Category Archives: Testosterone Replacement Therapy

An interview with Abraham Morgentaler, M.D.

It could be said that testosterone is what makes men, men. It gives them their characteristic deep voices, large muscles, and facial and body hair, distinguishing them from women. It stimulates the growth of the genitals at puberty, plays a role in sperm production, fuels libido, and contributes to normal erections. It also fosters the production of red blood cells, boosts mood, and aids cognition.

Over time, the testicular machinery that makes testosterone gradually becomes less effective, and testosterone levels start to fall, by about 1% a year, beginning in the 40s. As men get into their 50s, 60s, and beyond, they may start to have signs and symptoms of low testosterone such as lower sex drive and sense of vitality, erectile dysfunction, decreased energy, reduced muscle mass and bone density, and anemia. Taken together, these signs and symptoms are often called hypogonadism (hypo meaning low functioning and gonadism referring to the testicles). Researchers estimate that the condition affects anywhere from two to six million men in the United States. Yet it is an underdiagnosed problem, with only about 5% of those affected receiving treatment.

Studies have shown that testosterone-replacement therapy may offer a wide range of benefits for men with hypogonadism, including improved libido, mood, cognition, muscle mass, bone density, and red blood cell production. But little consensus exists on what constitutes low testosterone, when testosterone supplementation makes sense, or what risks patients face. Much of the current debate focuses on the long-held belief that testosterone may stimulate prostate cancer.

Dr. Abraham Morgentaler, an associate professor of surgery at Harvard Medical School and the director of Mens Health Boston, specializes in treating prostate diseases and male sexual and reproductive difficulties. He has developed particular expertise in treating low testosterone levels. In this interview, Dr. Morgentaler shares his views on current controversies, the treatment strategies he uses with his own patients, and why he thinks experts should reconsider the possible link between testosterone-replacement therapy and prostate cancer.

What signs and symptoms of low testosterone prompt the average man to see a doctor?

As a urologist, I tend to see men because they have sexual complaints. The primary hallmark of low testosterone is low sexual desire or libido, but another can be erectile dysfunction, and any man who complains of erectile dysfunction should get his testosterone level checked. Men may experience other symptoms, such as more difficulty achieving an orgasm, less-intense orgasms, a smaller amount of fluid from ejaculation, and a feeling of numbness in the penis when they see or experience something that would normally be arousing.

The more of these symptoms there are, the more likely it is that a man has low testosterone. Many physicians tend to dismiss these soft symptoms as a normal part of aging, but they are often treatable and reversible by normalizing testosterone levels.

Arent those the same symptoms that men have when theyre treated for benign prostatic hyperplasia, or BPH?

Not exactly. There are a number of drugs that may lessen sex drive, including the BPH drugs finasteride (Proscar) and dutasteride (Avodart). Those drugs can also decrease the amount of the ejaculatory fluid, no question. But a reduction in orgasm intensity usually does not go along with treatment for BPH. Erectile dysfunction does not usually go along with it either, though certainly if somebody has less sex drive or less interest, its more of a challenge to get a good erection.

How do you determine whether a man is a candidate for testosterone-replacement therapy?

There are two ways that we determine whether somebody has low testosterone. One is a blood test and the other is by characteristic symptoms and signs, and the correlation between those two methods is far from perfect. Generally men with the lowest testosterone have the most symptoms and men with highest testosterone have the least. But there are some men who have low levels of testosterone in their blood and have no symptoms.

Looking purely at the biochemical numbers, The Endocrine Society* considers low testosterone to be a total testosterone level of less than 300 ng/dl, and I think thats a reasonable guide. But no one quite agrees on a number. Its not like diabetes, where if your fasting glucose is above a certain level, theyll say, Okay, youve got it. With testosterone, that break point is not quite as clear.

Is total testosterone the right thing to be measuring? Or should we be measuring something else?

Well, this is another area of confusion and great debate, but I dont think its as confusing as it appears to be in the literature. When most doctors learned about testosterone in medical school, they learned about total testosterone, or all the testosterone in the body. But about half of the testosterone thats circulating in the bloodstream is not available to the cells. Its tightly bound to a carrier molecule called sex hormonebinding globulin, which we abbreviate as SHBG.

The biologically available part of total testosterone is called free testosterone, and its readily available to the cells. Almost every lab has a blood test to measure free testosterone. Even though its only a small fraction of the total, the free testosterone level is a pretty good indicator of low testosterone. Its not perfect, but the correlation is greater than with total testosterone.

This professional organization recommends testosterone therapy for men who have both

Therapy is not recommended for men who have

Do time of day, diet, or other factors affect testosterone levels?

For years, the recommendation has been to get a testosterone value early in the morning because levels start to drop after 10 or 11 a.m. But the data behind that recommendation were drawn from healthy young men. Two recent studies showed little change in blood testosterone levels in men 40 and older over the course of the day. One reported no change in average testosterone until after 2 p.m. Between 2 and 6 p.m., it went down by 13%, a modest amount, and probably not enough to influence diagnosis. Most guidelines still say its important to do the test in the morning, but for men 40 and above, it probably doesnt matter much, as long as they get their blood drawn before 5 or 6 p.m.

There are some very interesting findings about diet. For example, it appears that individuals who have a diet low in protein have lower testosterone levels than men who consume more protein. But diet hasnt been studied thoroughly enough to make any clear recommendations.

In this article, testosterone-replacement therapy refers to the treatment of hypogonadism with exogenous testosterone testosterone that is manufactured outside the body. Depending on the formulation, treatment can cause skin irritation, breast enlargement and tenderness, sleep apnea, acne, reduced sperm count, increased red blood cell count, and other side effects.

Preliminary research has shown that clomiphene citrate (Clomid), a drug generally prescribed to stimulate ovulation in women struggling with infertility, can foster the production of natural testosterone, termed endogenous testosterone, in men. In a recent prospective study, 36 hypogonadal men took a daily dose of clomiphene citrate for at least three months. Within four to six weeks, all of the men had heightened levels of testosterone; none reported any side effects during the year they were followed.

Because clomiphene citrate is not approved by the FDA for use in men, little information exists about the long-term effects of taking it (including the risk of developing prostate cancer) or whether it is more effective at boosting testosterone than exogenous formulations. But unlike exogenous testosterone, clomiphene citrate preserves and possibly enhances sperm production. That makes drugs like clomiphene citrate one of only a few choices for men with low testosterone who want to father children.

What forms of testosterone-replacement therapy are available?*

The oldest form is an injection, which we still use because its inexpensive and because we reliably get good testosterone levels in nearly everybody. The disadvantage is that a man needs to come in every few weeks to get a shot. A roller-coaster effect can also occur as blood testosterone levels peak and then return to baseline. [See Exogenous vs. endogenous testosterone, above.]

Topical therapies help maintain a more uniform level of blood testosterone. The first form of topical therapy was a patch, but it has a very high rate of skin irritation. In one study, as many as 40% of men who used the patch developed a red area on their skin. That limits its use.

The most commonly used testosterone preparation in the United States and the one I start almost everyone off with is a topical gel. There are two brands: AndroGel and Testim. The gel comes in miniature tubes or in a special dispenser, and you rub it on your shoulders or upper arms once a day. Based on my experience, it tends to be absorbed to good levels in about 80% to 85% of men, but that leaves a substantial number who dont absorb enough for it to have a positive effect. [For specifics on various formulations, see table below.]

Are there any drawbacks to using gels? How long does it take for them to work?

Men who start using the gels have to come back in to have their testosterone levels measured again to make sure theyre absorbing the right amount. Our target is the mid to upper range of normal, which usually means around 500 to 600 ng/dl. The concentration of testosterone in the blood actually goes up quite quickly, within a few doses. I usually measure it after two weeks, though symptoms may not change for a month or two.

What about pills?

There are pills in the United States for testosterone supplementation, but their use is strongly discouraged because they cause significant liver toxicity. A safe oral formulation called testosterone undecanoate is available in Canada and in Europe, but not in the United States. Whats quite exciting is that an injectable version of testosterone undecanoate (Nebido) was submitted to the FDA for approval in August 2007. (Its already approved in many other countries.) It lasts for 12 weeks, so a patient could come in and get a shot about four times a year. [Editors note: In December 2009, the brand name of the drug in the United States was changed to Aveed. As of January 2011, it was still awaiting FDA approval.]

