TESTOSTERONE & LOW TESTOSTERONE
Testosterone is the most important male sex hormone. It helps your body produce and maintain a healthy libido. Low levels of testosterone affect a man’s sex drive, physical features like muscle and bone strength, sense of well-being and attitude. Millions of American men have low testosterone and don't even know it. A fast and easy blood test is all that is needed to find out if you have Low T.
Low Testosterone symptoms can be treated with hormone replacement therapy, usually testosterone injections, testosterone creams, testosterone gels or testosterone dermal patches.
This summary explains what testosterone does for the body. It also describes what happens if a man does not have enough testosterone. Included are diagnosis, treatment options and associated risks of low testosterone on a man's health. Testosterone affects women as well and many Endocrinologists, Age Management Doctors and Hormone Physicians prescribe Testosterone for women as a comprehensive part of an HRT (Hormone Replacement Therapy) program.
Testosterone is the hormone of desire for both men and women and optimal levels should be maintained for healthy personal and sexual relationships.
There are a number of medical conditions that can cause low testosterone. The next sections discusses a glossary of male hormone terminology including symptoms, causes and treatment of low testosterone in adult males.
Anabolic steroids, also known as anabolic-androgenic steroids, are drugs that have similar effects to that of testosterone in the body. They increase protein within cells, especially in the muscles. Anabolic steroids have androgenic and virilizing properties including the development and maintenance of masculine characteristics such as the growth of the vocal cords and deep voice, testicles, bigger muscles and bones, and other male sexual characteristics like body hair.
Anastrozole also known as Arimidex® by AstraZeneca, is an estrogen blocking or aromatase-inhibiting drug approved for treatment of breast cancer and is also used by men undergoing testosterone replacement therapy to reduce estradiol and disrupt estrogen receptor sites. Anastrozole works by inhibiting the synthesis of estrogen as it binds the aromatase enzyme inhibiting the conversion of androgens to estrogens.
Androgen, also called androgenic hormone or testoid, is the generic term for any natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of male characteristics.
Testosterone (Androderm®) is a prescription drug that comes in a dermal patch that raises the amount of testosterone in a man's body when his body does not make enough natural testosterone. Testosterone is a male hormone produced in the testes. When insufficient levels are produced a health condition known as hypogonadism exists.
Adroderm&teg; patches are used to treat hypogonadism or low testosterone in men.
AndroGel®, a prescription testosterone therapy is a topical hormone gel that raises the amount of testosterone in a man's body when his body does not make enough natural testosterone. It works by replacing or supplementing the testosterone that is naturally made in the body. Testosterone is a naturally occurring male hormone necessary for mal health. The gel is normally applied to the torso, shoulders, stomach, arms or thighs.
AndroGel® is used to treat conditions in men that result from a lack of natural testosterone, also known as hypogonadism.
Andropause is also known as male menopause, and sometimes called man-opause. Andropause is the stage in a man's life when symptoms and effects of aging in men appear which are similar to symptoms and effects of menopause in women.
Andropause is a steady decline in the male hormone testosterone. This drop in testosterone levels leads to loss of sex drive, energy and concentration, depression, and mood swings. While andropause does not cause a man's reproductive system to stop working altogether as in menopause, many men experience soft erections and erectile dysfunction or impotence.
During Andropause, a clinical health condition known as Hypogonadism or Low Testosterone normally occurs. For most men the loss of testosterone production is gradual and almost imperceptable until levels of testoserone are so low as to be cause symptoms. Hypogonadism or testosterone deficiency exists when the production of the hormones testosterone and dehydroepiandrosterone in middle-aged men either is below normal or has ceased.
Andropause is characterized by lower than normal levels of testosterone in a man's system associated with a decrease in Leydig cells that produce testosterone, increasing SHBG (Sex Hormone Binding Globulin) that reduces bio-available tesoterone, impaired hormone receptor cells, and low LH or luteinizing hormone that normally induces testosterone production, resulting in a steady decline in testosterone levels with age.
