TESTOSTERONE SUPPLEMENTATION -- SHOULD YOU TEST YOUR TEST?


Gentlemen, please answer the following questions:

1. Do you have a decrease in libido (sex drive)?
[ ] yes [ ] no

2. Are your erections less strong?
[ ] yes [ ] no

3. Do you have a decrease in strength and/or endurance?
[ ] yes [ ] no

4. Have you lost height?
[ ] yes [ ] no

5. Have you noticed a decreased "enjoyment of life?"
[ ] yes [ ] no

6. Are you sad and/or grumpy?
[ ] yes [ ] no

7. Do you have a lack of energy?
[ ] yes [ ] no

8. Have you noticed a recent deterioration in your ability to play sports?
[ ] yes [ ] no

9. Are you falling asleep shortly after dinner?
[ ] yes [ ] no

10. Has there been a recent deterioration in your work performance?
[ ] yes [ ] no


If you answered yes to number 1 or 2, or yes to three or more questions total, you may be a candidate for testosterone replacement therapy, and should have your testosterone levels checked by a physician.

Testosterone is primarily made in the testes of men, and plays a vital role in many of the processes mentioned in the questionnaire. The hormone enters muscle cells and signals them to create protein. Testosterone is available in our blood in two main forms: bound to carrying proteins, or unbound to these proteins (free). It's only in this free state that testosterone can exert it's affect.

The testes create testosterone in different amounts during the life of a man. Blood levels of testosterone in preadolescent boys is about 50-200. During puberty, the level can be as high as 1,000. Most labs consider the normal testosterone level of an adult male to be around 250-850. Women have levels of about 50 due to other glands creating some testosterone. Elite bodybuilders who take high amounts of extra testosterone frequently have levels of 3,000-4,000.

Men who exhibit many of the maladies mentioned in the questionnaire will sometime have low testosterone levels. It is also possible that these men could have levels in the normal range, but on the low end of normal, and be significantly lower compared to a higher level they used to have. The gradual decline in testosterone men may experience leading to symptoms has been coined "andropause," and exhibits some similarities to the more sudden and drastic decline experienced by women with menopause.

The effect of testosterone on the male body decreases with age in three main ways. First, the testes produce less testosterone with time. Secondly, some men metabolize testosterone differently. Testosterone's two main byproducts are dihydrotestosterone (and even more potent form of testosterone) and estradiol (yes, the main female sex hormone). Some men have abundant activity of the enzyme (aromatase) that converts testosterone into estradiol, thereby more sharply lowering testosterone levels. Thirdly, as we age we tend to make greater amounts of the protein (sex hormone binding globulin) that binds testosterone, thus making less of it available to be used in the body.

Supplementing testosterone in men has shown to improve muscle mass, energy, libido, bone density, and sense of well-being. The goal is usually to give enough extra testosterone to improve symptoms, increasing testosterone levels well into normal range, and preferably not going above normal. Similar to most things in the body, too much or too little can get you into trouble. Too much testosterone can create acne, mood swings, prostate enlargement, and worsen the cholesterol profile.

The favored way of supplementing testosterone in recent years is the transdermal route -- rubbing gel or cream containing testosterone into the skin daily, or wearing a patch. These methods mimic the body's daily production. Androgel and Testim are FDA approved testosterone gels, and Androderm is an approved patch. Some people don't wind up absorbing the testosterone in gels very well. In those cases, periodic injections of testosterone are an alternative.

An even newer way of increasing testosterone in men is being studied and shows promise. It involves blocking the action of the enzyme (aromatase) that converts testosterone to estradiol. This allows more testosterone to be available. These aromatase inhibitors may also indirectly make the testes produce more testosterone. The possible advantage aromatase inhibitors may have over actual testosterone supplementation is lower estrogen levels. It has been theorized that higher estrogen levels in men may predispose to prostate cancer, and have been definitely shown to stimulate breast tissue growth in men. Neither testosterone supplementation nor aromatase inhibition has been shown to increase the incidence of prostate cancer. Aromatase inhibitors, such as Arimidex, are currently approved to treat and prevent breast cancer in women. (Arimidex has also been shown to increase IGF-1 levels -- see the growth hormone section of my website for this benefit).  Any use in men is done with the understanding that it is "off-label."

If you feel you made need your testosterone checked, be sure to ask your doctor to check both your free and total testosterone levels, and consider checking estrogen levels should you begin supplementation.