Testosterone Therapy

If you are suffering with low testosterone or symptoms of andropause, you have probably already considered testosterone therapy (hormone replacement therapy).  This is because you already know how ugly life can be without that precious male hormone:  a could-care-less-about-anything attitude, the feeling of being in a "mental fog", low libido, difficulty concentrating, loss of muscle mass, anxiety and on and on.  Low testosterone effects your sex life, your relationships, your health and your career, and so no matter what reservations you might have, it's going to be on your mind.

Plus, if you have read the Symptoms link, you know that low testosterone is potentially deadly, leading to heart disease, depression, mental difficulties and even osteoporosis. Low testosterone will also lead to the atrophy of the muscle tissue in the penile area making erections difficult for even the highest nitric oxide male. Again, once our sex life is affected, testosterone therapy is taken from back stage to center stage.

For some of you, the day you get on testosterone therapy will be your day of victory.  Of course, it can take a few weeks or even a couple of months after beginning testosterone therapy before your body rebuilds itself using its new found testosterone levels. But the day that you get yourself on testosterone therapy with a decent doctor, your life begins again. 

If your testosterone levels are above about 350, you should look at the Testosterone Lowering Factors, Mind, Sleep and Sex links to see if you can make some simple lifestyle changes and boost your testosterone naturally. These methods may boost your testosterone 20-50% and, if you're sitting in at about 350-400, may put you into safe territory without even going on testosterone therapy (hormone replacement therapy).

But odds are that if you're reading this link, your testosterone is very low:  350 or less.  If that is the case, then I recommend investigating testosterone therapy immediately.  ( Free testosterone readings are critical as well, but the two usually go hand in hand.)  Again, you MUST, for the sake of your long term health, get your total testosterone level into reasonable territory, hopefully 500-600 or maybe a little more.   Try a hundred doctors if you have to:  the struggle is well worth it and may even save your career, marriage and life. 

COMMON QUESTION:  What about those with high hormone levels?  For example, is someone with high testosterone and/or estrogen at greater risk of prostate cancer? Well, the good news is that they have been studying this for years and the studies show no correlation with testosterone therapy and prostate cancer.  There were theories for awhile that "fast converters", i.e. guys that converted to DHT and estrogen easily, could develop prostate cancer.  But, again, the research have shown these to be theories without merit. In fact, one huge metanalysis that aggregated multiple studies and thousands of HRT participants found found no risk for high, DHT estrogen or testosterone. [7]  I mention this, because I get asked if someone who is overweight, i.e. someone with probably high estrogen levels, is at risk for prostate cancer. Of course, talk to your doctor because you may have specialized case, but the general data looks very good.

In fact, from all we know at this point, it looks like the real risk is not going on testosterone therapy if you have low testosterone. One study, for example, found that testosterone therapy actually lowered PSA levels and decreased most of the major symptoms of an enlarged prostate. [5] Several other major journals, including the prestigious publications New England Journal of Medicine and the Journal of the American Medical Association, have found no link between prostate cancer and testosterone supplementation. [6] Again, talk to your doctor about your specific situation, but it's important to note that the study results are looking very solid at this point.

The Oncology Times [1] summarized by stating that they "reviewed decades of research and found no compelling evidence that testosterone replacement therapy increases the incidence of prostate cancer or cardiovascular disease". And, if you have heard stories of men having their prostate cancer treated with low testosterone levels, consider what else the authors had to say: 

"It has been known since the 1940s that severe reductions of testosterone can cause shrinkage of metastatic prostate cancer, and therefore there has been a concern that raising testosterone levels might cause growth of any hidden prostate cancers. But the study by Dr. Morgentaler and his coauthor, Ernani L. Rhoden, MD, found no connection between higher testosterone levels and prostate cancer, nor did they find evidence that testosterone treatment causes prostate cancer."

Staying off testosterone supplementation is not going to protect your prostate.  If you want to protect your prostate, you need to read my Prostate Cancer link. I give you the latest research showing what foods whack prostate cancer risk. The key is not depriving your body of much-needed hormones:  the key is how you eat and live.

By the way, testosterone therapy will likely help cure, or even permanently cure your Erectile Dysfunction (ED).  Of course, one should realize, especially if you are past the age of about 35, that most erectile difficulties center around poor endothelial function, i.e. low levels of Nitric Oxide.  Nevertheless, researchers have found that testosterone therapy can make dramatic improvments in your sex life:

One study from Taiwan found that 34% of men with ED that were unresponsive to Viagra, which is pretty serious impotence, responded well to testosterone supplementation.  And 38% of the man responded to both Viagra and testosterone therapy, so almost three fourths of the men with ED were significantly improved by simply taking testosterone. If you couple testosterone therapy, i.e. hormone replacement therapy, with the advice that I give on boosting nitric oxide here and here, you'll feel about twenty years younger in EVERY way!

Do you know the foods and drinks that increase erection-boosting Nitric Oxide? Check out the Peak Erectile Strength Diet where I show you how to dramatically and naturally improve your erectile strength.

Testosterone therapy can also improve your memory, brain, cognition and learning.  Yes, testosterone is intimately linked to cerebral function.  Several studies have shown that, in particular, visual spacial skills are tied to testosterone levels.  And hypogonadal (low testosterone) men have been shown in several studies to have lower verbal skills. [2]

You will find that testosterone, and therefore testosterone therapy, also improves mental outlook:  low testosterone is correlated to depression, anxiety and other mental struggles.  And by boosting your testosterone levels, you can help reduce your risk for diabetes and many other life-threatening low testosterone maladies.