Cherrier MM, Asthana MD, Plymate S, et al. Testosterone Supplementation Improves Spatial and Verbal Memory in Healthy Older Men. Neurology 2001;57:8088. PMID: 11445632.

Isidori AM, Giannetta E, Greco EA, et al. Effects of Testosterone on Body Composition, Bone Metabolism and Serum Lipid Profile in Middle-aged Men: A Meta-analysis. Clinical Endocrinology 2005;63:28093. PMID:16117815.

Liu PY, Swerdloff RS, Veldhuis JD. Clinical Review 171: The Rationale, Efficacy and Safety of Androgen Therapy in Older Men: Future Research and Current Practice Recommendations. Journal of Clinical Endocrinology and Metabolism 2004; 89:478996. PMID: 15472164.

Moffat SD, Zonderman AB, Metter EJ, et al. Longitudinal Assessment of Serum Free Testosterone Concentration Predicts Memory Performance and Cognitive Status in Elderly Men. Journal of Clinical Endocrinology and Metabolism 2002;87:50017. PMID: 12414864.

Wang C, Cunningham G, Dobs A, et al. Long-term Testosterone Gel (AndroGel) Treatment Maintains Beneficial Effects on Sexual Function and Mood, Lean and Fat Mass, and Bone Mineral Density in Hypogonadal Men. Journal of Clinical Endocrinology and Metabolism 2004;89:208598. PMID: 15126525.

Other than improvement in sexual symptoms, what are some of the potential benefits of testosterone-replacement therapy?

Some studies have looked at testosterone therapy and cognition. Although the findings werent definitive, there was some evidence of cognitive improvement. Other studies have shown that it improves mood. Testosterone therapy has also been shown to be effective in the treatment of osteoporosis and in increasing muscle bulk and strength. [See Testosterones impact on brain, bone, and muscle, above.]

What risks do you consider when prescribing testosterone-replacement therapy?

When patients ask about risks, I remind them that they already have testosterone in their system and that the goal of testosterone treatment is to restore its concentration back to what it was 10 or 15 years previously. And the molecule itself that we give is identical to the one that their bodies make naturally, so in theory, everything should be hunky-dory. But in practice, there are always some curveballs.

For example, testosterone can increase the hematocrit, the percentage of red blood cells in the bloodstream. If the hematocrit goes up too high, we worry about the blood becoming too viscous or thick, possibly predisposing someone to stroke or clotting events. Although, frankly, in a review that I wrote in the New England Journal of Medicine* where we reviewed as much of this as we could, we found no cases of stroke or severe clotting related to testosterone therapy. Nevertheless, the risk exists, so we want to be careful about giving testosterone to men who already have a high hematocrit, such as those with chronic obstructive pulmonary disease, or those who have a red-blood-cell disorder.

Although its rare to see swelling caused by fluid retention, physicians need to be careful when prescribing testosterone to men with compromised kidney or liver function, or some degree of congestive heart failure. It can also increase the oiliness of the skin, so that some men get acne or pimples, but thats quite uncommon, as are sleep apnea and gynecomastia (breast enlargement).

What about the risk of developing prostate cancer?

I think that the biggest hurdle for most physicians prescribing testosterone is the fear that theyre going to promote prostate cancer. [See Incongruous findings, below.] Thats because more than six decades ago, it was shown that if you lowered testosterone in men whose prostate cancer had metastasized, their condition improved. (It became a standard therapy that we still use today for men with advanced prostate cancer. We call it androgen deprivation or androgen-suppressive therapy.) The thinking became that if lowering testosterone makes prostate cancer disappear, at least for a while, then raising it must make prostate cancer grow. But even though its been a widely held belief for six decades, no one has found any additional evidence to support the theory.

Havent there been any studies that follow men who go on testosterone-replacement therapy to see what their rate of cancer is compared with that in men who are not on it?

As with a number of treatments or medicines that have been around for a long, long time, it hasnt been scrutinized like a new drug would be. And although theyve been discussed, there arent any large-scale, randomized controlled clinical trials of testosterone-replacement therapy under way. [See A male equivalent to the Womens Health Initiative? below.]

There have been a number of smaller studies on men receiving testosterone-replacement therapy, and if you look at the results cumulatively, the rate of prostate cancer in these men was about 1% per year. If you look at men who show up for prostate cancer screening, same sort of age population, the rate tends to be about the same. You have to be cautious in comparing studies and combining the results, but theres no signal in these results that testosterone-replacement therapy creates an unexpectedly high rate of prostate cancer.

We also have epidemiologic studies, like the Physicians Health Study, the Baltimore Longitudinal Study of Aging, and the Massachusetts Male Aging Study, that include tens of thousands of men who are followed for 5, 10, 15, or even 20 years. At the end of the study period, the researchers see who developed prostate cancer and who didnt. They can then look at blood samples taken at the start of the study to see if, for example, the group that got prostate cancer had a higher level of testosterone over all. About 500,000 men have been entered in some 20 trials of this type around the world. Not one of those studies has shown a definitive correlation between prostate cancer and total testosterone. Three or four have shown weak associations, but none of those have been confirmed in subsequent studies.

Another point Id like to make for people worried about a link between high testosterone and prostate cancer is that it just doesnt make sense. Prostate cancer becomes more prevalent in men as they age, and thats also when their testosterone levels decline. We almost never see it in men in their peak testosterone years, in their 20s for instance. We know from autopsy studies that 8% of men in their 20s already have tiny prostate cancers, so if testosterone really made prostate cancer grow so rapidly we used to talk about it like it was pouring gasoline on a fire we should see some appreciable rate of prostate cancer in men in their 20s. We dont. So, Im no longer worried that giving testosterone to men will make their hidden cancer grow, because Im convinced that it doesnt happen.

Can testosterone worsen BPH?

The evidence shows that testosterone treatment does not change the strength or rate of urine flow, does not change the ability to empty the bladder, and does not change other symptoms such as frequency or urgency of urination, as assessed by the American Urological Association Symptom Score or the International Prostate Symptom Score. Ive had a couple of patients over the years who had some worsening of urinary symptoms with testosterone, but thats rare, even with long-term use.

Studies have come to conflicting conclusions about whether high levels of testosterone increase the risk of developing prostate cancer. A sampling of studies that have helped drive the controversy follows.

Increases in cancer risk

Parsons JK, Carter HB, Platz EA, et al. Serum Testosterone and the Risk of Prostate Cancer: Potential Implications for Testosterone Therapy. Cancer Epidemiology, Biomarkers, and Prevention 2005;14:225760. PMID: 16172240.

Shaneyfelt T, Husein R, Bubley G, et al. Hormonal Predictors of Prostate Cancer: A Meta-Analysis. Journal of Clinical Oncology 2000;18:84753. PMID: 10673527.

No effect or decreases in cancer risk

Eaton NE, Reeves GK, Appleby PB, et al. Endogenous Sex Hormones and Prostate Cancer: A Quantitative Review of Prospective Studies. British Journal of Cancer 1999;80:93034. PMID: 10362098.

Mohr BA, Feldman HA, Kalish LA, et al. Are Serum Hormones Associated with the Risk of Prostate Cancer? Prospective Results from the Massachusetts Male Aging Study. Urology 2001;57:93035. PMID: 11337297.

Morgentaler A. Testosterone and Prostate Cancer: An Historical Perspective on a Modern Myth. European Urology 2006;50:93539. PMID: 16875775.

Mixed findings

Slater S, Oliver RT. Testosterone: Its Role in the Development of Prostate Cancer and Potential Risks from Use as Hormone Replacement Therapy. Drugs and Aging 2000;17:43139. PMID: 11200304.

Whats your strategy for the concomitant administration of erectile dysfunction drugs?

My preference is to start men on testosterone, for a couple of reasons. First, if a man has successful return of his own erections, its like a home run for him. He doesnt have to take a pill in anticipation of having sex. He can have sex whenever he wants. Second, the benefits of testosterone-replacement therapy often go way beyond erectile dysfunction. That may be what brought the patient into the office originally, but then he comes back saying how much better he feels in general, how much more energetic and motivated he is, how his drives on the golf course seem to be going farther, and how his mood is better.

