular (IM).

Objectives: The aim of this narrative review was to describe and compare all available and approved testosterone preparations according to pharmacology, PKs and adverse effects.

Materials and methods: We have performed an extensive PubMed review of the literature on TRT in clinical practice. Contraindications and monitoring of TRT were analyzed by comparing available guidelines released in the last five years. We provide a review of advantages and disadvantages of different modalities of TRT and how to monitor treatment to minimize the risks.

Results: TRT is associated with multiple benefits highly relevant to the patient. However, the recommendations given in different guidelines on TRT are based on data from a limited number of randomized controlled trials (RCTs), as well as non-randomized clinical studies and observational studies. This is the case for the safety of a long-term TRT in late-onset hypogonadism (LOH). No evidence is provided indeed on the effects of TRT on endpoints such as deterioration of heart failure suggesting a cautious approach to T replacement in older men with a history of heart failure.

Conclusion: Clinicians must consider the unique characteristics of each patient and make the necessary adjustments in the management of LOH in order to provide the safest and most beneficial results.

Keywords: androgen deficiency; hormonal therapy; late-onset hypogonadism; testosterone.

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Testosterone replacement therapy - PubMed

Testosterone therapy is used mostly by aging men with low testosterone levels but is exploited by others looking to stop the normal testosterone decline thats part of male aging. (Photo for illustrative purposes only. Getty Images/Nastasic).

October 13, 2022

By Mike RichmanVA Research Communications

"This could mean that men in some ways could derive benefit from T therapy even if their T level is not as low as defined by the Endocrine Society."

A new study finds that an increase in the male hormone testosterone helps to improve body composition, even in men with testosterone levels near the lower end of normal.

The researchers also concluded that testosterone may benefit men from a metabolic standpoint.

The results appeared in Frontiers in Endocrinology in July 2022.

Dr. Reina Villareal, an endocrinologist at the Michael E. DeBakey VA, led the study.

Dr. Reina Villareal, an endocrinologist at the Michael E. DeBakey VA Medical Center in Houston and a professor at the nearby Baylor College of Medicine, led the study. She, first author Dr. Fnu Deepika, and their colleagues aimed to determine if there are differences in changes in body composition, metabolic profile, and bone turnover markers and bone mineral density in response to testosterone (T) therapy. Bone mineral density is a measure of the thickness of bones, and bone turnover is the process of resorption followed by replacement by new bone with little change in shape.

Regarding the significance of the findings, Villareal says, This could mean that men in some ways could derive benefit from T therapy even if their T level is not as low as defined by the Endocrine Society, whose guideline for low T is less than 264 nanograms per deciliter (ng/dL).

However, I am not advocating to treat anyone with normal T levels for those benefits because of the serious side effects associated with T therapy, such as an increase in cardiovascular issues, blood clots, and prostate enlargement, she says. There is an ongoing randomized placebo-controlled study with over 5,000 men that is addressing the cardiovascular and prostate safety of T replacement therapy. That will likely confirm or dispute the safety concerns of T replacement therapy.

Testosterone therapy is a billion-dollar industry, with studies reaching myriad conclusions on the pros and cons of the treatment. Its used mostly by aging men with low testosterone levelsa condition called hypogonadismbut is exploited by others looking to stop the normal testosterone decline thats part of male aging and, in a sense, to relive their youth. Testosterone is a key male hormone that affects sex drive, bone mass, the production of red blood cells, and muscle size and strength.

In addition to older men, about 35% of men older than 45 and up to 50% of men withobesity or type 2 diabetes have low T levels, according to the Endocrine Society.

Plus, although not approved for obesity, testosterone therapy is becoming more popular as a possible option to deal with obesity in men. Usually, T therapy doesnt produce a change in body weight. But a redistribution in body composition involves an increase in lean or muscle mass and a reduction in body fat.

The basis for Villareals study was the finding from another study that bone mineral density (BMD) response to testosterone therapy in men with low T levels is influenced by baseline T levels. That study showed that a baseline T level of less than 200 ng/dL is linked to greater increases in spine BMD. A BMD test helps clinicians detect osteoporosis and predict risk for bone fractures.

Villareal and her colleagues set out to learn if body composition and metabolic response varies according to baseline T levels. Research has shown that these outcomes can be improved with testosterone therapy, but its unclear if response would vary according to baseline T levels.