The impact of low levels of testosterone include loss of libido, sexual potency, excess weight gain and belly fat, muscle and bone loss, irritability, nervousness, depression, impaired memory, inability to focus or concentrate, fatigue, insomnia, hot flushes, and night sweats. Andropause has been observed in association with Osteoporosis and Alzheimer's disease.
Andropause is sometimes clinically referred to as Androgen Deficiency of the Aging Male(ADAM), and Partial Androgen Deficiency in Aging Males (PADAM).
Androstenone is a steroid found in both male and female sweat and urine. Androstenone was the first mammalian pheromone to be identified.
A steroid androgen which is a precursor for testosterone.
A steroid hormone produced in the adrenal glands and the gonads as an intermediate step in the production of testosterone, as well as the estrogens - estrone and estradiol.
Androstenedione is the common precursor of both male and female sex hormones and subsequently used to produce testosterone or estrogen depending upon the respective enzymes.
Androstenedione has been shown to increase serum testosterone levels over an eight-hour period in men when taken as a single oral dose of 300 mg. Serum levels of estradiol also increased following the 300 mg dose producing estrogenic side effects.
A testosterone supplement product known as Andro (androstenedione supplement) was banned by the FDA in 2004 because the drug had health risks commonly associated with steroids like depression and mood swings. Some of the side effects for men included breast development (Gynecomastia), behavioral and mood changes, male pattern baldness, and heart disease.
Side effects for women included deeper voices, facial hair growth from excessive increases in their level of testosterone.
Anastrozole® is produced and sold under the name Arimidex® by AstraZeneca. Arimidex® is an aromatase-inhibiting drug (estrogen inhibiting drug) approved by the FDA for the treatment of breast cancer after surgery. It is also prescribed to help fight metastasis in both pre and post-menopausal women.
Estrogen can increase the severity of breast cancer and Armidex® (Anastrozole) works by inhibiting the synthesis of estrogen in the body of both men and women. For this reason Arimidex may be used to inhibit estrogen synthesis in men who are taking testosterone as part of a Testosterone Replacement Therapy program.
Anastrozole binds reversibly to the aromatase enzyme to inhibit the conversion of androgens to estrogens in surrounding tissues. This efffectively allows men with Low T levels to benefit from increasing testosterone levels without converting excess androgens to estrogen in the body.
Aromatase is also called estrogen synthetase or estrogen synthase. Aromatase is an enzyme responsible for biosynthesis or the productions of estrogens in the body. Aromatase converts testosterone to estradiol, and converts androstenedione to estrone.
Aromatase inhibitors (AIs) are a class of drugs used in the treatment of breast cancer and ovarian cancer in postmenopausal women. AIs are also used to treat or prevent gynaecomastia or growth of breast tissue in men. Aromatase is the enzyme that synthesizes estrogen. AIs are taken to either block the production of estrogen or block the action of estrogen on receptors.
Bioavailability of Testosterone
Testosterone is present in the blood circulation both in protein bound (96%) and in non-protein bound or free forms (4%). In men about 44% of the testoserone is bound to Sex Hormone Binding Globulin (SHBG) making it unavailable biologically for use by the body.
About 50% of a man's testosterone is bound to albumin that could be potentially used biologically, and 2-3% is free or bioavalable for use by a man's body.
Bioidentical hormone replacement therapy (BHRT), bioidentical hormone therapy or natural hormone therapy, refers to hormones that are identical, on a molecular level, with endogenous hormones or hormones produced by the human body.
Specific hormones used in BHRT include estrone, estradiol, estriol, progesterone, testosterone, dehydroepiandrosterone, HGH Human Growth Hormone and HCG among others.
Chrysin is a naturally occurring isoflavone chemically extracted from the plant Passiflora coerulea. Europen studies show that after supplementing with Chrysin, blood levels of testosterone are up to 30% higher than normal. Two of the major hormones in the body are testosterone and estrogen.Testosterone is anabolic and promotes muscle growth. Estrogen, on the other hand, is catabolic, and promotes the breakdown of muscle tissue. In other words, if you want to promote muscle growth, then a higher level of testosterone and lower level of estrogen will be beneficial. Unfortunately, your body naturally converts some testosterone into estrogen, a process which accelerates as testosterone levels go up. This also occurs to a greater extent in overweight or obese men. So, if you have large amounts of bodyfat, your body will naturally produce more estrogen. Chrysin stimulates muscle growth by inhibiting the conversion of testosterone to estrogen.