But if somebody fails testosterone therapy, meaning that their erections arent any better, Ive said, Well, lets stop the testosterone and try one of the PDE5, or phosphodiesterase type 5, inhibitors sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra). A lot of patients then say, Well, actually, Id like to stay on the testosterone. True, its not helping my erections, but Im more turned on, and Im getting these other benefits. So we often continue the testosterone and add a PDE5 inhibitor.

Theres a significant failure rate of the PDE5 inhibitors for erectile dysfunction, something on the order of 25% to 50%, depending on the underlying condition. It turns out that a third of those men will have adequate erections with testosterone-replacement therapy alone and another third will have adequate erections with the pills and testosterone combined. Theres still a third who dont respond, but normalizing their testosterone level has definitely rescued many men who had failed on PDE5 inhibitors.

In 2002, the federally sponsored Womens Health Initiative (WHI) stopped its hormone replacement therapy (HRT) trial (estrogen plus progestin), which included more than 16,000 women, three years early because those taking the pills had an increased risk of developing breast cancer and blood clots, and an increased risk of suffering a stroke or heart attack than those taking a placebo. The findings ran counter to the long-held belief that HRT could preserve health and trim heart-disease risk in women.

Unlike previous studies of HRT, which had been observational in nature, the WHI was a double-blind, randomized controlled trial. The gold standard of scientific inquiry, these trials can conclusively test theories and assess cause and effect.

To date, no large, double-blind, randomized controlled studies of a link between testosterone treatment and prostate cancer have been completed. In its 2004 report, the Institute of Medicine (IOM) committee studying the need for clinical trials of testosterone-replacement therapy noted that only 31 placebo-controlled studies had been done in older men, with the largest one enrolling just 108 participants. Most of these studies lasted only six months.

The IOM report estimated that a study of whether there is an increased risk of prostate cancer in men on testosterone therapy might require following 5,000 men for three to five years. Before launching such an endeavor, the report recommended more firmly establishing the effectiveness of testosterone-replacement therapy, saying that studies of long-term risks and benefits should be conducted only after short-term efficacy has been proven. That means the male equivalent of the WHI remains far off.

Whats your thinking on performing a prostate biopsy before prescribing testosterone therapy?

I started doing prostate biopsies before putting men on testosterone therapy because the fear had always been that a hidden cancer might grow due to increased testosterone. It was also believed that low testosterone was protective. Well, we found prostate cancer in one of the first men with low testosterone we biopsied, even though his PSA level and digital rectal exam (DRE) were normal. As we did more of these, we found more and more cases, about one out of seven, despite normal DRE and normal PSA. When we had data for 77 men and the cancer rate was about the same, 14%, the Journal of the American Medical Association published our findings. At the time, that rate of prostate cancer in men with normal PSA was several times higher than anything published previously, and it approximated the risk of men who had an elevated PSA or an abnormal DRE. That was in 1996.

In a subsequent study of 345 men with normal PSA and low testosterone, we found the cancer rate was similar: 15%. And we had a large enough group to look at the impact of testosterone on cancer risk. For men whose total testosterone or free testosterone value was in the lowest third, the odds of having a positive biopsy were double the odds in the rest of the men. Thats the first evidence that low testosterone may be an independent predictor for the development of prostate cancer.

That would argue for doing a routine prostate biopsy on anyone considering testosterone-replacement therapy.

Its not universally accepted, but thats what I do. Several recent studies have shown that low testosterone is associated with higher Gleason scores, with advanced-stage prostate cancer, and, even worse, with shorter survival times. [See Low testosterone, PSA, and prostate cancer, below.]

What recommendations do you have for monitoring once testosterone therapy begins?

The general recommendation is that men 50 and older who are candidates for testosterone therapy should have a DRE and a PSA test. If either is abnormal, the man should be evaluated further for prostate cancer, which is what we do with everybody whether they have low testosterone or not. That means a biopsy. But if all of those results are normal, then we can initiate testosterone therapy. The monitoring that needs to happen for men who begin testosterone therapy is really very simple: DRE, PSA, and a blood test for hematocrit or hemoglobin, once or twice in the first year and then yearly after that, which is pretty much what we recommend for most men over age 50 anyway.

Morgentaler A, Rhoden EL. Prevalence of Prostate Cancer Among Hypogonadal Men with Prostate-Specific Antigen Levels of 4.0 ng/dL or less. Urology 2006;68:126367. PMID: 17169647.

Morgentaler A, Bruning CO 3rd, DeWolf WC. Occult Prostate Cancer in Men with Low Serum Testosterone Levels. Journal of the American Medical Association 1996;276:19046. PMID: 8968017.

Massengill JC, Sun L, Moul JW, et al. Pretreatment Total Testosterone Level Predicts Pathological Stage in Patient with Localized Prostate Cancer Treated with Radical Prostatectomy. Journal of Urology 2003;169:16705. PMID: 12686805.

Isom-Batz G, Bianco FJ Jr, Kattan MW, et al. Testosterone as a Predictor of Pathological Stage in Clinically Localized Prostate Cancer. Journal of Urology 2005;173:193537. PMID: 15879785.

What changes do you see taking place on the testosterone front over the next five years?

I think that the importance of testosterone for cardiovascular health is going to be increasingly recognized. In the past, because men die of heart attacks more often than women and men have more testosterone, the fear has been that testosterone causes heart problems. But every single study of whether testosterone is bad for the heart has been negative, and what people havent pointed out in most of those negative studies is that there may be a beneficial effect.

I think well also find out in five years that there very well may be general health benefits of having normal testosterone compared to low testosterone. There are growing data for all-cause mortality that men who have low testosterone die earlier than those who have normal testosterone. A study by the Veterans Administration reported about a year ago showed low testosterone levels were associated with a dramatically increased mortality rate. Its hard to know why that is, but I think well be focused on that in the coming years.

Any closing thoughts?

I think that low testosterone is under-recognized, its effects are greatly underappreciated, and its diagnosis isnt readily understood. This is an area that has tremendous research potential in the coming years.*

Originally published March 2009; last reviewed February 18, 2011.

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A Harvard expert shares his thoughts on testosterone ...

Suffering from low testosterone, or low t, can mean that you may have the low testosterone symptoms of fatigue, weakness, poor sleep, poor concentration, decreased strength, loss of muscle mass and decreased libido. At Mantality, we confirm these symptoms through blood tests. Once confirmed, we can successfully treat low testosterone with testosterone replacement therapy also known as TRT. While many testtestosterone levels, our blood test will help determine your free testosterone levels.

Testosterone hits the blood stream in a few forms:

- SBGH or Sexual Binding Globulin, this testosterone is not available for use in the body.

- Estrogen, through a process called aromatization, the testosterone is changed to estradiol.

- Free Testosterone, the testosterone that is free to be used by the body.

At Mantality, free testosterone is what we recognize in the blood that is available to be used by your body. The name implies exactly what it is for, free use by the body. Free testosterone is also known as bioavailable testosterone as it is biologically available testosterone for maximum use by the body. But, is the rest of the testosterone gone?

We have a lot of men come to the office claiming their doctor or physician tested their total testosterone and claimed it was normal. While that may be true, a mans total testosterone could be within the accepted normal limits, however, free testosterone can be low causing symptoms of low t.

Mantality is able to increase the amount of unbound or free T in your body through the use of testosterone treatment & therapy. This is the most readily available form of testosterone for your body to use. This allows us to treat the body using testosterone injections which helps bring the body back into hormone balance meaning you are now stronger, leaner, sharper and can take life on with no fatigue.

