Testosterone

What is testosterone?

Sources of testosterone

MEN

WOMEN

Contraindications

References

What is testosterone?

Testosterone is a steroid hormone produced in men's testes. Women also produce a little testosterone in their ovaries and adrenal glands - only about 5-10% as much as men.

In both men and women, testosterone plays a crucial role in stimulating muscle growth; bone growth; energy production; the retention of electrolytes (sodium, potassium, and chloride) and nitrogen; and water retention in body fluid balance. Testosterone also affects the libido and mood, and when it declines they are negatively affected.

The small amount of testosterone in women does not have a masculinising effect. However, testosterone is not normally given to girls until they are physically mature adult women.

Testosterone is an androgen, one of a group of hormones that control masculine sex characteristics. In men, these androgens promote muscle growth, the development of a deeper voice, testicles, and facial and body hair. Testosterone stimulates men's libido, sexual function, body shape, mood and energy levels. Testosterone makes the veins under the skin more prominent and the skin less fatty. It is essential for the development and maintenance of the male sex organs and the male secondary sex characteristics.

In both men and women, testosterone production occurs during the night and early morning, and is therefore at its highest level upon waking. The high level of testosterone in the morning explains why healthy men often wake with an erection. Blood serum testosterone level slowly decreases during the day and is at its lowest in the late afternoon or early evening.

After the glands produce testosterone, it is secreted into the blood. 99% of it is quickly adhered to by a protein sex hormone-binding globulin (SHBG), which acts as a carrier to move hormones around the body. The remaining 1% (free testosterone) is bio-available to act on and enter into cells throughout the body.

Testosterone level can be measured with a blood test, and it should preferably be taken in the morning when testosterone level is the highest. If possible it is best to measure both the SHBG bound testosterone and the free testosterone levels. If only the total testosterone is measured, you do not get an accurate representation of how much testosterone is free to act in the body. It is the levels of free testosterone and SHBG that determine how effective testosterone is in the body, and how much supplementation is needed.

Sources of testosterone

Pure testosterone is not found in any plants. In other words, you cannot use any plant as a source of testosterone.

Testosterone was first manufactured in the late 1930's. Today, soya bean substrates are used to manufacture natural testosterone. Natural/genuine/pure/bio-identical testosterone cannot be patented.

Warning. The pharmaceutical industry has developed a number of testosterone look-alikes. These synthetic testosterone analogues (look-alikes) with testosterone-like activities are not naturally-occurring and can therefore be patented. Unlike natural bio-identical testosterone, they are not as effective as the real thing, and more importantly they have a variety of nasty side-effects including low sperm count / sterility. They include fluoxymesterone and methyltestosterone. Some doctors are not aware of this crucial difference between natural bio-identical testosterone and the patented look-alikes. It is absolutely critical that you always use the real thing - bio-identical hormones. (3)

MEN

Medical causes of testosterone deficiency in men (male hypogonadism)

Risk factors for testosterone deficiency in men

Symptoms of testosterone deficiency in men

Aging in men

Testosterone replacement therapy (TRT) for men

Side-effects from excessive testosterone in men

Medical causes of testosterone deficiency in men (male hypogonadism)

Testicular damage (primary hypogonadism)

Klinefelter's syndrome (when males have an extra X chromosome).
Cryptorchidism (the absence of one or both testes from the scrotum).
Problems during testis development (twisted or strangulated testes).
Orchitis (inflammation of the testes).
Orchidectomy (testes surgically removed).
Toxic damage (radiation, chemotherapy, industrial or environmental toxins).

Brain disorders (secondary hypogonadism)

Pituitary gland malfunction.
Hypothalamus malfunction.
Kallmann's syndrome (genetic disorder of sex glands).
Haemochromatosis (Blood iron disorder).
Brain tumour.

Risk factors for testosterone deficiency in men

Ageing.
Pharmaceutical drug use (including glucocorticoids, opiates, anabolic steroids).
Alcohol.
Smoking.
Severe trauma, illness, burns or major surgery.

Symptoms of testosterone deficiency in men

Fatigue.
Low energy and lethargy.
Muscle strength diminished.
Muscle mass decreased.
Change of body shape, with increased abdominal fat and rudimentary breast development (man boobs).
Body hair decreased (feminisation).
Mood changes, ill temper, depression.
Erectile dysfunction - difficulty getting and maintaining an erection.
Low libido, loss of sexual interest.
Low sperm count in semen.
Osteoporosis or decreased bone mineral density.
Anaemia.

Aging in men

Healthy men continue to produce testosterone throughout their lives, but at slowly decreasing rates. Young men have high levels of testosterone and old men lower levels.

Testosterone does not cause prostate cancer or BPH. If testosterone were the cause, young rather than old men would be suffering from enlarged prostates and dying of prostate cancer. Studies show that older men with the highest level of testosterone have the least prostate enlargement. Conversely, men with the highest level of estrogen have enlarged prostates.

