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Testosterone In Men

Author: Dr. George Shanlikian, M.D.  |   Last Updated: February 5th, 2024

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Testosterone Replacement Therapy

Millions of Americans use testosterone prescriptions to restore normal levels of the hormone and for them to feel more alert, young, energetic, sexually functional, and mentally sharp. An overwhelming body of clinical research has shown that testosterone replacement therapy helps treat signs and symptoms of testosterone deficiency or medically known as hypogonadism. Depending on the nature and severity of testosterone deficiency, doctors may prescribe testosterone in the form of injections, pellets, tablets, patches, or gels.

Insufficiency

Hypogonadism or testosterone deficiency is a condition in which the body does not produce sufficient levels of testosterone as a result of an underlying medical condition or other causes. It is likely that testosterone deficiency is underdiagnosed and is often mistaken for other medical conditions due to the fact that its signs and symptoms resemble other diseases, especially psychiatric disorders.

Testosterone deficiency is classified according to the location of its cause:

  • Primary: This type of testosterone deficiency is also known as primary testicular failure. The causes of the deficiency originate from a testicular problem.
  • Secondary: In this type of testosterone deficiency, the testicles are normal but their functions are altered due to a problem with the pituitary gland or hypothalamus (the brain region that regulates temperature).

Hypogonadism may be present at birth (congenital) or may develop later in life (acquired). Congenital causes of hypogonadism include the following:

  • Klinefelter’s Syndrome: This condition results from a congenital abnormality of the sex chromosomes, X and Y. Normally, a male only has one X and one Y chromosome. In this condition, two or more X chromosomes are present in addition to one Y chromosome. This causes the testicles to develop abnormally, which in turn affects the production of testosterone.
  • Undescended testicles (Cryptorchidism): Normally, the testicles move down the scrotum after birth. Sometimes, one or both of the testicles may not descend and remain inside the abdomen. If not corrected in early childhood, it may affect the function of the testicles and reduce the rate at which testosterone is produced.
  • Kallmann syndrome: This condition is referred to as abnormal development of the hypothalamus. This abnormality can also affect the ability to smell (anosmia) and can lead to red-green color blindness.
  • Hemochromatosis: This condition occurs when there is too much iron in the blood. As a result, the testicles or pituitary gland malfunctions, affecting the production of testosterone.

Acquired causes of testosterone deficiency include the following:

  • Injury or trauma to the testicles: This can impair blood flow going to the testicles and affect the production of testosterone.
  • Cancer treatment: Chemotherapy or radiation therapy can interfere with the production of sperm and testosterone. Although the effects are temporary, there is still a chance that permanent infertility may occur.
  • Pituitary disorders: Any abnormality in the pituitary gland such as tumors can hinder the release of hormones from the pituitary gland to the testicles, thus affecting the production of testosterone.
  • Inflammatory disease: Tuberculosis, sarcoidosis, and histiocytosis can affect the hypothalamus and pituitary gland, which in turn impair the production of testosterone.
  • Autoimmune disorders: HIV/AIDS (Acquired immunodeficiency syndrome) can impair testosterone production by affecting the hypothalamus, pituitary gland, and testes.
  • Medications: Long-term use of medications for high cholesterol such as statins can lower testosterone levels as a side effect.
  • Stress: Chronic stress raises the levels of the stress hormone called cortisol in response to the situation. This in turn suppresses the central hormone pathways which include testosterone.

Testosterone in Men

In men, the sex hormone testosterone is produced by the testicles. It plays several important roles in the body including regulation of sex drive, production of sperm and red blood cells, distribution of fat, and maintenance of muscle mass and strength.

The levels of testosterone change from hour to hour and vary from person to person. They tend to be highest in the morning (that’s why early morning erections are common) and lowest at night. In general, the normal testosterone levels in males range from 270 to 1070 ng/dL. From the age of 30 onwards, total testosterone levels in men decrease by 1% per year.

As men reach andropause, sometimes called male menopause (usually between the ages of 40 and 80 above), they can experience a number of symptoms related to the natural decline in testosterone levels. One of the most common symptoms of low testosterone levels in men is a decrease in sexual function. They experience reduced sex drive and fewer erections. Other physical changes include increased body fat, decreased muscle mass and body hair, fragile bones, swelling or tenderness in the breast tissue, increased fatigue, and abnormal cholesterol levels. They can also experience decreased energy levels, sleeping problems, depression, low mood, and an overall decrease in the sense of well-being.

