What Is Testosterone And What Does It Do?
In short the T count is what makes a man a man but by the time a man is 40 testosterone levels drop by 1% per year, so what’s the best form of testosterone replacement therapy for a man who wants to remain vital?
Don’t think it’s a vanity thing or a forever young mid-life crisis question. A mans’ testosterone level directly effects the primary characteristics of deeper voice, muscle growth and body hair. From puberty it stimulates growth of genitals, sperm production, libido and erections. In terms of general health it also looks after red blood cell production, dictates moods, bone density, and helps cognition.
Symptoms Of Low Testosterone
Unfortunately, as men age passed their 40’s into their 50’s, 60’s, and beyond their levels of testosterone falls off giving way to symptoms of low testosterone known as hypogonadism (“hypo” meaning low functioning and “gonadism” referring to the testicles).
The most common sign a man maybe suffering from testosterone deficiency and may think about seeking help is the lowering sexual desire or erectile dysfunction. With these symptoms common complaints are difficulty climaxing, a less intense climax, less ejaculate released, and numbness in the penis when experiencing something that would normally create arousal.
Additional symptoms include;
Fatigue and poor energy level
Decreased muscle mass
Body and facial hair loss
Low sense of well-being
The more of these symptoms the more likely a man is suffering from a lowering of his testosterone levels. Although these symptoms are widely thought of as normal processes of ageing, there are treatments designed to offer men a reversal of the symptoms that return their testosterone levels to a normal level.
Once a men seeks help there are two ways to determine if it’s a low testosterone situation. Firstly, a blood test and second, the correlation between symptoms and signs as men with most symptoms have the lowest testosterone and vice versa.
The symptoms and signs option is not always accurate illustrated by the fact that some men with low levels of testosterone have no symptoms.
Using the the blood test option would obviously seem better and The Endocrine Society* guideline state total testosterone level of less than 300 ng/dl indicate a low level, although this is contended by some so there is little agreement.
Another area of confusion is the idea of ‘free testosterone’ and ‘total testosterone’. Total testosterone is as it sounds, all the testosterone in the body where as free testosterone is the amount available to the cells, the other half of the testosterone circulating in the bloodstream is bound to a molecule called sex hormone–binding globulin.
Testosterone Replacement Treatments
There are several forms of testosterone replacement therapy.
Skin Patch. Much like a Nicotine patch, the Androderm patch is applied to the upper arm once a day
Gels. There are a number of gels available, AndroGel, Testim, AndroGel, Axiron, Fortesta, and Natesto. AndroGel, Axiron and Fortesta are delivered in a pump prescribed by your doctor, Natesto gel is applied inside the nose, and AndroGel and Testim come in clear packs of clear gel to apply to the skin.
Mouth Patch. Designed to be stuck to the upper gum above the incisor, the Striant tablet is applied twice a day to continually release testosterone.
Injections & Implants. Designed to be slowly absorbed by the body, implants are pellets embedded in soft tissues, which injections go directly to the muscle.
Out of these methods there are pros and con associated with all of them, for example the Topical therapies do have a more uniform blood testosterone levels but the Patch form of Topical which was the first form used, was known for causing skin irritation manifesting as a red coloration on the skin in 40% of users.
The most common testosterone preparation used in the USA comes in gel form called AndroGel and Testim, delivered in a dispenser and applied to the upper arms daily. This method is seen to be successfully absorbed by 80% to 85% of subjects leaving a number of subjects unable to absorb enough for it to have a positive effect.
The oldest and most efficient way to get testosterone to its target is the injection. It is inexpensive and reliably, giving good testosterone levels across the board, however, the disadvantage lies in the peaks in blood testosterone levels every few weeks with every top up shot.
Is Testosterone Replacement Therapy Me?
Endocrine Society recommends testosterone therapy for men who have both the symptoms of low testosterone and a the testosterone count less than 300 ng/dl.
However, it is not recommended for men with the following conditions.
Prostate or breast cancer
A nodule on the prostate that can be felt during a DRE
A PSA greater than 3 ng/ml without further evaluation
A hematocrit greater than 50% or thick, viscous blood
Untreated obstructive sleep apnea
Severe lower urinary tract symptoms
Class III or IV heart failure.