As most men age, the level of estrogens, estrogen look-alikes and xenoestrogen toxins in their bodies rises. Declining testosterone from aging, together with this increasing level of various estrogens, is the most likely reason for prostate enlargement and prostate cancer in men.

As many as 37% of all men over the age of forty have symptoms of testosterone deficiency, according to recent medical studies. These late-onset hypogonadal men are often undiagnosed. They are middle aged and older men who have symptoms associated with lowered testosterone levels, but do not have primary or secondary hypogonadism.

Late-onset hypogonadal symptoms are often non-specific, and can be further complicated by pre-existing medical conditions such as obesity, diabetes and other chronic illness. These men typically complain of lethargy and low energy, insomnia and sleep disturbance, low libido, irritability, anxiety, reduced concentration and an unhappy mood.

Older hypogonadal men usually have a blood testosterone level that is at the bottom end of the "normal" range, but not low enough to alert the medical practitioner to the real cause. So doctors often treat the symptoms by prescribing anti-depressants, rather than correcting the low level of testosterone.

Testosterone replacement therapy (TRT) for men

Many doctors assume that testosterone is not an issue if a patient's blood testosterone level test is at the low end of normal. It is essential that a diagnosis and a decision on whether to use testosterone is NOT made on the result of a blood test alone. Nearly all men who experience symptoms will positively respond to testosterone supplementation and enjoy a significantly improved quality of life. Unfortunately too many doctors see a testosterone result in the "normal" range and dismiss testosterone as a treatment option. Instead, they prescribe antidepressants or other drugs to treat the symptoms.

Testosterone replacement therapy effectively restores blood testosterone level in men with hypogonadism to the normal level of healthy young males.

The aim of TRT is to re-establish normal energy and strength, sexual function and libido, correction of anaemia, brain health (wellbeing and optimism, improvement in memory performance and cognitive status, mental acuity, clear thinking) and physical status (reduction in fat and increase in lean body mass muscle bulk and strength, male body characteristics, increase in bone mineral density) by the most effective and risk-free means available. It is widely accepted that testosterone therapy lessens the risk of cardiovascular disease and some cardiologists routinely prescribe testosterone when testosterone levels are low or following a heart attack.

TRT is highly effective and safely resolves most if not all symptoms associated with testosterone deficiency.

For many decades, testosterone has been used to treat men. Today, the most popular, patient-friendly and flexible form of treatment is testosterone skin cream. It can be applied directly to the skin of the scrotum or other receptive areas. Gels and creams have mostly replaced other forms of testosterone. For example, injections can be painful and do not provide a consistent level of testosterone in the following days and weeks; patches have a high level of adverse skin reactions and are unsightly; pellets need surgical application, can become infected, may be painful, and can fall out; oral capsules may be erratically absorbed, poorly tolerated in the gastrointestinal system, and do not provide consistent testosterone levels.

Side-effects from excessive testosterone in men

These side-effects are usually caused by excessive levels of serum testosterone after taking it by injection. You are much less likely to overdose when taking it as a cream, and this is the safe way to use testosterone.

Persistent or too frequent erections (priapism).
Vomiting or nausea.
Acne.
Swelling of the ankles.
Headaches.
Excessive or increased appetite.
Breast development (gynecomastia).
Raised blood fat (serum lipid) level. This is NOT normally a risk of using pure bio-identical testosterone, however, it is a risk when using testosterone analogues or look-alikes.
Abnormal increase in red blood cells (polycythemia). Men with hypogonadism tend to have anaemia and testosterone replacement corrects the low red blood cell level. However, too high a dose of testosterone, even for a short period, can lead to polycythemia. The effect is not life-threatening, but should be monitored by your doctor.
Increased prostate size, mainly during the first six months of treatment. This should not be a problem because men with testosterone deficiency usually have a slightly smaller prostate that returns to normal size during treatment. Many studies have shown that there is no increase in BPH symptoms during testosterone supplementation. Similarly, years of research confirm that there is no evidence to suggest that replacement of low testosterone levels back to the normal range leads to any increase in the occurrence of prostate cancer or the levels of prostate specific antigen (PSA). PSA is often below normal in hypogonadal men and is generally restored to normal levels with testosterone supplementation.

WOMEN

Symptoms of testosterone deficiency in women

Medical causes of testosterone deficiency in women

Possible causes of testosterone deficiency in women

Side-effects from excessive testosterone in women

Before using testosterone treatment for women

Testosterone replacement therapy (TRT) for women

"I'm just too tired for sex"
"I sleep for 9 hours and still need more"
"Forget the sex, I just wish I had some energy"
"I love him, but I just don't have the energy for sex"
"It's all too much, I don't want to go out tonight"
"My drive and motivation have disappeared"

This is the kind of comment that testosterone deficient women are making to their partners, friends and doctors.

Three main hormones (progesterone, estrogen and testosterone) operate in a woman's body. Testosterone plays a vital role in a woman's sexual behaviour, enhancing her interest in initiating sexual activity and response to sexual stimulation. It is also associated with increased energy and vitality, a feeling of greater well-being and with reduced anxiety and depression.