Potential Health Benefits

  • Treats mood disorders and depression [1-15]
  • Treats symptoms of diabetes and improves blood sugar levels [16-28]
  • Prevents cognitive decline [29-55]
  • Improves bone health [56-88]
  • Improves muscle mass and strength [89-111]
  • Improves symptoms of HIV/AIDS [112-117]
  • Treats erectile dysfunction and low libido [118-135]
  • Improves symptoms of metabolic syndrome [136-161]
  • Lowers risk of heart disease [162-177]
  • Normalizes blood pressure [178-184]
  • Improves cholesterol levels [185-193]
  • Treats symptoms of rheumatoid arthritis [194-208]
  • Improves sleep quality [209-215]
  • Promotes fat loss [216-235]
  • Reduces wrinkles and signs of skin aging [236-237]
  • Fights hair loss [238-240]
  • Improves quality of life [241-250]

Proven Health Benefits

Treats Mood Disorders and Depression

A growing number of scientific evidence shows that testosterone replacement therapy does have a positive effect in improving the mood of men suffering from anxiety, depression, stress, and other mood disorders:

  1. Numerous studies found that low levels of testosterone were associated with a higher risk of depression in men. [1-4]
  2. Studies suggest that low mood are generally experienced by men with testosterone deficiency and testosterone replacement therapy can help improve this condition. [5-7]
  3. In depressed men who had low testosterone levels and had not responded to antidepressants, administration of 400 mg of testosterone biweekly for 8 weeks showed improvements in depressive symptoms. [8]
  4. A study found that men with bipolar disorder had significantly lower testosterone levels. [9]
  5. In patients who are unresponsive to mood stabilizers and second-generation antipsychotics, testosterone therapy alleviated psychiatric symptoms. [10]
  6. In older men, testosterone supplementation produced anti-anxiety effects. [11-14]
  7. In patients with chronic pain, testosterone improved mood by decreasing pain responses. [15]

Treats Symptoms of Diabetes and Improves Blood sugar Levels

A number of convincing studies suggest that testosterone exerts its anti-diabetic effects by improving blood sugar levels

  1. A study found that men with type 2 diabetes were twice as likely to have low testosterone levels compared to men who don’t have diabetes. [16]
  2. A study also reported that low levels of testosterone in men were associated with insulin resistance or reduced insulin sensitivity. [17]
  3. In men with testosterone deficiency and type 2 diabetes, testosterone replacement therapy reduced insulin resistance and improved blood sugar levels. [18-19]
  4. In middle-aged men with type 2 diabetes and symptoms of testosterone deficiency, oral testosterone undecanoate treatment improved blood sugar levels. [20]
  5. Several clinical trials reported that testosterone improved blood sugar levels in people with type 2 diabetes by reducing the levels of various inflammatory markers, promoting fat loss, and enhancing the body’s response to the effects of insulin. [21-23]
  6. In men with type 2 diabetes, low testosterone levels were associated with a higher death rate. [24-28]

Prevents Cognitive Decline

Several studies report that testosterone is beneficial in preventing cognitive decline related to aging and brain disorders:

  1. Numerous studies suggest that low levels of testosterone were associated with reduced cognitive ability. [29-38]
  2. In older men, treatment with testosterone improved spatial intelligence (deals with judgment and the ability to visualize) and verbal memory. [39]
  3. In men with Alzheimer disease (AD) or mild cognitive impairment (MCI), injection of testosterone improved spatial memory, constructional abilities, and verbal memory. [40]
  4. In healthy subjects, it was found that higher levels of testosterone were related to increased brain activation. [41]
  5. In middle-aged men, higher testosterone levels were found to be associated with preservation of brain tissue in different regions. [42]
  6. A study reported that testosterone activates a network in the brain which helps improve cognition as well as verbal and visual memory. [43]
  7. A study found that testosterone supplementation can significantly reduce the risk of dementia, a condition characterized by a decline in memory or other thinking skills. [44]
  8. In patients with testosterone deficiency and age-related decline in cognitive function, testosterone replacement therapy improved various parameters of cognitive health, including memory, attention, language, visuospatial ability, and thinking skills. [45-55]

Improves Bone Health

Studies also suggest that testosterone is integral for bone health and can help prevent various bone disorders:

  1. In men with low levels of testosterone, a high incidence of early bone loss and low bone density was observed. [56-57]
  2. Studies found that low testosterone levels were associated with a higher risk of osteoporosis and other bone disorders. [58-62]
  3. A study investigating the effects of testosterone patch treatment on bone mineral density of men over 65 years of age resulted in increased bone mineral density of the lumbar spine. [63]
  4. In men aged 65 years and older with low testosterone levels, the combination of testosterone therapy and finasteride increased vertebral and hip bone mineral density. [64-65]
  5. The 2012 Endocrine Society Osteoporosis in Men guideline recommends testosterone replacement therapy in men with symptomatic low testosterone who are at high risk of fracture. [66-67]
  6. Clinical trials assessing the beneficial effects of testosterone replacement therapy found an improvement in bone mineral density of the lumbar spine and femoral head. [68-72]
  7. Numerous clinical trials reported that testosterone replacement therapy can reduce the risk of fractures and other bone disorders by increasing bone mineral density in different body parts. [73-88]

Improves Muscle Mass and Strength

Several studies report that testosterone is integral for maintaining muscle mass and strength, which makes it beneficial for age-related muscle changes and various muscular disorders:

  1. A number of studies found that low testosterone levels were associated with muscle wasting or muscle loss. [89-94]
  2. In healthy men with low or borderline blood testosterone levels, intramuscular testosterone enanthate injections at a dose of 100 mg weekly for 3 months resulted in an increase in lean body mass. [95]
  3. In men with low testosterone levels, testosterone enanthate injections at a dose of 200 mg/ml every 2 weeks for 3 months improved right hand muscle strength. [96]
  4. Testosterone enanthate injections at a dose of 100 mg/week for 18 months among testosterone-deficient men increased lean muscle mass without any adverse side effects. [97]
  5. In older men with testosterone deficiency, daily skin application with testosterone gel increased lean muscle mass and improved lower limb muscle strength without any adverse effects. [98-99]
  6. In patients with HIV/AIDS- or COPD-related muscle wasting, testosterone replacement therapy promoted lean weight gain. [100-102]
  7. Studies found that testosterone may help improve muscle mass, strength, and function in older persons with muscle wasting related to various health conditions. [103-111]

Improves Symptoms of HIV/AIDS

Numerous studies suggest that HIV-infected men with testosterone deficiency can benefit from testosterone replacement therapy:

  1. In HIV-infected men with testosterone deficiency, testosterone supplementation increased muscle mass, reduced depression, and improved quality of life. [112]
  2. In HIV-positive men with symptoms of testosterone deficiency, bi-weekly testosterone injections followed by 12 weeks of maintenance treatment for a period of 6 weeks restored sex drive and energy, alleviated depression, and increased muscle mass. [113]
  3. In HIV-infected men, administration of 200 mg of testosterone cypionate injections every 2 weeks for 3 months improved overall sense of well-being and muscle strength without any adverse side effects. [114]
  4. In men with HIV wasting syndrome, testosterone administration resulted in significant improvements in lean body mass, total body weight, overall exercise functional capacity, and perceived quality of life without any adverse side effects. [115]
  5. In HIV-infected men, testosterone therapy increased average lean body mass by 2.3 kg. [116]
  6. In HIV-infected men who received testosterone therapy for 12 months, significant improvement in sexual function, depression scores, and body composition were observed. [117]

Treats Erectile Dysfunction and Low Libido

Evidence suggests that testosterone is beneficial in treating sexual dysfunction:

  1. In men with low testosterone levels, testosterone replacement therapy for 6 months restored sexual function. [118-119]
  2. In men with testosterone deficiency, 12-month treatment with a testosterone gel improved sexual function. [120]
  3. In depressed men, testosterone treatment was associated with improvement in sexual function and mood. [121]
  4. In men with erectile dysfunction and low testosterone levels, testosterone administration increased libido. [122]
  5. In men with testosterone deficiency, testosterone replacement therapy improved sleep-related erections. [123]
  6. When combined with PDE5 inhibitors (medications for erectile dysfunction), testosterone gel significantly improved erectile function in men with low to low-normal testosterone levels. [124]
  7. In men who received testosterone replacement therapy, better scores in various tests assessing sexual function and self-confidence were observed. [125]
  8. In men who do not respond to PDE5 inhibitors, testosterone replacement therapy restored sexual function. [126-127]
  9. A study reported that testosterone therapy is potentially advantageous for treating male sexual dysfunction. [128]
  10. The combination therapy of sildenafil and testosterone was found to be successful in restoring sexual function in men with erectile dysfunction. [129]
  11. Studies also found that testosterone replacement therapy in men with sexual dysfunction can help improve erections, mood, and overall sexual health. [130-135]