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Testosterone Replacement Therapy Low T Treatment | Mantality

At NovaGenix, we consider ourselves to be more than a Testosterone Therapy Clinic in West Palm Beach. Our goals with our patients are to help improve their health, mood, appearance and performance in the bedroom for them to lead a happier, more balanced lifestyle, both physically and emotionally. Much research has been conducted, which validates the claims that testosterone therapy has several positive health benefits for men over 40. Studies on the effectiveness and safety of Testosterone Therapy Treatment by medical teams have proven Physician prescribed and monitored Hormone Therapy programs to be safe for most men, however there remains several misconceptions about TRT even within the medical community. Thus, the importance of both research as well as scheduling an appointment to sit down with an expert in their field of HRT medicine. As it turns out, being on a physician prescribed and monitored TRT regimen has several health benefits, and many of the myths about TRT have been discredited by the medical community. Statements by the American Urological Association confirm its safety. In the conclusion of their 2016 study, they state " Prostate cancer appears to be unrelated to endogenous testosterone levels. TRT for symptomatic hypogonadism does not appear to increase PSA levels nor the risk of prostate cancer development. " Click Here To See The Study. Another recent study has shown that there is no increased the risk of heart disease or stroke because of TRT and even concluded that patients on a long-term testosterone replacement program could even benefit from BHRT and have shown a reduction in cardiovascular incidents and stroke. Hormone replacement is both safe and potentially improves more than just vitality and quality of life, but overall health and well-being too. Click Here To Read A Report on HRT and Heart Risk. TRT for men with Low T in Palm Beach Gardens helps educate our patients about the health risks and benefits. If you're looking for a Jupiter Testosterone Replacement Therapy Clinic

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Jupiter Testosterone Replacement Therapy Clinic - NovaGenix

Benefits of Testosterone for Women: The Case for Testosterone Replacement in Aging Women

Television, the internet, and magazine ads all target men with products that address the drop in testosterone that occurs with age, but despite being classified as a male hormone, testosterone is also produced by women. While its true that men produce far more testosterone than women do, during the early reproductive years, women have 10 times more testosterone than estrogen within the body, leading experts to believe that its really testosterone loss that results in many of the symptoms women go through in midlife, such as low libido, fatigue, low muscle tone, weight gain, and loss of mental focus.1 Testosterone for women has become a hot button issue as women begin to realize that they too are at risk for deficiencies since testosterone levels drop with age in women as well. Around the world, testosterone therapy is being used to treat the symptoms of testosterone deficiency in both pre- and post-menopausal women as research continues to show that healthy testosterone levels are essential for the physical and mental health of both men and women.

Since the ovaries are responsible for producing both estrogen and testosterone, as the ovaries age, they produce less estrogen and testosterone.2 As women enter pre-menopause, testosterone production is reduced, and once women reach menopause, its common for them to produce less than half the testosterone they did previously. Every woman becomes at risk for testosterone deficiency as she ages, and women who go through a hysterectomy or oophorectomy have an even higher risk of dealing with low testosterone levels.

Women who begin experiencing a testosterone deficiency often notice many of the same symptoms men deal with as they deal with low T levels. Low levels of testosterone in women often lead to an increased risk of osteoporosis, since low T levels can leach away strength from the skeleton.3 Low levels can also lead to an increased risk of gaining weight since testosterone levels have been linked with fat mass in women in studies published in the American Journal of Epidemiology.4 A report published in the Journal of Womens Health even showed that testosterone deficiencies could be a risk factor for the development of heart disease in women.5 Since cardiovascular disease is the number one killer of postmenopausal women, this is an interesting hypothesis that underscores the importance of balanced hormones in women, including testosterone.

Both women and men may experience a wide variety of symptoms with low testosterone, such as fatigue, weight gain, low libido, and mental fogginess. Testosterone therapy has the potential to relieve these symptoms. Low libido is one of the most common complaints among aging women, and studies show that treating women with testosterone can significantly improve their sex drive.6 For women going through menopause, testosterone therapy often provides symptom relief. Studies show that testosterone therapy in menopausal women can relieve the symptoms of menopause, including urinary urgency, incontinence, vaginal dryness, and hot flashes.7 Testosterone therapy may also help protect against cardiovascular events, dilating blood vessels and increasing blood flow, as well as offering a reduced risk of Type 2 diabetes by lowering insulin resistance.8 While some buy into the myth that testosterone therapy may increase the risk of breast cancer, studies show that instead of increasing a womans risk for the disease, taking testosterone may actually help prevent breast cancer.9 Other benefits of testosterone women may experience include improve focus and mental clarity, reduced fatigue, reduced anxiety, improved bone density, and increases in lean muscle mass.

Women suffering from testosterone deficiency can benefit from choosing bio-identical hormone replacement therapy (BHRT). Since bio-identical hormones have the same molecular structure as the hormones a womans body naturally produces, hormones can be properly used and naturally metabolized and excreted by the body. When compared to traditional hormone replacement therapy, BHRT offers a much lower risk of side effects. BHRT is tailor made to meet each womans specific needs, ensuring that hormone levels are increased safely to prevent negative side effects. Women who are aging or who have undergone a hysterectomy or oophorectomy are at risk for declining testosterone levels. Aging women who experience low libido, poor concentration, symptoms of menopause, or other symptoms related to low levels of testosterone can benefit from testosterone therapy.10 Choosing bio-identical hormone replacement therapy can benefit women by reducing the symptoms of menopause, preventing osteoporosis, protecting the heart, increasing lean muscle mass, and improving overall quality of life.11 For more information contact us at http://www.renewmetoday.com to take the hormone health test, and find out where your nearest office is.

References

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Benefits of Testosterone for Women Renew Me Today

Understand the potential risks and consider alternatives before boosting your hormones indefinitely.

Millions of American men use a prescription testosterone gel or injection to restore normal levels of the manly hormone. The ongoing pharmaceutical marketing blitz promises that treating "low T" this way can make men feel more alert, energetic, mentally sharp, and sexually functional. However, legitimate safety concerns linger. For example, some older men on testosterone could face higher cardiac risks.

"Because of the marketing, men have been flooded with information about the potential benefit of fixing low testosterone, but not with the potential costs," says Dr. Carl Pallais, an endocrinologist and assistant professor of medicine at Harvard Medical School. "Men should be much more mindful of the possible long-term complications."

MIND Depression Reduced self-confidence Difficulty concentrating Disturbed sleep

BODY Declining muscle and bone mass Increased body fat Fatigue Swollen or tender breasts Flushing or hot flashes

SEXUAL FUNCTION Lower sex drive Fewer spontaneous erections Difficulty sustaining erections

Images: Thinkstock

A loophole in FDA regulations allows pharmaceutical marketers to urge men to talk to their doctors if they have certain "possible signs" of testosterone deficiency. "Virtually everybody asks about this now because the direct-to-consumer marketing is so aggressive," says Dr. Michael O'Leary, a urologist at Harvard-affiliated Brigham and Women's Hospital. "Tons of men who would never have asked me about it before started to do so when they saw ads that say 'Do you feel tired?'"

Just being tired isn't enough to get a testosterone prescription. "General fatigue and malaise is pretty far down my list," Dr. O'Leary says. "But if they have significant symptoms, they'll need to have a lab test. In most men the testosterone level is normal."

If a man's testosterone looks below the normal range, there is a good chance he could end up on hormone supplementsoften indefinitely. "There is a bit of a testosterone trap," Dr. Pallais says. "Men get started on testosterone replacement and they feel better, but then it's hard to come off of it. On treatment, the body stops making testosterone. Men can often feel a big difference when they stop therapy because their body's testosterone production has not yet recovered."

This wouldn't matter so much if we were sure that long-term hormone therapy is safe, but some experts worry that low-T therapy is exposing men to small risks that could add up to harm over time.

A relatively small number of men experience immediate side effects of testosterone supplementation, such as acne, disturbed breathing while sleeping, breast swelling or tenderness, or swelling in the ankles. Doctors also watch out for high red blood cell counts, which could increase the risk of clotting.

Men on long-term testosterone appear to have a higher risk of cardiovascular problems, like heart attacks, strokes, and deaths from heart disease. For example, in 2010, researchers halted the Testosterone in Older Men study when early results showed that men on hormone treatments had noticeably more heart problems. "In older men, theoretical cardiac side effects become a little more immediate," Dr. Pallais says.

Some physicians also have a lingering concern that testosterone therapy could stimulate the growth of prostate cancer cells. As with the hypothetical cardiac risks, the evidence is mixed. But because prostate cancer is so common, doctors tend to be leery of prescribing testosterone to men who may be at risk.

For men with low blood testosterone levels, the benefits of hormone replacement therapy usually outweigh potential risks. However, for most other men it's a shared decision with your doctor. It offers men who feel lousy a chance to feel better, but that quick fix could distract attention from unknown long-term hazards. "I can't tell you for certain that this raises your personal risk of heart problems and prostate cancer, or that it doesn't," Dr. Pallais says.

So, keep risks in mind when considering testosterone therapy. "I frequently discourage it, particularly if the man has borderline levels," Dr. Pallais says.

These steps can help you feel more energetic today without drugs or dietary supplements:

Pace yourself: Spread out activities throughout the day.