So what are you waiting for?  You can improve your mood, your sex life, your erectile stength and boost your memory and mental abilities.  Yes, it takes several weeks (or even a few months) for testosterone therapy to "take effect":  your tissues must literally rebuild themselves.  But the minute you start taking testosterone, you have instantly set the clock back and have improved many of the most important aspects of your life.

I want to emphasize one more time that if your testosterone is even moderately low, many standard life events can whack it.  As I document on this site, stress, too little sleep, a poor mental outlook, overtraining, excitotoxins and even pesticides can significantly decrease your testosterone. When you are already a little low to begin with, your body suddenly finds itself taken to dangerous levels.  Isn't it much better to have a stable, steady supply of this all-important hormone in the midst of all the things that can happen in life?

Testosterone Therapy - Side Effects

Are their side effects related to testosterone therapy?  Please read below for a detailed discussion (and talk with your doctor of course).  But, in summary, side effects are relatively rare assuming you are not overweight and have a reasonable dose.  By reasonable dose, I mean a dose that gets your total testosterone in the 500-700 range. 

Many of you will find this hard to believe as you have heard so many stories.  For example, some guys are concerned that their testes will shrink:  this is rare for a reasonable dose as well - your testes will still continue to make some testosterone. Again, some steroids - and many steroid users take too high of a dosage - can shrink the testes, but this is uncommon with standard testosterone therapy.

 Testosterone therapy can give males enlarged "breasts", but, again, this is rare except in guys that are overweight.  (The problem is that the engorged fat cells of an overweight person convert the extra testosterone to estrogen.)

So are there any legitimate concerns regarding testosterone therapy?  Yes, for certain relatively uncommon conditions.  First of all, if you have a soy allergy, you should realize that many of the most popular testosterone therapies are made from soy and so could potentially trigger a soy allergy.  If this is your situation, discuss it with your doctor of course.

Another consideration is fertility:  testosterone therapy can in some cases decrease sperm count, leutinizing hormone and follicle stimulating hormone. Remember that Gonadotropen-releasing hormone (GnRH) is secreted by the hypothalamus, which is why excitotoxins can wreak such havoc, and GnRH in turn signals the pituitary to secrete luteinizing hormone (LH) and follicle-stimulating hormone (FSH).  LH governs testosterone production in the testes and FSH is responsible for spermatogenesis, i.e. creation of the sperm.  So adding testosterone can affect both LH and FSH levels.

 Most guys going on testosterone therapy are past the I-want-more-kids stage, but with all the excitotoxin and endothelial damage out there, I receive quite a few emails from guys in their early 30's who are struggling with low testosterone. Plus, as you know, I recommend in many case that guys who follow what's on Peak Testosterone to consider Going Out With a Younger Woman.

In both of these situations, you may want to do some research first and talk to a specialist.  There are doctors that specialize in fertility issues and I would recommend talking to such a doctor if there's any chance you may want to have children in the future. 

Thirdly, you should realize that, if you have sleep apnea, some studies show low testosterone can worsen that condition. [3] Again, though, sleep apnea is very correlated to weight.  Some dropping some weight, which can boost testosterone directly, may solve your apnea, but work with your doctor in this situation.

Finally, testosterone therapy can actually make your skin more oily and even lead to acne.  Although it may seem exciting to go through puberty one more time, most of us are thankful to have survived the experience and certainly don't want acne as a reminder.  Again, this can generally be controlled and worked around if it arises.  See my link on Acne for details and solutions.

One last thing:  almost all testosterones given in testosterone therapy are very well-tolerated by the liver, but you want a doctor that will test your liver function just to play it ultra safe. You've only got one liver after all!  Get a doctor that will test your liver function, and of course PSA, along with total testosterone and free every three months.  Once you've stabilized, i.e. you've got the right dose and all tests look okay, then you can possibly go to six months depending on what your doctor says.

NEWS FLASH:  A recent Newsweek [Nov 9, 2009, p. 56f] article covered how some guys on HRT are being negligent.  They are applying the gel to their chest, shoulders and arms and then are in direct contact with their children.  This is very serious indeed:  a young child can be developmentally affected by this, including potentially the brain. In a young boy, for example, the lines on the scrotal sac can be altered and pubic hair thickened and grown.  I was just talking with a pediatric endocrinologist about this and it is imperative that guys wash their hands and keep any areas of application covered. He had only noticed problems in guys who were careless and/or ignorant of the risks involved. There have been enough reports of this problems that the FDA is currently forcing a generic version of Testim to undergo "hand washing studies" to make sure that it is as safe in this regard as the original.  Furthermore, even the original products may have to carry a "black box" warning label.  Keep your family safe!

You may be wondering about injections?  Generally, most doctors are now prescribing the new topical preparations, i.e. Androgel and Testim.  However, injections of testosterone cypionate and enanthate are sometimes used.  There are a couple of things to consider and ask you doctor about should he want to go this route: 

a) Neither of these are bioidentical:  they are "estherized", meaning they have an esther attached on one end.  However, this is probably not a big concern as the esther is easily broken off by the body and is then metabolized in a "normal" fashion.

b) The other issue with injection-based testosterone therapy is that a shot is usually given about every two weeks.  So initially the patient starts out with high levels that decrease over the next few weeks.  Some patients can notice this decrease in terms of energy and other testosterone-related effects. 

REFERENCES:

1) Mar 25 2004,26(6):30-35

2) Saving Your Brain, Jeff Victoroff, p. 135

3) Clin Endocrin (Ox),1988;28:461-470