Why the Growing Interest in Male Testosterone Replacement Therapy (TRT)
As men age, the amount of testosterone in their bodies gradually declines. The natural decline in testosterone starts after the age of 30 and continues throughout the life.
This decline can affect men in several ways, such as loss of energy, reduced sex drive, erectile dysfunction, loss of muscle mass, loss of strength, loss of bone mineral density, increase in body fat, decreased sense of well being, and several other undesirable affects that can dramatically decrease quality of life. Such changes, in association with low testosterone levels, have been called "male menopause."
Causes of Testosterone Deficiency
Testosterone deficiency results from the testes being unable to produce the normal levels of testosterone. This deficiency can be physiological or pathological. Physiological deficiency occurs with age. As a man ages, the amount of testosterone in his body gradually declines. This natural decline starts after the age of 30 and continues throughout the life.
In healthy male population 20-40 years of age, the level of early morning testosterone should be 21.8 nmol/L (627 ng/dL).
Pathological deficiency is caused by some other condition and the most common causes are:
1. Injury or infection of the testicles
2. Chemotherapy or radiation treatment for cancer
3. Genetic abnormalities such as Klinefelter's Syndrome
4. Hemochromatosis caused by too much iron in the body
5. Dysfunction of the pituitary gland
6. Inflammatory diseases such as sarcoidosis
7. Medications, especially hormones used to treat prostate cancer and corticosteroid drugs
8. Chronic illness
9. Chronic kidney failure
10. Liver cirrhosis
Best Candidates for Testosterone Replacement Therapy
In order to be treated correctly, and to even be properly considered for male hormone therapy several male hormone levels should be reviewed.
|Male Hormone Levels|
|Hormone to Test||Normal Values||What value means|
Testosterone is a hormone produced by the Leydig cells of the testes. Like other steroid hormones, testosterone is derived from cholesterol. It has many functions and it is responsible for normal growth, development of the male sex organs and maintenance of the secondary sex characteristics.
600-625 ng/dl is considered by most doctors as "normal" however these numbers can vary widely.
|Free Testosterone||.95-4.3 ng/dl||It is important to remember that blood levels of both free and total testosterone vary widely among individuals, making it difficult to establish a general threshold for treatment. However, levels are quite consistent within individuals, so it is helpful for men to have multiple tests over time to determine trends and individual thresholds for treatment.
It is also important to note that so-called normal levels of testosterone for older men is not something that I personally would shoot for. Why be average and accept loss of energy, vitality? The levels out there are conservative. Lonnie I believe a more valid optimal range for men who are into health and fitness would be in the upper one-third of the range for men aged 21 to 49 years, and that you seek supplementation to restore hormone levels to that range. Just have it done slowly so you feel comfortable with the changes and as such can also evaluate any "effects", both good and if any of the bad.
|% Free Testosterone||.3% - 5%||A normal male has about 2% free, unbound testosterone. Many people forget the importance of this number.|
|Follicle Stimulating Hormone (FSH)||1-18 mIU/ml||Basic hormone testing for males often only includes FSH and testosterone. FSH stimulates spermatogenesis.
|Luteinizing Hormone (LH)||2-18 mIU/ml||
LH stimulates Leydig cells and production of testosterone.
A problem with LH levels alone is rarely seen, so testing is only needed if testosterone level is abnormal. As men age, a number of changes occur that reduce the testosterone level available to the body and that alter the ratio between testosterone and the chief female hormone, estrogen. This condition is now referred to as partial androgen deficiency of aging men.
|Estradiol (E2)||10-60 pg/ml||Elevated estradiol levels in males can lead to gynecomastia. Increased estradiol levels in males may be caused by increased body fat, resulting in enhanced peripheral aromatization of androgens. Levels in men can also be increased by excessive use of marijuana, alcohol, or prescribed drugs. Estradiol levels can also be dramatically elevated in germ cell tumors and tumors of a number of glands in both men and women.
It is also imperative to also test estrogen levels. Many of the unwanted effects of male hormone imbalance are actually caused by an elevated estrogen level relative to testosterone level (the estrogen/testosterone ratio).
|Progesterone (P4)||.3-1.2 ng/ml|
As far as a Testosterone Replacement therapy approach, measuring for the items above should give the doc a pretty good picture, especially if used in conjunction with a eval of testosterone/estrogen levels (ratio).
Pros and Cons of Testosterone Replacement Therapy
There are many pros and cons of testosterone replacement therapy if your levels are low.
Pros of Testosterone Replacement Therapy
Many of the pros can make you feel like a new person and increase your quality of life. Here are just a few examples of the pros of Testosterone replacement therapy (TRT):
- improved energy,
- decreased lethargy,
- increased sex drive,
- better erections,
- increased muscle mass,
- lower body fat,
- improvement in your sense of well being,
- improvements in bone health.