Improves Symptoms of Metabolic Syndrome

Metabolic syndrome (MetS) is a cluster of conditions including high blood pressure and blood sugar level, abnormal cholesterol levels, and excess body fat around the waist. Studies show that men with this condition can benefit from testosterone replacement therapy:

  1. Studies show that men with low testosterone levels are at higher risk for metabolic syndrome. [136-147]
  2. In men with MetS, testosterone replacement therapy decreased waist-hip ratio. [148]
  3. In men with MetS who have diabetes, testosterone replacement therapy improved blood sugar levels, cholesterol, blood pressure, and energy levels. [149-152]
  4. In elderly men with sexual dysfunction and symptoms of MetS, testosterone undecanoate administration reduced the symptoms. [153]
  5. Studies in men with MetS found that testosterone replacement therapy decreased body fat percentage, improved insulin levels, and reduced cholesterol levels. [154-161]

Lowers Risk of Heart Disease

Several lines of evidence suggest that testosterone can protect against cardiovascular disease:

  1. Studies found that men with lower testosterone levels were at increased risk for heart disease and related deaths. [162-167]
  2. Studies also reported that men with coronary heart disease, atherosclerosis (narrowing of the heart’s muscular pumping chamber), and other heart disorders have low testosterone levels. [168-171]
  3. A study found that testosterone has anti-thrombotic action, which means that it has the ability to reduce the formation of blood clots. [172]
  4. In men with coronary artery disease, short-term administration of testosterone in the coronary artery induced relaxation of the artery and increased blood circulation. [173-176]
  5. In men with coronary heart disease who were treated with different formulations and doses of testosterone replacement therapy, an improvement in exercise capacity and results of electrocardiogram (measures the electrical activity of the heart) were observed. [177-177]

Normalizes Blood Pressure

Studies suggest that testosterone can be beneficial in men with high blood pressure:

  1. A study reported that testosterone has potent vasodilatory effects, which causes blood vessels to widen and lower blood pressure. [178]
  2. Studies found a strong association between low blood testosterone levels and high blood pressure. [179-181]
  3. In male patients with type 2 diabetes mellitus, treatment with testosterone undecanoate 250 mg/ml intramuscularly once every 3 months resulted in significant reductions in blood pressure readings. [182]
  4. In obese men, treatment with testosterone produced beneficial effects on blood pressure and well-being, as well as cardiovascular and diabetes risk profile. [183]
  5. In men with type 2 diabetes and/or MetS, application of testosterone gel for 12 months lowered blood pressure. [184]

Improves Cholesterol Levels

Studies also support the beneficial effects of testosterone on cholesterol levels:

  1. Studies found that men with abnormally low testosterone levels have higher low density lipoprotein (bad cholesterol). [185-186]
  2. In men with testosterone deficiency, 6 months of testosterone treatment resulted in significant reductions in total cholesterol and triglycerides. [187]
  3. In elderly men, intramuscular injections of testosterone enanthate 200 mg every second week reduced low density lipoprotein cholesterol levels with no side effects. [188]
  4. In ageing men with metabolic syndrome, testosterone treatment significantly improved lipid profiles without any adverse side effects. [189-193]

Treats Symptoms of Rheumatoid Arthritis

Evidence also shows that testosterone can reduce symptoms of rheumatoid arthritis through its anti-inflammatory effects:

  1. A study revealed that testosterone can protect against the development of inflammation-induced autoimmune conditions like rheumatoid arthritis. [194]
  2. Studies found that low testosterone levels were associated with a higher risk of rheumatoid arthritis. [195-203]
  3. In patients with rheumatoid arthritis, testosterone supplementation resulted in significant improvements in symptoms as well as quality of life without any adverse side effects. [204]
  4. Studies suggest that testosterone replacement therapy in patients with rheumatoid arthritis significantly reduced the levels of IgM rheumatoid factor, a protein that is highly associated with the disease. [205-206]
  5. A study also reported that testosterone administration in patients with rheumatoid arthritis reduced the levels of proinflammatory cytokines TNF-alpha and IL-1beta. [207]
  6. Improvements in symptoms as well as function of the affected body part were observed in patients with rheumatoid arthritis who received testosterone treatment. [208]