Take a walk: It gives you a lift when you feel pooped out.

Snack smart: Have a snack with fiber and some protein between meals.

A large, definitive trial for hormone treatment of men is still to come. Until then, here is how to take a cautious approach to testosterone therapy.

Have you considered other reasons why you may be experiencing fatigue, low sex drive, and other symptoms attributable to low testosterone? For example, do you eat a balanced, nutritious diet? Do you exercise regularly? Do you sleep well? Address these factors before turning to hormone therapy.

If your sex life is not what it used to be, have you ruled out relationship or psychological issues that could be contributing?

If erectile dysfunction has caused you to suspect "low T" as the culprit, consider that cardiovascular disease can also cause erectile dysfunction.

Inaccurate or misinterpreted test results can either falsely diagnose or miss a case of testosterone deficiency. Your testosterone level should be measured between 7 am and 10 am, when it's at its peak. Confirm a low reading with a second test on a different day. It may require multiple measurements and careful interpretation to establish bioavailable testosterone, or the amount of the hormone that is able to have effects on the body. Consider getting a second opinion from an endocrinologist.

After starting therapy, follow-up with your physician periodically to have testosterone checks and other lab tests to make sure the therapy is not causing any problems with your prostate or blood chemistry.

Approach testosterone therapy with caution if you are at high risk for prostate cancer; have severe urinary symptoms from prostate enlargement; or have diagnosed heart disease, a previous heart attack, or multiple risk factors for heart problems.

Ask your doctor to explain the various side effects for the differentformulations of testosterone, such as gels, patches, and injections. Know what to look for if something goes wrong.

Testosterone therapy is not a fountain of youth. There is no proof that it will restore you to the level of physical fitness or sexual function of your youth, make you live longer, prevent heart disease or prostate cancer, or improve your memory or mental sharpness. Do not seek therapy with these expectations in mind.

If erectile function has been a problem, testosterone therapy might not fix it. In fact, it might increase your sex drive but not allow you to act on it. You may also need medication or other therapy for difficulty getting or maintaining erections.

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Is testosterone therapy safe? Take a breath before you ...

League City & Friendswood Testosterone Therapy

Welcome to Titan T-Center & Weight Loss, League City and Friendswood, Texas finest testosterone replacement therapy clinic. Our clinic is outfitted with the latest technologies to provide our patients with efficient,safe and accurate results. In addition to our modern equipment, the medical professionals at our facilityare some of the most skilled and knowledgeable individuals in the industry. To all of us here, providing premier testosterone therapy requires more than just basic medical treatment. Our staff believes in building relationships and improving the lives of each and every individual that walks through our door.

Low testosterone, or hypogonadism, is a condition in which the bodys natural production of the hormone is below normal levels. By the age of 30, it is very common for men to begin seeing a decline in testosterone. Men may see a variety of symptoms, including but not limited to, a decrease in sex drive. Although age plays a factor in the production of testosterone, diabetes and excessive weight, have been associated with the condition as well.

Although testosterone supplements may be available in several forms, testosterone injections are believed to be safer and more effective than a pill. Oral testosterone is available, however, it is believed that testosterone taken orally may damage the liver. Furthermore, testosterone injections go directlyinto thebloodstream, making each treatment more effective.

Titan T-Center & Weight Loss is here to help you determine whether or not youmay be in need of therapy to lift your testosterone levels. We encourage you to look through the rest of our website to learn more about low t and its impact on your day-to-day life. Should you have any questions or if you would like to come in for a visit, contact us your convenience. Titan T-Center serves patients residing all over the League City and Friendswood areas.

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Testosterone Replacement Therapy | Titan Men's Health

Introduction to testosterone replacement therapy

Testosterone replacement therapy is a treatment in which additional testosterone is added to a mans body (e.g. by injecting medicines that contain testosterone), to increase the concentration of testosterone in his body. It is used to treat hypogonadism, a condition characterised by low levels of testosterone in the blood and clinical symptoms of testosterone deficiency (e.g. lack of body hair, excessive breast growth). Hypogonadism occurs when a mans testes do not produce enough testosterone, either because the testes are not working properly, or because the hypothalamus or pituitary glandin the brain are not working properly. The hypothalamus and pituitary glands produce hormones that stimulate testosterone production in the testes.

The aim of testosterone replacement therapy is to increase blood testosterone concentrations to normal levels. In doing so, it can also restore the mans sex drive and expression of male sex characteristics (e.g. deep voice, body hair).

Testosterone is one of the oldest marketed drugs and has been used in testosterone replacement therapy since the 1930s.

Testosterone replacement therapy is used to treat men who have received a definitive diagnosis of hypogonadism. In order to be diagnosed with hypogonadism, a man musthave both low blood concentrations of testosterone and clinical symptoms of deficiency (e.g. lack of body hair, breast growth). As most of the causes that underlie testosterone deficiency (e.g. testicular dysfunction) are untreatable, most men who commence testosterone replacement therapy must be treated for the rest of their lives. In men with reversible or age-related causes of testosterone deficiency, testosterone replacement therapy is not used.

Ageing men (> 40 years of age)

As men age, their testosterone levels naturally decrease in a process sometimes called andropause or male menopause. This can lead to clinical symptoms of testosterone deficiency and/or low blood testosterone levels. There is no evidence that testosterone replacement therapy is beneficial for these men.

For older men, treatments that address the conditions causing or worsening testosterone deficiency (e.g.obesity, diabetes, chronic illness) may be effective.

Chronic or transient illness or recent trauma

Testosterone replacement therapy is rarely beneficial where hypogonadism is caused by illness (e.g. diabetes) or trauma (e.g. injury to the testicles). In these cases, the illness or trauma causing testosterone deficiency should be treated.

Prostate or breast cancer

Testosterone replacement therapy is not used to treat men with breast or prostate cancer, because there is a hypothetical risk that treatment may stimulate the growth of these cancers.

Competitive athletes

Use of testosterone replacement therapy may lead to disqualification for professional athletes.

Others

Testosterone replacement therapy is not used to treat men with the following conditions:

Testosterone replacement therapy is not used totreat infertility, erectile dysfunction or non-specific symptoms.

Certain conditions require special consideration before testosterone replacement therapy is used. Tell your doctor if you have:

The goal of testosterone replacement therapy is to restore blood testosterone to normal levels. When used to treat men with hypogonadism, it may also result in other benefits, including:

Improvements in blood testosterone levels and libido generally occur within the first week of treatment, and other benefits usually occur within two months.

It is important to note that testosterone replacement therapy typically induces a strong placebo effect in the initial stages of therapy. This means that many men who are treated with testosterone notice an improvement (e.g. bettersex drive), not because of the testosterone-containing medication has improved their testosterone concentrations, but because of the psychological effect of taking it. In short, some men think testosterone therapy is working and then feel better, even though the treatment does not work. This may lead to confusion and dissatisfaction as the placebo effect of treatment diminishes.

Most adult men begin receiving replacement testosterone at a dose sufficient for restoring blood testosterone to normal levels in men aged < 40 years. In boys who have not yet reached puberty and elderly men, lower doses are usually used at the beginning to avoid excessive increases in libido or energy, which may be dangerous. Once treatment has started, the doctor will monitor the mans blood testosterone levels and symptoms, and may need to adjust the dose depending on how these change.

Testosterone can be administered in various ways, depending on the person. Most men will first receive treatment in the form of testosterone injections every two weeks. Men who cannot receive injections (e.g. those with bleeding disorders) will receive different modes of testosterone treatment. The doctor may also change the type of testosterone administered if the man is dissatisfied with thecurrenttreatment. A doctor will try to prescribe a type of testosterone therapy that suits the patient in terms of cost, response and convenience, and individuals should talk to their doctor if they have concerns about any aspects of treatment.

Injectable testosterone

Injectable testosterone is the standard and most cost-effective treatment option. It can be used in all men except those with bleeding disorders. The injection is an oil-based solution containing testosterone. It is administered by intramuscular injection. Once injected, the solution gradually releases testosterone into the bloodstream.

The standard starting dose is one injection containing 200250 mg of testosterone every 23 weeks. The dose may be reduced to as little as 100 mg in very young or old men. The quantity and frequency of the dose will be adjusted by the doctor, according to the response to treatment. Men who do not achieve adequate increases in blood testosterone may have the dose increased, while those who gain too much blood testosterone may have the dose reduced.

