If you are a man struggling with fatigue, weight gain, difficulty sleeping or decreased sex drive, you may be suffering from symptoms of “Low T”, or low testosterone. Testosterone therapy for men can provide relief for these symptoms that are often associated with aging. Just as women experience a decline in hormone levels as they age, men experience a decrease in their testosterone levels beginning at around age 30. By 60, natural testosterone production has often dropped to about half of early adult levels. Studies have shown that over 13 million men in the U.S. suffer from low testosterone.
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What is Testosterone?
Testosterone is a hormone, a molecular messenger that travels through your bloodstream to act on many organs and tissues in your body, including your brain, muscles, fat, bones and sexual organs.
–Testosterone and the brain.
Your thinking abilities and general sense of well-being, including your mood, energy level and sense of vitality, and sexual drive or libido are all affected by testosterone.
–Testosterone and muscle.
Testosterone creates muscle cells and causes them to grow in size and strength.
–Testosterone and fat.
Testosterone has been shown to reduce body fat, particularly in the midsection and chest. The result is an improvement in lean body mass.
–Testosterone and bones.
Testosterone helps prevent the normal bone destruction of aging and actually improves bone density. This reduces the risk of osteoporosis and fractures.
–Testosterone and the heart.
Testosterone can inﬂuence cardiovascular risk factors indirectly through its effect on the amount of fat in your body, and there is evidence it beneﬁts the heart directly. It may help open the coronary arteries, and possibly improve cardiac function in people with heart disease and heart failure.
–Testosterone and sexual organs.
Testosterone is important for proper erectile function, and it can improve the quality of erections. These physiological aspects are separate from the effects testosterone has on the brain and your libido, but are related and are important for the normal enjoyment of life.
Potential Benefits of Testosterone Therapy
• Increased energy
• Increased bone density
• Reduced risk of obesity, diabetes and metabolic syndrome
• Reduced risk of cardiovascular disease
• Reduced risk of osteoporosis
• Reduced body fat
• Reduced risk of anemia
• Increased lean body mass and muscle strength
• Increased libido
• Increased sexual enjoyment
• Increased satisfaction with erections
• Increased sexual activity
• Improved mood and sense of well being
• Improved cognition and memory function
Factors that affect Low Testosterone in Men
DHEA: Dehydroepiandrosterone (DHEA) is a hormone produced from cholesterol that then follows one of two pathways, both involving two-step enzymatic conversions, to yield either estrogens or testosterone. Thus, levels of DHEA can have a role in determining levels of estrogen and testosterone, though DHEA alone is seldom enough to sufficiently restore testosterone levels in aging men.
Aromatase: One of the most important factors that affect testosterone levels and the ratio between testosterone and estrogen is the aromatase enzyme. Aromatase converts testosterone to estrogen, further depleting free testosterone levels and increasing estrogen levels.
Obesity: Obesity and associated hyperinsulinemia suppress the action of luteinizing hormone (LH) in the testis, which can significantly reduce circulating testosterone levels, even in men under the age of 40. In addition, increased belly fat mass has been correlated with increased aromatase levels. The vicious circle of low testosterone and obesity has been described as the hypogonadal/obesity cycle. In this cycle a low testosterone level results in increased abdominal fat, which in turn leads to increased aromatase activity. This enhances the conversion of testosterone to estrogens, which further reduces testosterone and increases the tendency toward abdominal fat.
Sex hormone-binding globulin (SHBG): Most testosterone circulating in the bloodstream is bound to either sex hormone-binding globulin (SHBG) (60%) or albumin (38%). Only a small fraction (2%) is unbound, or “free”. Testosterone binds more tightly to SHBG than to albumin. Consequently, only albumin-bound testosterone and free testosterone constitute the bioavailable forms of testosterone, which are accessible to target tissues and carry out the actions of the essential hormone. Thus the bioavailability of testosterone is influenced by the level of SHBG. Aging men experience both an increase in aromatase activity and an elevation in SHBG production. The net result is an increase in the ratio of estrogen to testosterone and a decrease in total and free testosterone levels. It is crucial that this skewed ratio be balanced.
Liver Function: The liver is responsible for removing excess estrogen and SHBG, and any decrease in liver function could exacerbate hormonal imbalances and compromise healthy testosterone levels. Thus it is important that aging men also strive for optimal liver function.
The Importance of Hormone Testing
Millions of aging men have the dual conditions of low testosterone and high cholesterol. Many physicians prescribe cholesterol-lowering drugs to reduce cholesterol, when, in fact, the age-related rise in cholesterol might simply be the body’s way of increasing hormone levels by supplying the raw materials necessary to make hormones.
The so-called “normal” levels of testosterone in older men reflect population averages. We believe that most aging men would prefer not to accept the loss of youthful vigor as normal. Instead, we suggest that a more valid optimal level for all men would be in the reference range used for men aged 21 to 49 years, and that any supplementation should aim to restore hormone levels to that range.
When measuring testosterone levels, it is critical to determine the levels of both free and total testosterone to understand the cause of any observed symptoms of deficiency.
It is also important to remember that blood levels of both free and total testosterone vary widely among individuals, making it difficult to establish a general baseline on which to prescribe a standardized treatment protocol. However, levels are quite consistent within individuals, and thus it is important that men have multiple tests over time to determine trends and individual thresholds for treatment.
Finally, during the initial testing, it is also imperative to test estrogen levels. Many of the unwanted effects of male hormone imbalance are actually caused by an elevated estrogen level relative to low testosterone levels (the estrogen/testosterone ratio).
*These are typical results, but results may vary and cannot be guaranteed.