Chrysin is generally considered to be safe, and no studies have reported any adverse side effects. Chrysin will accelerate muscle growth via elevated testosterone levels when combined with a programme of resistance exercise and a good diet that provides a sufficient number calories and high-quality protein.
Clomiphene, sometimes called Clomifene belongs to a class of medications known as Selective Estrogen Receptor Modulators or SERM’s. Clomid may be used by men undergoing testosterone treatment in order to stimulate natural testosterone production and mitigate the conversion of testosterone to estrogen by the aromatase enzyme preventing estrogenic side effects.
Clomid works biologically by preventing estrogen from binding to receptor cells by binding itself to the receptors in its place which can be very advantageous for men on a testosterone therapy program.
Clomid stimulates the release of Luteinizing (LH) and Follicle Stimulating Hormones (FSH) which causes the production and release of testosterone throughout the man's body.
Dehydroepiandrosterone - DHEA
DHEA is also known as androstenolone - an important endogenous steroid hormone. It is the most abundant circulating steroid in the human body instrumental in the biosynthesis or production of androgen (testosterone) and estrogen sex steroids.
Dihydrotestosterone (DHT), or 5α-dihydrotestosterone (5α-DHT), also known as androstanolone (5α-androstan-17β-ol-3-one) as well as 17β-hydroxy-5α-androstan-3-one,
is a sex steroid and androgen hormone.
The enzyme 5α-reductase synthesizes DHT in the prostate, testes, hair follicles, and adrenal glands.
This enzyme reduces the 4,5 double-bond of the hormone testosterone. In men, approximately 5% of testosterone undergoes 5α-reduction to form the more potent androgen, DHT dihydrotestosterone.
DHT has two to three times greater androgen receptor affinity than testosterone and has 15-30 times greater affinity than adrenal androgens.
The dissociation rate of testosterone from the receptor is five-fold faster than DHT.
During embryogenesis DHT has an essential role in the formation of the male external genitalia, while in the adult DHT acts as the primary androgen in the prostate and in hair follicles.
Estradiol, Estrogen (Estrace, Alora, Vagifem)
Only about 1-2% of testosterone in the male body is unbound, bioavailable or "free testosterone" and therefore, biologically active and able to enter a cell and activate its receptor.
SHBG (Sex Hormone Binding Globulin) inhibits the function of sex hormones making the bioavailability of sex hormones like testosterone influenced by the level of SHBG.
FSH stands for follicle-stimulating hormone (FSH). This hormone is released by the anterior pituitary gland. In women, FSH stimulates the hormone estradiol and the production of eggs during the first half of the menstrual cycle. In men, FSH stimulates the production of sperm.
Gynecomastia is the enlargement of breast tissue in males. Half or more of adolescent boys have some breast development during puberty.
Gynecomastia may arise as an abnormal condition associated with disease or metabolic disorders, as a side-effect of medication, or as a result of the natural increase of estrogen and decrease of testosterone production in older males.
When on testosterone replacement therapy, men normally take estrogen inhibitors or estrogen blockers so that aromatization of testosterone to estrogen is prevented.
Human Chorionic Gonadotropin. HCG is the hormone is produced by women's bodies when they become pregnant to enusre proper use of energy and calories.
Hormone Replacement Therapy
Hormones are chemical messnegers released by glands, cells or organs in one part of the body that sends signals to and affects other cells, tissues and organs in the body.
Only a small amount of hormone secretion is required to alter a cell's metabolism. Endocrine hormones circulate in the bloodstream and seek out receptor cells. A specific receptor cell responds to a specific hormone.
The hormone binds to the receptor cell protein resulting in a cell type-specific response. Endocrine hormone molecules are secreted directly into the bloodstream, whereas paracrine hormones diffuse through the tissues.