The study consisted of 105 male Veterans, ages 40 to 74, with low testosterone levels. It was carried out from 2011 to 2016 at the Michael E. DeBakey VA and the New Mexico VA Health Care System. The authors described it as the first study to evaluate whether the effects of testosterone therapy on body composition, metabolic profile, and bone turnover markers are influenced by baseline T levels.

The researchers looked at testosterone replacement therapy for men with low T, defined as less than 300 ng/dL, the Endocrine Societys guideline until 2018. That year, its guideline was changed to less than 264 ng/dL. However, since the study was conducted before that change, some of the men who participated would have normal testosterone levels based on the new criteria.

Therapy consisted of injecting 200 milligrams every two weeks of testosterone cypionate (trade name Depo-Testosterone), an androgen and anabolic steroid used mainly to treat low T levels in men. The dose was later adjusted to a blood level of 500 to 800 ng/dL, then 300 to 600 ng/dL after the third year of the study upon the direction of the FDA. Side effects from the drug, including nausea, vomiting, and headache, were no different from what has been previously reported.

Villareal and her team found that men, regardless of their baseline testosterone level, benefited to some extent from T therapy. For instance, men with levels less than 264 ng/dL showed a greater increase at 18 months in total fat-free mass, which is mostly lean muscle mass, compared with those higher than 264 ng/dL.

Contrary to the study hypothesis, men with T levels above 264 ng/dL appeared to experience greater benefit from a metabolic standpoint, including a reduction in Hemoglobin A1c (HbA1c), a diabetes marker, along with a decline in blood glucose levels, which rise in people with diabetes and LDL (bad cholesterol). A decrease in leptin, supposedly an appetite suppressant, was due mostly to a drop in fat mass, which produces leptin. But that should not be construed as a negative effect of T therapy, according to Villareal.

We found that surprising, she says. Our original hypothesis was that response in these parameters will be better for those with lower testosterone levels. That did not happen, suggesting that those with normal T by the current guidelines will benefit from the drug.

However, the researchers cautioned against using testosterone to improve metabolic levels: Although prior studies have suggested improvement in insulin sensitivity in men with low T, a recommendation to give T to improve the metabolic profile remains controversial. Our findings support the partial metabolic benefit from T among men with levels of more than 264 ng/dL who, by current guidelines, will not be treated with T. Therefore, the information presented in the manuscript could be valuable for both clinicians and patients in shared decision-making.

Regarding the differences in the findings based on testosterone levels, We surmise that the better response in fat-free mass in those with lower T levels could be due to greater sensitivity of the muscle to testosterone replacement than those with higher levels, Villareal says. However, one should not forget that those with higher levels had an increase in fat-free mass, as well, only to a lesser extent compared to those with lower T levels.

On the other hand, she adds, the better metabolic response among those with higher T levels is hard to explain, except that maybe the group with less than 264 ng/dL needed more time on adequate T levels to see a significant improvement in blood sugar and other metabolic factors such as cholesterol. We are working on clarifying the reason for this finding in a lab at the Michael E. DeBakey VA.

There, Villareal and her team are pursuing a VA-funded study looking at the impact of T therapy on men who have diabetes and low testosterone levels. The researchers are also examining changes in bone structure and strength.

We hope to reach a conclusion for our findings from this cohort down the road, she says.

She and her team are interested in other outcomes, as well, noting that evidence is emerging of a link between bone metabolism and glucose metabolism, or diabetes control.

Hence, any change in bone metabolism brought about by T therapy may also be accompanied by changes in glucose metabolism, she notes. Since we are also assessing all the metabolic parameters in this study, broadly, we would like to explore if changes in bone parameters associated with T therapy will correlate with changes in metabolic parameters.

Well know more as time goes on.

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Increase in male hormone testosterone helps improve body composition, even in men with low testosterone levels - VA's Office of Research and...

Men are more likely to start using tobacco products. However, women who start the habit are less successful at stopping.

Women also relapse more and seem to be more resistant to smoking cessation strategies.

In vitro and animal studies have shown that nicotine can impede the production of an enzyme that regulates estrogen production.

Researchers at Uppsala University in Uppsala, Sweden discovered that the effect happens in the thalamus, which is part of the brains limbic system. The limbic system is a key component of the temporal lobe which is involved with emotion and motivation.

Lead researcher Dr. Erika Comasco, an associate professor in the institutions Department of Womens and Childrens Health, presented the teams findings at the 35th European College of Neuropsychopharmacology annual conference in Vienna on October 16, 2022.