Improves Sleep Quality

Testosterone has also been found to have beneficial effects on the sleep quality of men with sleeping problems:

  1. Studies found that men with low testosterone levels were more likely to experience reduced sleep efficiency and sleep disturbances. [209-213]
  2. In men with sleeping problems due to testosterone deficiency, intramuscular injections of testosterone enanthate 200 mg every 2 weeks resulted in longer sleep time. [214]
  3. In men with testosterone deficiency, testosterone replacement therapy for 6 months resulted in significant improvements in sleeping time and quality of life. [215]

Promotes Fat Loss

Studies suggest that testosterone can help protect against obesity and can help improve body composition:

  1. Studies have shown that low testosterone and obesity are strongly linked. [216-219]
  2. Studies also found that lean men have normal testosterone levels while obese men have low testosterone levels. [220-225]
  3. Studies also show that testosterone can help promote fat loss by inhibiting fat cell formation and regulating the balance of leptin (satiety hormone) and ghrelin (hunger hormone) in the body. [226-227]
  4. In men with testosterone deficiency, testosterone treatment reversed fat accumulation with significant improvement in lean body mass without any adverse side effects. [228]
  5. Long-term treatment with testosterone among testosterone-deficient men produced marked and significant decrease in body weight, waist circumference, and body mass index. [229-230]
  6. In obese men with testosterone deficiency, administration of intramuscular testosterone undecanoate injections for 12 weeks resulted in greater reductions in fat mass and visceral fat. [231]
  7. In middle-aged men, testosterone administration either given as a single injection (500 mg) or in moderate doses (40 mg x 4) for 6 weeks in an oral preparation significantly reduced waist/hip circumference without any adverse side effects. [232]
  8. In obese patients, testosterone administration reduced body fat percentage and increased lean muscle mass. [233-235]

Reduces Wrinkles and Signs of Skin Aging

A good deal of evidence supports the anti-ageing effects of testosterone on the skin:

  1. A study suggested that higher levels of testosterone in men were associated with thicker skin and coarser skin pores. [236]
  2. A study found that the age-related decrease in testosterone can also lead to low dihydrotestosterone (DHT), which in turn causes dry, scaly skin. [237]

Fights Hair Loss

A number of studies suggest that the anti-ageing properties of testosterone can help fight hair loss in men:

  1. Studies found that baldness is a hormonal dysfunction that is associated with low blood levels of testosterone. [238-239]
  2. In men with hair loss due to testosterone deficiency, testosterone replacement therapy increased the growth of facial hair, pubic hair, and underarm hair. [240]

Improves Quality of Life

Studies suggest that the beneficial effects of testosterone on the different aspects of health can help improve quality of life:

  1. Studies found that testosterone deficiency can impair one’s quality of life by negatively affecting cognition, energy levels, physical capabilities, and sexual function. [241-242]
  2. In men with testosterone deficiency, testosterone replacement therapy improved the quality of life, increased lean body mass and significantly decreased total cholesterol. [243]
  3. In men with late-onset testosterone deficiency, administration of long-acting intramuscular testosterone undecanoate (TU) for up to 5 years improved the quality of life of the subjects by improving sexual function and age-related symptoms. [244]
  4. In elderly men, testosterone injections at a dose of 200 mg every 2 weeks significantly improved the quality of life of study participants without increasing their risk of prostate cancer. [245]
  5. In men who received 12 intramuscular injections of testosterone enanthate 250 mg every 4 weeks, a significant improvement in the quality of life, muscle volume, voiding, physical role functioning, and sexual function were observed. [246]
  6. A significant improvement in the quality of life including libido, vigour and vitality, sleep quality, and body composition were also observed in men who received testosterone undecanoate treatment. [247]
  7. In men with type 2 diabetes and testosterone deficiency, administration of 1000 mg of testosterone undecanoate for 30 weeks improved quality of life as well as sexual function. [248-250]

Testosterone in Athletics

Testosterone can be used to improve one’s performance. In sports, testosterone shots or creams are supposed to be magic bullets that spur athletes to run, jump, swim and to recover faster, and to become more aggressive and focused. However, it is considered to be a form of doping in most sports. [314] Anabolic steroids (including testosterone) have also been taken to build muscles, enhance strength, or endurance. They work directly by increasing the protein synthesis of the muscles, leading to large muscle fibers and enhanced repairing ability. [315]