Hypogonadism is a medical term used to describe low testosterone production or diminished functional activity of the gonads in males and females.
Low androgen or testosterone levels are referred to as hypoandrogenism. Other hormones produced by the gonads which may be decreased by hypogonadism include progesterone, DHEA, activin, and inhibin.
Spermatogenesis in men and ovulation in women may be impaired by hypogonadism. In men hypogonadism usually occurs during the stage of a man's life known as Andropause and testosterone replacement may be required to restore low testosterone levels.
Leydig cells are testosterone producing cells, also known as interstitial cells of Leydig, are found adjacent to the seminiferous tubules in a man's testicles.
They produce testosterone in the presence of luteinizing hormone (LH). Leydig cells release a full class of androgen hormones (steroids). They secrete testosterone, androstenedione and dehydroepiandrosterone (DHEA) when stimulated by the pituitary hormone luteinizing hormone (LH).
LH increases cholesterol desmolase activity which is an enzyme associated with the conversion of cholesterol to pregnenolone. Pregnenolone is used for testosterone synthesis and secretion by Leydig cells.
Prolactin (PRL) increases the response of Leydig cells to LH by increasing the number of LH receptors expressed on Leydig cells.
LH - Luteinizing Hormone
LH stimulates testosterone secretion by the testes.
Low Testosterone Levels, also known as hypogonadism.
The stage in a man's life characterized by low testosterone levels or androgen deficiency also known as Andropause.
An acronym for the Male Menopause or Andropause characterized by low testosterone levels and symptoms in men.
At about the age of 50, the menstrual cycle stops in women, this is known as menopause, but menopause is not caused by the pituitary not releasing LH or FSH, in fact a woman releases LH or FSH for their entire life but the ovaries stop responding.
Postmenopausal woman can have high levels of LH and FSH because they no longer have the negative feedback loop of the ovaries functioning to tell the pituitary when to stop releasing these hormones.
Normal Testosterone Levels
Progesterone (Prometrium, Prochieve)
SHBG (Sex Hormone Binding Globulin)
Sex hormone-binding globulin (SHBG) or sex steroid-binding globulin (SSBG) is a glycoprotein that binds to sex hormones in the body making them unavailable for use by the body; androgens in men and estrogens in women.
Testosterone Replacement Therapy or Testosterone Replacement Treatment
Nolvadex (Tamoxifen) belongs to the SERM class of medications to block estrogen from binding with receptor cells and stimulate LH and FSH. Nolva®, however is 8 times stronger than Clomid (Clomiphene).
Testosterone Injection used for HRT. Intramuscular injection, contains Testosterone Cypionate, USP which is the oil-soluble 17 (beta)- cyclopentylpropionate ester of the androgenic hormone testosterone.
Testosterone Cypionate, USP is a white or creamy white crystalline powder, odorless or nearly so and stable in air. It is insoluble in water, freely soluble in alcohol, chloroform, dioxane, ether, and soluble in vegetable oils.
Testosterone Injection used for HRT. Testosterone Enanthate Description
Testosterone Enanthate Injection, USP provides Testosterone Enanthate, USP a derivative of the primary endogenous androgen testosterone, for intramuscular administration. In their active form, androgens have a 17-beta-hydroxy group. Esterification of the 17-beta-hydroxy group increases the duration of action of testosterone; hydrolysis to free testosterone occurs in vivo. Each mL of sterile, colorless to pale yellow solution provides 200 mg Testosterone Enanthate, USP in Sesame Oil, USP with 5 mg Chlorobutanol, USP (chloral derivative) as a preservative.
Testosterone Injection used for HRT. A testosterone hormone with the Propionate ester attached carries a half-life of approximately 4 days and is generally the shortest ester attached to any testosterone hormone.
Testosterone Dermal Patch
Testosterone skin patches contain the prescription drug testosterone that comes in an adhesive dermal patch that raises the amount of testosterone in a man's body when his body does not make enough natural testosterone. Testosterone is a male hormone produced in the testes. When insufficient levels are produced a health condition known as hypogonadism exists.