Testosterone injections which are administered every two weeks are known as short-acting injectable testosterones(e.g. Sustanon). While they are effective in increasing blood testosterone levels and often improve symptoms (e.g.libido, mood, energy), testosterone levels and symptoms tend to fluctuate between injections. Men using these injections may experience very high peaks intestosterone levels and a resulting increase in libido and energy in the period immediately following the injection, followed by a period of much lower blood testosterone. Long-acting injections of testosterone (e.g. Reandron), which are administered every 3 months, provide an alternative for men who experience the peaktrough effect.

Long-acting testosterone injections provide testosterone replacement for 1014 weeks.They areadministered by injection deep into the gluteal muscle. The testosterone is released gradually into the bloodstream.

For more information on long-acting testosterone injections, see testosterone undecanoate (Reandron).

Transdermal testosterone patches

Testosterone patches that adhere to the skin may also be suitable for long-term testosterone replacement therapy. However, the patches contain substances that increase the absorption of testosterone, and these cause skin irritation in up to 50% of men who use them. Some 10% of men stop using testosterone patches because of skin irritation. Men may also discontinue use because they find the patches cosmetically displeasing. They may find other transdermal methodsof administrationmore appropriate (e.g. gels, creams).

Most men require a single patch containing 5 mg of testosterone daily. The patch can be applied to the abdomen, upper arm or thigh, and should be left in place for 24 hours after application, when a new patch should be applied.

For more information on testosterone patchess, seetestosterone (Androderm).

Oral testosterone

Oral testosterone therapy (e.g. Andriol Testocaps) uses testosterone undecanoate, the only natural form of testosterone that can be absorbed when taken orally. It may be more expensive and less effective than other modes of testosterone replacement, and is therefore usually used by men who cannot use other forms of testosterone. Oral therapy may also be used to treat older men who are starting therapy, as treatment can be stopped quickly if they are diagnosed with prostate cancer.

The starting dose varies and may be as low as 40 mg daily, although men typically require 160240 mg a day, taken in 24 doses. The doctor will adjust the dose, depending on the response to treatment. Oral testosterone should be taken with food, as this increases the amount of testosterone absorbed by the body.

Testosterone implants

Testsosterone implants contain 800 mg of testosterone (usually in the form of four 200 mg pellets). They are implanted into the buttocks or abdomen, and provide testosterone replacement for around six months. Implants are replaced periodically, once symptoms of testosterone deficiency recur. Inserting the testosterone pellets is a minor surgical procedure, requiring local anaesthetic; this is the major limitation of this method of treatment. However, men using this form of testosterone replacement are usually satisfied with the method, and are more likely to continue being treated than men using other modes of testosterone replacement.

Testosterone implants are not safe for use by older men, who have an increased risk of prostate cancer. If prostate cancer is diagnosed, testosterone replacement must be stopped immediately, which cannot be done if an implant is being used. Implants are also unsuitable for young men with bleeding disorders. Another form of testosterone replacement must be used first, so that a doctor can be sure they will not have any negative reaction to testosterone, before starting this long-term mode of treatment.

For more information on testosterone implants, see testosterone(Testosterone Implants).

Testosterone gel

Testosterone gels (e.g. Testogel)contain 1% testosteronethat is absorbed through the skin. The gel is applied to the skin on the abdomen, shoulder or arm on a daily basis. The standard dose is 5 g (50 mg testosterone), although the dose may be increased to as much as 10 g daily in some men, while others will respond adequately to 2.5 g daily.

Care must be taken to ensure the gel does not come into contact with the skin of individuals other than the man being treated (e.g. sexual partners, children) for at least six hours following application, as this may cause testosterone to be transferred to the contacts skin and absorbed by their body. Absorbing testosterone may be dangerous for children and women, especially pregnant women.

For more information on testosterone gel, see testosterone (Testogel).

Testosterone cream

Andromen forte (testosterone) is a cream containing 5% testosterone. It is ideally applied to the skin of the scrotum on a daily basis. The cream can be applied to the skin of the torso, back, chest, arms and legs, although a higher dose might be required if these sites are used, as less testosterone is absorbed compared to if the cream is applied to the scrotum. The usual starting dose is 1 g of cream (5 mg testosterone), but a doctor may adjust the dose depending on how the man responds to the treatment.

As the causes of testosterone deficiency are typically irreversible, testosterone replacement therapy is usually lifelong. Men who use testosterone replacement therapywill be monitored throughout their treatment to assess their response.

To assess the mans response to treatment, levels of testosterone in his blood are usually measured three months after the start of treatment. Levels of luteinising hormone (LH) may also be measured three to six months after treatment starts, as low levels of LH indicate that the treatment is effective.

If blood tests show that testosterone replacement therapy has failed to adequately increase concentrations of testosterone in the mans blood, hypogonadism may not be the cause of the symptoms. In these cases, testosterone replacement therapy will be stopped and the doctor will start treating other conditions that may contribute to testosterone deficiency.

A doctor will monitor changes to symptoms of testosterone deficiency and side effects of the treatment. This monitoring usually occurs three and six months after treatment commences and annually thereafter. A doctor will typically examine a man for signs of:

Tests that will usually be conducted periodically include:

Testosterone replacement therapy may sometimes be combined with treatment using PDE-5 inhibitors, a medication used to treat erectile dysfunction, for men with both hypogonadism and erectile dysfunction. It should be noted, however, that testosterone deficiency is rarely associated with erectile dysfunction.

Effective testosterone therapy has numerous immediate and long term benefits. These include:

Physical

Sexual

Psychological

The side effects associated with testosterone replacement therapy are rare and vary depending on the age of the man being treated, his life circumstances and health condition. They include:

Testosterone replacement therapy increases the risk of some health conditions, including:

The rest is here:
Testosterone Replacement Therapy in Men | myVMC

Hormone replacement therapy (HRT) of the female-to-male (FTM) type is hormone replacement therapy and sex reassignment therapy used to change the secondary sexual characteristics of transgender and transsexual people from feminine (or androgynous) to masculine. Usually called "cross-sex hormone therapy" (XHT) or "hormone therapy", it is one of two types of HRT for transgender and transsexual people (the other being male-to-female), and is predominantly used to treat transgender men. Some intersex people also receive this form of HRT, either starting in childhood to confirm the assigned sex or later if the assignment proves to be incorrect.

The purpose of this form of HRT is to cause the development of the secondary sex characteristics of the desired sex, such as voice deepening and a masculine pattern of hair, fat, and muscle distribution. It cannot undo many of the changes produced by naturally occurring puberty, which may necessitate surgery and other treatments (see below). The medications used in HRT of the FTM type include, mainly, androgens (namely testosterone) and GnRH analogues.

While HRT cannot undo the effects of a person's first puberty, developing secondary sex characteristics associated with a different gender can relieve some or all of the distress and discomfort associated with gender dysphoria, and can help the person to "pass" or be seen as the gender they identify with. Introducing exogenous hormones into the body impacts it at every level and many patients report changes in energy levels, mood, appetite, etc. The goal of HRT, and indeed all somatic treatments, is to provide patients with a more satisfying body that is more congruent with their gender identity.

Several contraindications to androgen therapy exist.[1] An absolute medical contraindication is pregnancy.

Relative medical contraindications are:

Hormone therapy for transgender individuals has been shown in medical literature to be safe in adults, when supervised by a qualified medical professional.[2]

Testosterone is metabolized by the cytochrome P450 enzyme system (specifically CYP3A isoforms) in the liver. There are certain drugs that increase or decrease the activity of cytochrome P450 enzymes and may cause increased or decreased levels of testosterone:

Testosterone can also alter the effects of other drugs:

Because of these interactions, it is advised that trans men make their healthcare providers aware of their hormone therapy, when this is relevant to their treatment for other medical issues.

The terminal half-life of testosterone in blood is about 70 minutes, so it is necessary to have a continuous supply of the hormone for masculinization.