After a series of scandals and publicity such as Ben Johnson’s improved performance at the 1988 Summer Olympics, the use of anabolic steroids was banned by many sports organizations. In 1990, the United States Congress prohibited testosterone and other anabolic steroids and were designated as a “controlled substance”, resulting in the creation of the Anabolic Steroid Control Act. [316]

Some female athletes may have naturally higher levels of the hormone testosterone than others, and may be asked by certain sports regulating body to consent to a “therapeutic proposal”, either surgery or drugs, to decrease testosterone levels to an acceptable level to compete fairly with others. [317]

History of Testosterone’s Use as an Anabolic Steroid

There is a significant difference between testosterone boosters and steroids. Testosterone boosters are consist of natural ingredients and supplements such as those from plants, [318] while steroids are synthetic substances that are created in a laboratory and are usually prescribed by doctors to treat a variety of health-related issues. [319] However, the use of steroids for the purpose of muscle building or enhancing an athlete’s performance without a prescription, are actually illegal. There are two common steroids in the market: anabolic and androgenic steroids. Anabolic steroids are designed to promote muscle growth while androgenic steroids are designed to assist with sexual dysfunction such as decreased libido and erectile dysfunction. [320] Most anabolic steroids are taken orally, through a pill while others are injected.

Anabolic steroids did not receive a worldwide recognition until the 20th century but the use of pure testosterone can be traced back to the original Olympic Games. [321] Early Olympic athletes were known to ingest animal testicles before a competition to improve their performance. [322] In 1935, researchers in the Netherlands were the first to isolate a few pure milligrams of testosterone. They named the substance “testosterone” from the words testicle, sterol and the suffix of ketone. [323] Also during this year, Butenandt and Hanisch created the first synthetic version of testosterone from cholesterol. [324] It was made available to the medical community for experimentation and treatment purposes. Later, during World War II, it was found that this artificial form of testosterone can help malnourished soldiers gain weight and improve performance during combat. [325] After the war, athletes began to use steroids to have an edge over other competitors.

In the 1956 Olympics in Moscow, Soviet wrestlers performed at exceptionally high levels after using the male anabolic steroid testosterone. [326] After learning about this incident, an American physician named John Bosley Ziegler created a more selective form of what we know as anabolic steroids. [327] From that point until the early 1970’s, the use of anabolic steroids became increasingly popular among Olympic athletes and professional sports players. In 1975, the International Olympic Committee finally prohibited the use of steroids and other performance-enhancing drugs in Olympic competition. [328] However, black market sales continued to increase in the following years. In 1988, the Anti-Drug Abuse Act was introduced in order to stiffen the penalties for the sale and possession of anabolic steroids. In 1990, the United States Congress prohibited anabolic steroids and other performance-enhancing drugs, and placed certain anabolic steroids on Schedule III of the Controlled Substances Act (CSA). [329] Previously, the use of steroids was controlled only by state laws. Today, illegal sales of steroids are still prevalent among athletes, bodybuilders and even adolescents.

Effects and Side Effects of Testosterone Use

The user generally experiences an increase in muscle mass and strength very quickly. They experience heightened ability to lift heavier weights and train for more often and for longer periods of time because of their improved recovery rate. [330-331] In addition to this, testosterone use can improve mood, cognition, blood sugar levels, bone mineral density, sexual function and well-being. Large retrospective or prospective studies failed to demonstrate any serious side effects related to testosterone use. [332]

Testosterone does not cause Prostate Cancer

Recently, there has been a paradigm shift whereby testosterone replacement therapy administration in prostate cancer patients has increased. Many longitudinal studies focusing on the relationship of blood testosterone levels and subsequent risk of prostate cancer failed to find any association. [333]

In a large meta-analysis of 18 prospective studies involving 3886 men, there was no association between the risk of prostate cancer development and serum concentrations of testosterone. [334] In another study, Morgentaler et al. proposed a saturation theory which explains why testosterone does not directly cause prostate cancer. According to his model, normal prostate cells and even cancer cells seem to have a saturation point and are not affected as testosterone levels increase. [335]

In the latest meta-analysis presented in the American Urological Association 2015 Annual Meeting, Dr. Peter Boyle reported that testosterone, whether occurring naturally or taken as replacement therapy, does not cause prostate cancer or stimulate increases in the levels of prostate-specific antigen (PSA) in men. [336]