Transdermal patches are used to treat hypogonadism or low testosterone in men.
Testosterone (Testoderm®) is a prescription drug that comes in a dermal patch that raises the amount of testosterone in a man's body when his body does not make enough natural testosterone. Testosterone is a male hormone produced in the testes. When insufficient levels are produced a health condition known as hypogonadism exists.
Testoderm&teg; patches are used to treat hypogonadism or low testosterone in men.
Testosterone Replacement Therapy
Each mL of the Testosterone solution contains Testosterone Cypionate, 200 mg; Benzyl Benzoate, 0.2 mL; Cottonseed Oil, 560 mg; Benzyl Alcohol as preservative, 9.45 mg. Paddock brand has an extra 0.45 mg of Benzyl Alcohol per ml than Watson Testosterone.
Signs of low testosterone in adult men may include:
• Decreased sex drive or libido
• No or poor erections of the penis (called impotence or erectile dysfunction).
• Lowered sperm count
• Increased breast size
Some men with low testosterone have hot flashes, increased irritability, inability to concentrate and depression. Men with severely low testosterone may lose body hair and muscle mass. Their bones may be more prone to fracture. Their testes may
become smaller and softer.
Low testosterone can cause erectile dysfunction. However, diseases of the nerves and blood vessels can also affect the penis and cause erectile dysfunction.
Causes Associated with Low Testosterone
Low levels of testosterone are linked with aging. Diseases of the glands that produce and control testosterone also cause low levels.
As a man ages, his body makes less testosterone. A lower level of testosterone in older men is sometimes called “andropause.”
As men age it is normal for them to have less interest in sex. However, it is abnormal for a man to have absolutely no interest in sex. This could be caused by significantly low levels of testosterone.
Damage to the cells of the testes can cause low testosterone. This kind of damage can be a result of
- Inflammation of the testicles
- Testicular cancer
- Radiation therapy or chemotherapy used
to treat testicular cancer
Diseases that affect the hypothalamus and the pituitary glands can cause low testosterone. These include cancer, inflammation and autoimmune diseases of either gland. Certain drugs can affect the way the pituitary gland works and cause low testosterone. Morphine and anabolic steroids are two examples.
Certain genetic diseases cause low testosterone. Abnormalities in chromosomes, the genetic materials of the body, cause genetic diseases. For example, myotonic dystrophy causes testicular failure between the ages of 30 and 40.
It is normal for men to have less interest in sex, as they get older. It is also normal for
older men to have less spontaneous erections.
Men with less sex drive, erectile dysfunction, reduced sperm count, decrease in
muscle size or other signs of low testosterone should have a blood test to find out their
Normal testosterone levels are 300 to 1,200 nanograms per deciliter (ng/dl). Testosterone levels are usually highest early in the morning. Doctors often measure it at that time.
The doctor’s main concern is to find out if there is a disease causing low testosterone. If not, it may be an extreme case of low testosterone due to aging.
It is not always easy to diagnose the cause of low testosterone. You can help your doctor by providing a detailed and accurate medical history. To get your medical history, the doctor will ask about:
- Your past or present illnesses
- All prescription and nonprescription drugs you are taking
- Any sexual problems you are having
- Recent events that may have caused you stress
Your doctor may request a bone density test. Low testosterone levels can make the bones more brittle. CT Scan If the doctor thinks there may be a tumor in the pituitary or
hypothalamus, he or she may need to take a picture of your brain. This is done with a CT scan or MRI. CTs and MRIs are painless. CT scans use x-rays and MRI uses a strong magnetic field. MRI is usually better at showing pituitary or hypothalamic tumors.
If the doctor suspects a genetic cause of low testosterone, he or she may request a genetic test. This is a process to examine a person’s DNA. It shows whether the person is at risk of passing a genetic condition to his or her descendants. If the doctor diagnoses a tumor, inflammation, or genetic disease that is causing low testosterone, it is best to get treatment. Sometimes a specialist is needed for treatment. Hormone replacement therapy may be recommended to make up for low levels of testosterone.