The Uppsala University researchers recruited 10 healthy females for their experiment. These women were non-smokers of reproductive age.

The participants submitted to a nicotine dose of two nasal sprays in the nostrils. They also received an injection with a radioactive tracer attached to the enzyme aromatase, also called estrogen synthase, which is responsible for estrogen synthesis.

With MRI and PET brain scans, scientists could see where and how much of the enzyme was in the brain. They noted high levels of estrogen synthase in the thalamus, hypothalamus, and amygdala regions of the brain.

The team discovered that nicotine exposure moderately reduced the amount of aromatase in the brain.

The researchers believe that their study is the first to show this inhibitory effect on aromatase production [] in humans.

For the first time, we can see that nicotine works to shuts down the estrogen production mechanism in the brain of women. We were surprised to see that this effect could be seen even with a single dose of nicotine, equivalent to just one cigarette, showing how powerful the effects of smoking are on a womans brain. Dr. Erika Comasco

Dr. Comasco said that her teams findings indicate that nicotines influence on estrogen production has a significant impact on the brain, but perhaps also on other functions, such as the reproductive system [].

Medical News Today discussed this study with Dr. Sandra Narayanan, board certified vascular neurologist and neurointerventional surgeon at Pacific Stroke & Neurovascular Center at Pacific Neuroscience Institute in Santa Monica, CA, who was not involved in the research.

Dr. Narayanan explained how sex hormone levels tie into nicotine addiction.

Not only is there less circulating estrogen [ but] cigarette smoking raises the levels of circulating testosterone (androgens) in women, and hyperandrogenemia (high levels of androgens) is associated with reduced quitting success in women. Dr. Sandra Narayanan

There is a large body of evidence suggesting a negative effect of cigarette smoking and the associated chemicals on the female as well as male reproductive systems, said Dr. Narayanan.

In women, this spans hormone secretion, metabolism, direct toxicity to eggs, ovulation, placental growth and health, fertility (including, specifically, risk of an ectopic pregnancy), rate of miscarriage, decreased fetal oxygen levels with the accumulation of carboxyhemoglobin, and fetal endocrine imbalances, she elaborated.

The Uppsala scientists acknowledged a few limitations pertaining to her research. Since their experiment involved a small population, they hope to obtain a larger sample to confirm their results.

However, Dr. Comasco maintained that the results are in line with the hypothesis, based on preclinical and animal studies.

MNT asked Dr. Comasco if using actual cigarettes would have had a different effect on estrogen production than the nasal nicotine application.

The only difference could be in [terms] of concentration and bioavailability levelsthe proportion that reaches systemic circulationas measured in blood that would be higher for the cigarette. This means that the spray had led to blunted results, and a stronger effect is expected when considering cigarettes, as demonstrated in baboons exposed to a higher dose, she said.

MNT also asked Dr. Comasco if secondhand smoke would reduce estrogen levels.

It can be expected that exposure to nicotine through passive smoking will block the enzyme responsible for the synthesis of estrogen, she said.

However, she said that the dose would be too low to detect with the current methodology.

Dr. Comasco pointed out that women show greater vulnerability for heritability of smoking and are at greater risk of developing primary smoking-related illnesses, such as lung cancer and heart attacks.

Now, her teams challenge is to find out if nicotines impact on the hormonal system is involved in the development of such reactions.

Dr. Comasco stressed that this research is still in its preliminary stages:

Were still not sure what the behavioral or cognitive outcomes are; only that nicotine acts on this area of the brain. However, we note that the affected brain system is a target for addictive drugs, such as nicotine.

Dr. Narayanans tips for breaking the smoking habit include setting a quit date and a specific plan. She said that having supporting partners at home, in the workplace, and with healthcare professionals are vital for success.

The neurologist suggested cutting back on cigarettes slowly:

Starting with a fixed daily number of cigarettes and reducing weekly can also help smokers gain control over the quitting process and bring it to a close by a certain date.

She advised asking healthcare providers about nicotine replacement therapy (NRT) but cautioned that is a temporary and potentially addictive tool.

Healthy eating and exercise can help reduce the stress of quitting, Dr. Narayanan said.

She also mentioned that relapses do happen: Its important to get back on the wagon and stick with it for the enormous early and sustained benefits of smoking cessation to nearly every system in the body.

Would-be quitters can also check out the American Heart Association and the American Cancer Society websites for more resources and tips on how to quit smoking.

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Nicotine and estrogen: Why it's harder for women to quit smoking - Medical News Today