Here are some additional recent studies supporting the possible of benefits of testosterone replacement therapy (TRT):
Benefits Bone Health. Approximately two million males have been diagnosed with osteoporosis and another three million are at risk. A recent study has shown that testosterone replacement therapy (TRT) can significantly improve bone mineral density (BMD; also known as bone mass). Reduced bone density or bone mass means there is less cushioning to protect the bone from cracking in a slip or fall. Testosterone replacement therapy (TRT) is now becoming the standard of care used to improve bone strength and muscle mass in males. A 2008 study conducted by the Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX found that testosterone administration appears to reduce bone turnover, perhaps closing the gap between resorption and formation. According to Dr. Dillon, the study's first author, "These preliminary data show beneficial effects of testosterone therapy on bone turnover markers in older men with low-to-normal testosterone concentrations using both continuous and monthly cycled testosterone replacement." He added, "The effects of sex hormones on markers of bone formation are complex, but this is an important step in understanding how the process works." Source: Continuous Testosterone Administration for Five Months Reduces Markers of Bone Turnover in Older Men. Retrieved January 9, 2009, from http://www.sciencedaily.com /releases/2006/10/061024010353.htm
Reduces Risk for Depression. Men with lower free testosterone levels in their blood appear to have higher prevalence of depression, according to a new study. The mechanism by which low hormone levels might affect depression risk has not been identified, but might involve changes in the levels of neurotransmitters or hormones in the brain, according to the researchers. Journal reference: Arch Gen Psychiatry. 2008;65:283-289.
Cons of Testosterone Replacement Therapy
The cons associated with the therapy, could include:
- Increase of blood cholesterol levels
- Increased red blood cell count (which could be a health improvement if you have anemia or low blood count). If your levels are normal however, your risk for heart attack or a stroke can increase.
- Changes in blood lipid concentration. Physiologic testosterone replacement is known to reduce total cholesterol, low density lipoprotein (LDL), and high density lipoprotein (HDL) levels. These elevations can cause significant increase in blood viscosity and can increase risk for heart disease and stroke.
- Increase in skin conditions/break outs.
- Increase in body hair, acceleration of head hair loss
- Fluid retention (can be a significant health risk for those with a history of heart failure or kidney disease).
- Decrease in sperm count producing infertility, etc.)
- Gynocamestia (breast enlargement)
Methods of Testosterone Replacement Therapy
In regards to methods of Testosterone Replacement therapy, the healthiest would be injections. By injecting hormone directly into the muscle it is the most effective therapy, however some people do not like needles or the inconvenience.
For the needle averse there are patches and gels. If patches are used it is best when these patches are applied to the skin on testicles, but, they can be applied almost anywhere on the body. The non-scrotal patch, known as Androderm, is meant to be worn on the arm or torso. In regards to the gel, the most common is called Androgel. Androgel is applied to the skin once a day. The main disadvantage of Androgel is the price.
The benefits of male hormone therapy are typically seen in as little as 3 weeks with injections, and up to 6 weeks when using gels and patches.
Top Male Hormone Replacement / Testosterone Replacement Therapy Physcians
If you are unsure whether your hormone levels are correct, visit Dr. Rand McClain in Santa Monica California. Dr. Rand McClain is a general practitioner who treats patients of all ages suffering from common illnesses. In addition, Dr. Rand McClain provides patients with vaccinations, and offers effective treatment for Type II Diabetes using Testosterone Restoration Therapy, Dietary Modification, and mino Acid Therapy, He can be reached at 310-452-3206. Refer to Dr. Rand McClaine's bio here: http://www.linkedin.com/pub/rand-mcclain/4/480/baa.
Testosterone Replacement Therapy Bottom Line
Get your blood panel done and have it evaluated by a knowledgeable
- Retrieved January 10, 2009, from http://www.sciencedaily.com /releases/2008/06/080617124020.htm
- Retrieved January 10, 2009, from http://www.sciencedaily.com /releases/2008/06/080616210025.htm
- Retrieved January 10, 2009, from http://www.sciencedaily.com /releases/2008/01/080109111320.htm
- Retrieved January 10, 2009, from http://www.sciencedaily.com /releases/2008/06/080617124016.htm
About the Author, Jeff Behar
Jeff Behar, MS, MBA is a recognized health, fitness and nutrition expert, regularly writing about hot topics in the areas of health, fitness, disease prevention, weight loss, nutrition, anti aging and alternative medicine. Jeff Behar's work also often appears in several of the major health and fitness newsletters, health and fitness magazines, and on major health, fitness and weight loss websites. Jeff Behar is also the CEO of MuscleMagFitness.com, MyBestHealthPortal.com and MyBestHealthPortal.net; three very popular health, fitness, disease prevention, weight loss, nutrition and anti aging information sites.