Testosterone is the predominant male hormone; it is produced in the testes and adrenal glands. Testosterone can convert to dihydrotestosterone (DHT,) the more potent male hormone. DHT produces the male sexual characteristics such as body hair, erections and a deep voice. Testosterone can also convert to estradiol, which can generate symptoms such as a female body appearance, reduce body hair and a female voice.
Because testosterone levels decrease with age, men will experience mental and physical symptoms of testosterone deficiency over time. There are daily fluctuations in testosterone levels. Some factors that decrease testosterone levels include: intense physical activity, frequent sexual intercourse, emotional stress, and a diet high in concentrated sugars.
Positive Actions of Testosterone
- Libido – Testosterone is the most important hormone for maintaining sex drive. Normal levels can increase sexual satisfaction, in addition to increasing sexual desire and responsiveness. It can have a beneficial effect in men with erectile dysfunction.
- Blood Sugar & Insulin – Testosterone can decrease obesity by reducing fat mass and increasing lean muscle mass. Testosterone also helps decrease the incidence of diabetes by its action of increasing the efficacy of insulin.
- Brain, Mood & Memory – Depression is one of the major symptoms associated with low testosterone levels. Normal levels have a significant effect on mood, sense of well-being, interpersonal relationships, self-confidence and self-worth.
- Skin – Testosterone is responsible for male pattern hair growth. Testosterone preserves skin collagen, which protects the skin from thinning. It also increases sebaceous gland activity, which helps lubricate the skin.
- Bones – Testosterone and dihydrotestosterone (DHT) directly stimulates receptors on the osteoblasts (bone building cells) to stimulate bone growth, bone mineralization and repair of damaged bone. It also works together with estrogen to preserve and rebuild the joint cartilage between bones.
- Heart – Testosterone has a relaxing (vasodilating) effect on coronary arteries and can decrease symptoms of angina (chest pain) and lower blood pressure. Testosterone can reduce blood cholesterol and minimize atherosclerosis. It also can decrease blood clot formation by increasing “anti-clotting” activities in the blood.
Common Symptoms of Testosterone Deficiency in Men
Physical:
- Decreased muscle mass and strength
- Persistent fatigue with lack of interest in exercise
- Decreased sex drive and erectile dysfunction
- Fat accumulation in the abdomen, hips , and breasts
- Disturbed sleep
- Joint and muscle pains
- Headaches
- Decreased body hair and male pattern baldness
Mental:
- Depression
- Lowered self confidence
- Decreased concentration and poor memory
- Anxiety and excessive worrying
Treatment
Requirements for Monitoring Testosterone Therapy:
- Baseline and periodic blood tests including total testosterone, “free” testosterone, DHT (dihydrotestosterone), estradiol, PSA (prostate specific antigen), CBC or hemoglobin, and liver enzymes
- Baseline and yearly prostate exam
- Other tests that may be needed include: electrocardiogram and other cardiac function tests, bone density scan, and prostate ultrasound
Medication:
Testosterone replacement is available in many forms, the best route is chosen based on patient needs and severity of symptoms. Doses may be adjusted to obtain positive effects and prevent unwanted side effects. Testosterone replacement can work slowly. It can take three months to see improvements and increases in libido can take up to six months.
- Sublingual (under the tongue) tablets
- Trans-dermal (topical cream or patch)
- Injections
- Oral (not recommended)
- Pellet implants (not recommended)
Signs and Symptoms of Too Much Testosterone Replacement
- Unwanted acne resulting from overactive sebaceous glands
- Urinary problems
- Increased male pattern hair loss and excessive body hair
- Increased aggression
- Oily hair
- Excessive sex drive
- Swelling of the feet
Risks and Benefits of Treatment
Risks:
- Prostate cancer may be aggravated by testosterone replacement. An individual risk assessment of prostate cancer must be done prior to starting testosterone replacement
- Side effects may include hair growth on the face or body, hair loss on the scalp, oily skin or acne, hoarseness or deepening of the voice, fluid retention, increased breast size, sleep apnea, lowered sperm production.
- Increased risk of blood clot or stroke. This is related to excess production of red blood cells and is monitored closely.
Contraindications:
- Active or untreated prostate cancer is an absolute contraindication for all testosterone replacement.
- History of treated prostate cancer is a relative contraindication and treatment should occur only with specific education as to the risk and benefits in this particular situation.
Benefits:
- May improve sexual desire, erectile function, orgasm, mood, drive, ambition, confidence, security
- Improves muscle strength and fitness, bone density
- Lowers risk of heart disease, osteoporosis, diabetes