Testosterone and Cardiac Disease

Cardiovascular diseases are associated with insufficient level of the sex hormone testosterone. [337] In the largest study to date, Khaw et al. investigated the effects of testosterone levels and mortality among 11 606 healthy men aged 40 to 79 years old over a 6 to 10-year follow-up period and observed a significant association between low levels of testosterone and increased risk of cardiovascular diseases. [338]

In the most recent study, Dr. Barua, an assistant professor of medicine at the University of Kansas School of Medicine, and his colleagues reported that testosterone supplementation can reduce the risk of myocardial infarction (MI), stroke, and all-cause mortality at normal levels. [339] In hopes of providing some answers to testosterone and cardiac disease association, the study team retrospectively examined national data on 83,010 men (aged 50 and above) with documented low testosterone levels who received care from the Veteran’s Administration between 1999 and 2014. The results of the study showed that treated men with testosterone levels at normal range were 56% less likely to die during the follow-up period, 24% less likely to suffer a myocardial infarction, and 36% less likely to have a stroke.

Measuring Testosterone Levels and Route of Administration

Symptoms associated with low testosterone level may resemble other medical conditions such as thyroid problems, hormonal imbalance, side effects of medications and illegal drugs, and mental problems. To determine what’s causing these symptoms, it is recommended to schedule an appointment with your doctor for a blood test. Test to determine testosterone levels should be done in the morning between 7:00 and 10:00 am. [340] For normal results, the test should be repeated to make sure that the result is accurate. In healthy men, the levels of testosterone can change a lot from day to day, so a second test is required.

After the decision to restore testosterone levels has been made, the next step is deciding on the most effective route of administration. There are several different modes in which testosterone can be delivered, but the best method varies from person to person. A number of factors should be considered when selecting a specific testosterone modality for replacement therapy. These factors include the following: [341]

  • Acceptability of the therapy to the individual patient.
  • Effects of the therapy in general and of a particular preparation.
  • Efficacy of the treatment, which relates to the levels of the testosterone obtained.

Types of Testosterone Tests

A testosterone test or also called serum testosterone test measures the amount of testosterone in the blood. This test is ordered to determine if a person has low levels of testosterone. It is important to inform your doctor about your current medications as it may affect the result of the test. Medications that can alter testosterone test results are steroids, anticonvulsants, barbiturates, clomiphene and estrogen therapy. [342]

The levels of testosterone in the blood can be measured in terms of total, bio-available, or free testosterone and there are various tests which can be used to measure each type of testosterone:

  • Total testosterone: This test measures free, albumin-bound and Sex hormone binding globulin (SHBG) bound testosterone and is the most commonly used blood test. Total testosterone blood test is used to assess testosterone levels in patients with suspected hypogonadism.
  • Bio-available testosterone: This test measures both free and albumin-bound testosterone, both of which are available for use by cells in the body. [340]
  • Free testosterone: This test measures only the 2% of testosterone which remains unbound to proteins in the blood. [343] Free testosterone levels can also be measured through the saliva.

Types of Testosterone Therapy

The different methods of testosterone delivery are the following:

  • Intramuscular Injections: This method of testosterone delivery has been used for years because it is cost-effective and has longer duration of action. It has a 100% success rate in providing usable hormone. This method allows precise control of the dosage of testosterone administered and is considered as the most effective testosterone replacement method.
  • Implantable Testosterone: This method makes use of pellets containing 75 mg of crystalline testosterone which are implanted beneath the skin of the upper thighs, deltoid, gluteal muscles, or lower abdomen to provide slow release over 4 to 6 months.
  • Transbuccal System: It is administered through a small tablet that adheres to the gum tissue. It is slowly absorbed by the inside lining of the cheeks called buccal mucosa. Transbuccal tablets contain 30 mg of testosterone, which peaks within 30 minutes and attain steady state within 24 hours.
  • Transdermal Testosterone: This method can be applied through a patch or gel. Transdermal testosterone mimics the normal circadian rhythm of testosterone, peaking in the morning and declining to its lowest point at night. TRT gel is the most expensive of the TRT modalities but is currently the most commonly used. Testosterone gel is applied to dry skin on the abdomen, upper arm, or shoulder after bathing.
  • Oral Testosterone: Oral testosterones such as oxandrolone, danazol, fluoxynesterone, or methyltestosterone are available for clinical use. Today, testosterone undecanoate is commonly used because it is able to bypass the liver.
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FAQ

What is testosterone and what role does it play in men's health?