'Depot' drug formulations are created by mixing a substance with the drug that slows its release and prolongs the action of the drug. The two primarily used forms in the United States are the testosterone esters testosterone cypionate (Depo-Testosterone) and testosterone enanthate (Delatestryl) which are almost interchangeable. Testosterone enanthate is purported to be slightly better with respect to even testosterone release, but this is probably more of a concern for bodybuilders who use the drugs at higher doses (2501000mg/week) than the replacement doses used by transgender men (50100mg/week). These testosterone esters are mixed with different oils, so some individuals may tolerate one better than the other. Testosterone enanthate costs more than testosterone cypionate and is more typically the one prescribed for hypogonadal males in the United States. Testosterone cypionate is more popular in the United States than elsewhere (especially amongst bodybuilders). Other formulations exist but are more difficult to come by in the United States. A formulation of injected testosterone available in Europe and the United States, testosterone undecanoate (Nebido, Aveed)[3][4] provides significantly improved testosterone delivery with far less variation outside the eugonadal range than other formulations with injections required only four times yearly. However, each quarterly dose requires injection of 4mL of oil which may require multiple simultaneous injections. Testosterone undecanoate is also much more expensive as it is still under patent protection. Testosterone propionate is another testosterone ester that is widely available, including in the United States, Canada, and Europe, but it is very short-acting compared to the other testosterone esters and must be administered once every 2 or 3 days, and for this reason, is rarely used.

The adverse side effects of injected testosterone esters are generally associated with high peak levels in the first few days after an injection. Some side effects may be ameliorated by using a shorter dosing interval (weekly or every ten days instead of twice monthly with testosterone enanthate or testosterone cypionate). 100mg weekly gives a much lower peak level of testosterone than does 200mg every two weeks, while still maintaining the same total dose of androgen. This benefit must be weighed against the discomfort and inconvenience of doubling the number of injections.

Injected testosterone esters should be started at a low dose and titrated upwards based on trough levels (blood levels drawn just before your next shot). A trough level of 500ng/dl is sought. (Normal range for a cisgender male is 290 to 900ng/dl).

Both testosterone patches, creams and gels are available. Both approximate normal physiological levels of testosterone better than the higher peaks associated with injection. Both can cause local skin irritation (more so with the patches).

Patches slowly diffuse testosterone through the skin and are replaced daily. The cost varies, as with all medication, from country to country, it is about $150/month in the US, and about 60 Euros in Germany.

Transdermal testosterone is available throughout the world under the brand names Andromen Forte, Androgel, Testogel and Testim. They are absorbed quickly when applied and produce a temporary drug depot in the skin which diffuses into the circulation, peaking at 4 hours and decreasing slowly over the rest of the day. The cost varies, as with all medication, from country to country, from as little as $50/month to about $280/month (in US Dollars).

Transdermal testosterone poses a risk of inadvertent exposure to others who come in contact with the patient's skin. This is most important for patients whose intimate partners are pregnant or those who are parents of young children as both of these groups are more vulnerable to the masculinizing effects of androgens. Case reports of significant virilization of young children after exposure to topical androgen preparations (both prescription and 'supplement' products) used by their caregivers demonstrates this very real risk.

Implants, as subcutaneous pellets, can be used to deliver testosterone (brand name Testopel). 6 to 12 pellets are inserted under the skin every three months. This must be done in a physician's office, but is a relatively minor procedure done under local anesthetic. Pellets cost about $60 each, so the cost is greater than injected testosterone when the cost of the physician visit and procedure are included. The primary advantages of Testopel are that it gives a much more constant blood level of testosterone yet requires attention only four times yearly.

Oral testosterone is provided exclusively as testosterone undecanoate. It is available in Europe and Canada, but not in the United States. Once absorbed from the gastrointestinal tract, testosterone is shunted (at very high blood levels) to the liver where it can cause liver damage (albeit very rarely) and worsens some of the adverse effects of testosterone, like lower HDL (good) cholesterol. In addition, the first pass metabolism of the liver also may result in testosterone levels too low to provide satisfactory masculinization and suppress menses. Because of the short terminal half-life of testosterone, oral testosterone undecanoate must be administered two to four times per day, preferably with food (which improves its absorption).

In 2003 the FDA approved a buccal form of testosterone (Striant). Sublingual testosterone can also be made by some compounding pharmacies. Cost for Striant is greater than other formulations ($180210/month). Testosterone is absorbed through the oral mucosa and avoids the 'first pass metabolism' in the liver which is cause of many of the adverse effect with oral testosterone undecanoate. The lozenges can cause gum irritation, taste changes, and headache but most side effects diminish after two weeks. The lozenge is 'mucoadhesive' and must be applied twice daily.

Synthetic anabolicandrogenic steroids (AAS), like nandrolone (as an ester like nandrolone decanoate or nandrolone phenylpropionate), are agonists of the androgen receptor (AR) similarly to testosterone but are not usually used in HRT for transgender men or for androgen replacement therapy (ART) in cisgender men. However, they can be used in place of testosterone with similar effects, and can have certain advantages like less or no local potentiation in so-called androgenic tissues that express 5-reductase like the skin and hair follicles (which results in a reduced rate of skin and hair-related side effects like excessive body hair growth and scalp hair loss), although this can also be disadvantageous in certain aspects of masculinization like facial hair growth and normal body hair growth). Although many AAS are not potentiated in androgenic tissues, they have similar effects to testosterone in other tissues like bone, muscle, fat, and the voice box. Also, many AAS, like nandrolone esters, are aromatized into estrogens to a greatly reduced extent relative to testosterone or not at all, and for this reason, are associated with reduced or no estrogenic effects (e.g., gynecomastia). AAS that are 17-alkylated like methyltestosterone, oxandrolone, and stanozolol are orally active but carry a high risk of liver damage, whereas AAS that are not 17-alkylated, like nandrolone esters, must be administered by intramuscular injection (via which they act as long-lasting depots similarly to testosterone esters) but have no more risk of liver damage than does testosterone.

For the sake of clarification, it should be noted that the term "anabolicandrogenic steroid" is essentially synonymous with "androgen" (or with "anabolic steroid"), and that natural androgens like testosterone are also AAS. These drugs all share the same core mechanism of action of acting as agonists of the AR and have similar effects, although their potency, pharmacokinetics, oral activity, ratio of anabolic to androgenic effects (due to differing capacities to be locally metabolized and potentiated by 5-reductase), capacity for aromatization (i.e., conversion into an estrogen), and potential for liver damage may all differ.

Dihydrotestosterone (DHT) (referred to as androstanolone or stanolone when used medically) can also be used in place of testosterone as an androgen. The availability of DHT is limited; it is not available in the United States or Canada, for instance, but it is available in certain European countries, including the United Kingdom, France, Spain, Belgium, Italy, and Luxembourg.[5] DHT is available in formulations including topical gel, buccal or sublingual tablets, and as esters in oil for intramuscular injection.[6] Relative to testosterone, and similarly to many synthetic AAS, DHT has the potential advantages of not being locally potentiated in so-called androgenic tissues that express 5-reductase (as DHT is already 5-reduced) and of not being aromatized into an estrogen (it is not a substrate for aromatase).

In all people, the hypothalamus releases GnRH (gonadotropin-releasing hormone) to stimulate the pituitary to produce LH (luteinizing hormone) and FSH (follicle-stimulating hormone) which in turn cause the gonads to produce sex steroids. In adolescents of either sex with relevant indicators, GnRH analogues, such as leuprorelin can be used to suspend the advance of sex steroid induced, inappropriate pubertal changes for a period without inducing any changes in the gender-appropriate direction. GnRH analogues work by initially over stimulating the pituitary then rapidly desensitizing it to the effects of GnRH. Over a period of weeks, gonadal androgen production is greatly reduced. There is considerable controversy over the earliest age, and for how long it is clinically, morally and legally safe to do this. The Harry Benjamin International Gender Dysphoria Association Standards of Care permit from Tanner Stage 2, but do not allow the addition of gender-appropriate hormones until 16, which could be five or more years. The sex steroids do have important other functions. The high cost of GnRH analogues is often a significant factor.

Antiestrogens (or so-called "estrogen blockers") like aromatase inhibitors (AIs) (e.g., anastrozole) or selective estrogen receptor modulators (SERMs) (e.g., tamoxifen) can be used to reduce the effects of high levels of endogenous estrogen (e.g., breast development, feminine fat distribution) in transgender men. In addition, in those who have not yet undergone or completed epiphyseal closure (which occurs during adolescence and is mediated by estrogen), antiestrogens can prevent hip widening as well as increase final height (estrogen limits height by causing the epiphyses to fuse).