Comparison Of Treatments
|Testosterone enanthate (Delatestryl) and testosterone cypionate (Depo-testosterone) injections||200 mg every 2–4 weeks (testosterone enanthate); 100 or 200 mg every 2–4 weeks (testosterone cypionate)||Relatively inexpensive||Peaks and valleys in blood testosterone levels; frequent office visits for injections|
|Scrotal testosterone patch (Testoderm)||One 6-mg patch/day||May be less irritating to skin than nonscrotal patches||Scrotum must be shaved in order for patch to adhere to skin|
|Nonscrotal testosterone patch (Testoderm TTS and Androderm)||One or two patches/day, depending on strength (2.5–5 mg/patch)||Ease of application; mimics normal daily rise and fall of testosterone||May need two patches a day; can cause skin irritation|
|Testosterone gels (AndroGel and Testim)||5–10 mg/day||Ease of application; generally well tolerated by skin||Not all patients absorb it well; potential to transfer to others through skin-to-skin contact soon after application; relatively expensive|
|Methyltestosterone (Testred) and fluoxymesterone (Halotestin) pills||Not recommended||None||Can cause liver toxicity|
|Buccal testosterone (Striant)||30-mg tablet twice a day; applied to gums||More effective at raising testosterone levels than skin patches||May cause gum or mouth irritation, pain, and tenderness; bitter taste|
|Injectable testosterone undecanoate (Nebido/Aveed)||1,000 mg to start; 1,000 mg at 6 weeks; 1,000 mg every 12 weeks thereafter||Needs to be administered only four times a year||Under FDA review and not currently available in the United States|
A testosterone supplementation in the form of a pill is available in the USA has been seen to cause liver toxicity so are not encouraged. There are however safe oral supplements in pill form available in Canada and Europe called undecanoate. The inject able version of undecanoate (Nebido)is now available in the USA.
Testosterone Replacement Therapy Risks
Like most things in life there is risk involved in any treatment, in the case, there are testosterone replacement therapy side effects. For example, this treatment can increase the hematocrit or percentage of red blood cells. In this case if the hematocrit is too high there could be a possibility the blood could become thick, increasing the theoretical possibility of a stroke or clotting.
Therefore giving testosterone replacement therapy to a patient with a high hematocrit condition like chronic obstructive pulmonary disease or red-blood-cell disorder would be dangerous.
Additionally, it could also be dangerous prescribing testosterone to a patient with compromised kidney or liver function, or even congestive heart failure. On a less serious note some patients have seen an increase in oily skin producing acne or pimples.
Can testosterone cause Prostate cancer?
The idea of testosterone replacement causing prostate cancer came about more than 50 years ago, when it was seen that lowering testosterone in patients with prostate cancer saw their condition improved. This became a standard school of thought and referred to as androgen deprivation or androgen-suppressive therapy.
Over the years there have been multiple studies looking at men receiving testosterone-replacement therapy with cumulative results. Looking at the tread the rate of prostate cancer in the screening group was about 1% per year which if you screened same sort of age population not receiving this treatment, the rate appears to be the same. The outcome is that no conclusive proof has been submitted to suggest that testosterone-replacement therapy creates an unexpectedly high rate of prostate cancer.
Can additional testosterone worsen Benign prostatic hyperplasia or BPH?
As assessed by the American Urological Association Symptom Score or the International Prostate Symptom Score, evidence supports that testosterone treatment has no affect on the strength or rate of urine flow, nor changes a patients ability to empty the bladder, or affect the frequency of urination.
Does testosterone replacement solve Erectile dysfunction?
Testosterone replacement treatment is a good fit for erectile dysfunction as a return of erection means no requirement for a pill in anticipation of sex. But the advantages don’t stop at erection but also in general feelings of positivity, increase in energy levels and motivation.
Monitoring Once Testosterone Therapy Begins
Candidates of 50 years and over should have a DRE and a PSA test and if any abnormalities are found further tests for prostate cancer in the form of a biopsy must be carried out. This is not anything out of the ordinary, as it’s carried out on everybody regardless of low testosterone or not. Should test result be normal testosterone therapy can be implemented. Additionally, the blood tests for DRE, PSA, hematocrit or hemoglobin is a standard recommendation for most men over age 50 and carried out twice in the first year then yearly after that.
No consensus exits regarding if high levels of testosterone increase the risk of developing prostate cancer.
*Note: The Endocrine Society publishes clinical practice guidelines with recommendations for who should and shouldn’t receive testosterone therapy. See “Endocrine Society recommendations summarized.” For a complete copy of the guidelines, log on to www.endo-society.org.
NOTE: In line with the premise of anti-ageing supplements main aim of introducing easy safe options, there is also an option to take a testosterone supplement know as TestRX. Follow this link to learn more about TestRX.
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