Testosterone is a hormone primarily produced in the testicles in men. It plays a crucial role in the development and maintenance of male sexual characteristics, such as facial and body hair, deepening of the voice, and muscle mass. Testosterone also contributes to sperm production, sex drive, bone density, and red blood cell production.

How does testosterone affect male sexual characteristics and reproductive functions?

Testosterone is responsible for the development of primary and secondary sexual characteristics in men. During puberty, it promotes the growth of the penis and testes, stimulates the growth of facial and body hair, and triggers the deepening of the voice. Testosterone is essential for the production of sperm and plays a role in maintaining healthy sexual function and libido in adult men.

What are the symptoms of low testosterone in men, and when should I consider getting tested?

Low testosterone, also known as hypogonadism, can cause various symptoms, including fatigue, reduced sex drive, erectile dysfunction, depression, decreased muscle mass, increased body fat, and reduced bone density. If you are experiencing persistent symptoms that could be associated with low testosterone, it is advisable to consult a healthcare professional who can determine if testing is necessary.

Are there any natural ways to boost testosterone levels in men?

While lifestyle changes alone may not significantly raise testosterone levels in men with clinically low levels, maintaining a healthy lifestyle can help optimize testosterone production. Regular exercise, weight management, stress reduction techniques, adequate sleep, a balanced diet rich in essential nutrients (including zinc, vitamin D, and healthy fats), and avoiding excessive alcohol intake are generally recommended for overall well-being and hormone balance.

What are the potential risks and benefits of testosterone replacement therapy for men with low levels?

Testosterone replacement therapy (TRT) may be recommended for men with diagnosed low testosterone levels. It can help alleviate symptoms such as low libido, fatigue, and mood changes. However, TRT is not without potential risks, including acne, fluid retention, prostate enlargement, increased risk of blood clots, and infertility. It is crucial to work closely with a healthcare professional to weigh the potential benefits and risks before considering TRT.

Can obesity and weight gain influence testosterone levels in men?

Yes, obesity and excessive weight gain can impact testosterone levels in men. Adipose tissue (fat) can convert testosterone to estrogen, leading to a decrease in testosterone levels. Additionally, obesity is associated with insulin resistance and inflammation, which can further contribute to lower testosterone production. Maintaining a healthy weight through regular physical activity and a balanced diet can help optimize testosterone levels.

What are the effects of testosterone on muscle mass, bone density, and overall physical performance in men?

Testosterone plays a significant role in maintaining muscle mass, bone density, and overall physical performance in men. It helps stimulate muscle protein synthesis, which aids in muscle growth and repair. Testosterone also contributes to bone mineralization and density, helping to prevent osteoporosis. Optimal testosterone levels are crucial for maintaining muscle strength, bone health, and overall physical vitality.

Are there any potential side effects or risks associated with long-term use of testosterone therapy in men?

Long-term use of testosterone therapy may have potential side effects, including increased red blood cell count, acne, fluid retention, enlargement of the prostate gland, decreased sperm production, and in rare cases, an increased risk of cardiovascular events. Monitoring hormone levels and working closely with a healthcare professional can help manage these risks and ensure the therapy’s safety and effectiveness.

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Unleash Your Inner Strength: Maximizing Testosterone Levels in Men

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The Hormone of Masculinity: Unveiling the Secrets of Testosterone in Men

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Testosterone, often referred to as the hormone of masculinity, plays a crucial role in men’s health and well-being. From influencing physical appearance to impacting libido and mood, testosterone holds many secrets that contribute to the essence of manhood. In this blog post, we will dive deeper into the fascinating world of testosterone, shedding light on its functions, effects, and ways to maintain optimal levels.

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Revitalize Your Drive: How Testosterone Affects Libido in Men

A healthy and satisfying sex life is an important aspect of overall well-being for men. Testosterone, the primary male sex hormone, plays a significant role in influencing libido and sexual function. In this blog post, we will explore the connection between testosterone and libido in men, uncovering how testosterone levels can impact your drive and ways to revitalize it.

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Unlocking Your Potential: Testosterone Optimization for Optimal Health in Men

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Unveiling the Myths and Facts about Testosterone in Men

Testosterone is often regarded as the quintessential male hormone, responsible for defining masculinity and influencing various aspects of men’s health. However, amidst the abundance of information available, myths and misconceptions about testosterone have emerged. It’s essential to separate fact from fiction to gain a better understanding of this vital hormone.

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The Role of Testosterone in Men’s Health: From Vitality to Performance

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