5-Reductase inhibitors like finasteride and dutasteride can be used to slow or prevent scalp hair loss and excessive body hair growth in transgender men taking testosterone.[7] However, they may also slow or reduce certain aspects of masculinization, such as facial hair growth and normal male-pattern body hair growth.[7] A potential solution is to start taking a 5-reductase inhibitor after these desired aspects of masculinization have been well-established.[7]

Depo-Provera (depot medroxyprogesterone acetate, or DMPA) may be injected every three months just as it is used for contraception. Generally after the first cycle, menses are greatly reduced or eliminated. This may be useful for transgender men prior to initiation of testosterone therapy.

In those who have not yet undergone or completed epiphyseal closure, growth hormone can be administered, potentially in conjunction with an aromatase inhibitor or a GnRH analogue, to increase final height.

The main effects of HRT of the FTM type are as follows:[8]

Many transgender men are unable to pass as cisgender men without hormones. The most commonly cited reason for this is that their voice may reveal them.

Facial changes develop gradually over time, and sexual dimorphism (physical difference between the sexes) tends to increase with age. Within a population of similar body size and ethnicity:

Frequently the first sign of endometrial cancer is bleeding in post-menopausal women. Transgender men who have any bleeding after the cessation of menses with androgen therapy should have an endometrial biopsy (and possibly an ultrasound) done to rule-out endometrial cancer.

A number of skeletal and cartilaginous changes take place after the onset of puberty at various rates and times. Sometime in the late teen years epiphyseal closure (in other words, the ends of bones are fused closed) takes place and the length of bones is fixed for life. Consequently, total height and the length of arms, legs, hands, and feet are not affected by HRT. However, details of bone shape change throughout life, bones becoming heavier and more deeply sculptured under the influence of testosterone. Many of these differences are described in the Desmond Morris book Manwatching.

The psychological changes are harder to define, since HRT is usually the first physical action that takes place when transitioning. This fact alone has a significant psychological impact, which is hard to distinguish from hormonally induced changes. Most trans men report an increase of energy and an increased sex drive. Many also report feeling more confident.

While a high level of testosterone is often associated with an increase in aggression, this is not a noticeable effect in most trans men. HRT doses of testosterone are much lower than the typical doses taken by steroid-using athletes, and create testosterone levels comparable to those of most cisgender men. These levels of testosterone have not been proven to cause more aggression than comparable levels of estrogen. It is assumed that the effect of the start of physical treatment is such a relief, and decreases pre-existing aggression so much, that the overall level of aggression actually decreases.

Some transgender men report mood swings, increased anger, and increased aggressiveness after starting androgen therapy. Many transgender men, however, report improved mood, decreased emotional lability, and a lessening of anger and aggression.

During HRT, especially in the early stages of treatment, blood work should be consistently done to assess hormone levels and liver function.

Israel et al. have suggested that for pre-oophorectomy trans men, therapeutic testosterone levels should optimally fall within the normal male range, whereas estrogen levels should optimally fall within the normal female range. Before oophorectomy, it is difficult and frequently impractical to fully suppress estrogen levels into the normal male range, especially with exogenous testosterone aromatizing into estrogen, hence why the female ranges are referenced instead. In post-oophorectomy trans men, Israel et al. recommend that both testosterone and estrogen levels fall exactly within the normal male ranges. See the table below for all of the precise values they suggest.[15]

The optimal ranges listed for testosterone only apply to individuals taking bioidentical hormones in the form of testosterone (including esters) and do not apply to those taking synthetic AAS (e.g., nandrolone) or dihydrotestosterone.

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Hormone replacement therapy (female-to-male) - Wikipedia

What is Testosterone?Testosterone is the hormone produced by the testicles. It is responsible for the proper development of male sexual characteristics. It helps promote the circulation of blood, and is responsible for the maintenance of muscle bulk. Without an adequate testosterone level there can be important psychological affects such as loss of libido, reduced brain and intellectual activity and mood changes. What causes the Andropause? As all men age there is a gradual decline in the level of testosterone. This natural decline starts after 30 and continues throughout life. By the age of 40, testosterone levels drop by 1% every year. Many men however can experience a lack of testosterone production sufficient to result in significant symptoms. This will apply to approximately 50% of men by age 55. Damaged testicles or disease will affect testosterone production as will long-term stress, smoking and excessive alcohol consumption. In 60% of cases no cause can be identified and hereditary factors are implicated. Are there any health issues associated with the Andropause? Low levels of testosterone may result in an increase in tummy and chest fat, a decline in the amount of muscle in the body and decline in strength. Low levels can also lead to Brittle bones, (osteoporosis) which may lead to hip and spinal fractures. In addition the bone marrow is less active and produces less haemoglobin and red blood cells to transport oxygen around the body.

A consultation is required and blood tests will be necessary. The blood tests include an examination for prostate cancer, as this is a contraindication to testosterone treatment. Any suspicion of prostate cancer may require further investigations. The aim of therapy is to return the blood testosterone level in the bloodstream to the normal range for the man's age. This is achieved by using bio-identical testosterone cream that is rubbed onto the skin daily.

IF YOU THINK YOU MIGHT HAVE LOW TESTOSTERONE, check out our quick online self assessment test.

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Many men with low testosterone report improved energy levels, sex drive, and mood after testosterone treatment. If testosterone is low, why not replace it?

Not so fast. A low testosterone level by itself doesn't need treatment. Testosterone replacement therapy can have side effects, and the long-term risks and benefits aren't known. Only men with symptoms of low testosterone and blood levels that confirm this as the cause of symptoms should consider testosterone replacement. Talking with your doctor is the only way to know if testosterone therapy is right for you.

The symptoms of low testosterone are sometimes obvious, but they also can be subtle. Testosterone levels decline naturally in men as they age over decades. But certain conditions can also lead to an abnormally low level. Symptoms of low testosterone include:

If a man has symptoms of low testosterone and tests show he has an abnormally low testosterone level, a doctor may suggest treatment. For millions of men who have low testosterone levels but no symptoms, no treatment is currently recommended. It is has also not been approved for treating men with low levels because of aging.

Testosterone replacement therapy is available in several forms. All can improve testosterone levels:

Why not a simple testosterone pill? Oral testosterone is available. However, some experts believe oral testosterone can have negative effects on the liver. Using other methods, such as skin patches, gels, orally disintegrating tablets, or injections, bypasses the liver and gets testosterone into the blood directly.

What can you expect from testosterone treatment? It's impossible to predict, because every man is different. Many men report improvement in energy level, sex drive, and quality of erections. Testosterone also increases bone density, muscle mass, and insulin sensitivity in some men.

Men also often report an improvement in mood from testosterone replacement. Whether these effects are barely noticeable, or a major boost, is highly individualized.

Karen Herbst, MD, PhD, an endocrinologist at University of California-San Diego, specializes in testosterone deficiency. She estimates about one in 10 men are "ecstatic" about their response to testosterone therapy, while about the same number "don't notice much." The majority have generally positive, but varying responses to testosterone replacement.

Testosterone replacement therapy side effects most often include rash, itching, or irritation at the site where the testosterone is applied.

However, there is also evidence of an increased risk of heart attack or stroke associated with testosterone use. Experts emphasize that the benefits and risks of long-term testosterone therapy are unknown, because large clinical trials haven't yet been done.

There are a few health conditions that experts believe testosterone therapy can worsen:

It will be years before large clinical trials bring any answers on the long-term benefits and risks of testosterone therapy. As with any medicine, the decision on whether the possible benefits outweigh any risks is up to you and your doctor.

Isn't taking testosterone replacement basically the same as taking steroids, like athletes that "dope"? It's true that anabolic steroids used by some bodybuilders and athletes contain testosterone or chemicals that act like testosterone.

The difference is that doses used in testosterone replacement only achieve physiologic (natural) levels of hormone in the blood. The testosterone forms some athletes use illegally are in much higher doses, and often combined ("stacked") with other substances that boost the overall muscle-building (anabolic) effect.

SOURCES:

Drugs.com: "Androderm Side Effects."

Swerdloff, R. Journal of Clinical Endocrinology & Metabolism, 2000.

Striant.com.

Wilson, J. American Journal of Medicine, 1980.

Bhasin, S. Journal of Clinical Endocrinology and Metabolism, 2006.

Karen Herbst, MD, PhD, assistant professor in medicine, University of California, San Diego.

News release, FDA.

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