The testosterone level in a woman peaks at about the age of 20. By the age of 40, it is about half the peak level, and it continues to fall as the years go by. Low libido, unexplained fatigue and lack of energy are often due to low testosterone in peri-menopausal and post-menopausal women.

Symptoms of testosterone deficiency in women

Low libido, loss of sexual desire, lack of arousal.
Fatigue, exhaustion.
Depression, mood changes.
Lack of concentration.
Diminished motivation and drive.
Decreased sense of personal wellbeing.
Hopelessness.
Body shape changes.

Medical causes of testosterone deficiency in women

Women who have had their ovaries removed (hysterectomised) and women with premature ovarian failure (early menopause) are most likely to experience a testosterone deficiency. Removal of the ovaries causes an immediate 50% reduction in serum testosterone level.

Various malfunctions of the adrenal glands or the pituitary gland in the brain can also cause low testosterone levels.

Possible causes of testosterone deficiency in women

Oral contraceptives or any other medications containing estrogen.
Hormone replacement therapy tablets.
Various non-hormonal pharmaceutical medications. Eg: the anticonvulsant phenytoin.
Thyroxine tablets (thyroid hormone).
Ageing.
Alcohol.
Smoking.
Pregnancy.
Reduced liver function.
Severe trauma, illness, burns or major surgery.

Side-effects from excessive testosterone in women

It is very important to understand that these side-effects are extremely unlikely when doses are monitored and blood testosterone levels are kept within the normal ranges. Side-effects are usually the result of sustained high dose testosterone supplementation (especially injections) causing blood levels to exceed the normal upper limits. When using a bio-identical testosterone cream, it is very difficult to overdose if the recommended daily dose is not exceeded.

Nausea and vomiting.
Headaches.
Jaundice.
Swelling of joints.
Acne.
Masculinisation, such as increased muscle bulk, increased body hair, and deepening of the voice.
Weight gain.

Before using testosterone treatment for women

Before you try testosterone treatment, it is important to rule out other possible causes of your symptoms. This requires an extensive examination by a trained medical practitioner. A pap smear, serum thyroid stimulating hormone TSH), and full blood examination including iron should be obtained. Issues to discuss include alternative treatments for sexual dysfunction, lack of vaginal lubrication or muscle tone, or incontinence. Conditions such as iron deficiency, breast lumps, low bone density, depression, abnormal bleeding, diabetes, thyroid or adrenal disease need to be investigated before using testosterone.

Testosterone replacement therapy (TRT) for women

After about 1970, it was standard medical practice to supplement with estrogen after removal of the ovaries, but ignore the hormones testosterone and progesterone. Eventually doctors started supplementing testosterone in the form of injections and implants. It was therapeutically effective, but because serum levels could not be closely controlled there were some serious side-effects such as masculinisation, hirsutism (body hair growth), acne and voice changes.

Estrogen supplementation does not usually restore libido in oophorectomised women. However, many studies have shown that women who get testosterone with the estrogen have a significant improvement in energy and libido with the combined treatment, without side-effects. Testosterone also has an additive effect on bone density when combined with estrogen - a very important protective factor for prevention of osteoporosis.

Many women who still have their ovaries can suffer from low testosterone causing reduced libido, low drive and motivation, and fatigue. In the USA, most of Asia, and South America, no testosterone products are government approved for the treatment of low libido in women. Consequently, doctors tend to use testosterone products approved for men, and give them to women in reduced doses.

In Europe and Australia, a 1% testosterone cream is the preferred choice of most doctors and their female patients. Injections, implants and patches all have disadvantages compared to the cream. They can deliver an unstable dose, causing side effects; injections and implants can be painful; patches unsightly. Creams are invisible and painless, and the dose is both accurate and can be precisely tailored to the patient's specific needs.

Small amounts of testosterone have now been used to manage low libido in women for decades. Its use has been widely reviewed in medical literature, showing it to be effective in restoring energy, libido and sexual response in women with low testosterone levels.

In the last decade there has been increasing interest in administering low doses of testosterone to pre and postmenopausal women, particularly to help with loss of libido. Testosterone treatment is tailored to meet individual requirements.

Contraindications

Patients with severe heart disease, liver disease or kidney disease should not use any kind of testosterone replacement therapy except under close medical supervision.

References

1. Goldstat R. et al. Transdermal testosterone therapy improves well-being, mood, and sexual function in premenopausal women. Menopause 2003; 10 (5): 390-398.

2. El-Hage et al. A double-blind, randomised, placebo-controlled trial of the effect of testosterone cream on the sexual motivation of menopausal hysterectomized women with hypoactive sexual desire disorder. Climacteric 2007; 10: 335-343.

3. Kent Holtorf. Bio-identical vs synthetic hormones. Postgraduate Medicine, Volume 121, issue 1, January 2009, issn - 0032-5481, e-issn - 1941-9260 9.