GENEMEDICS APP

GENEMEDICS NUTRITION

Testosterone In Men

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

Share This Page

Book a Free Consultation

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.
Share This Page

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.

Blog

Testosterone Levels in Men - Blog Images-01

Unleash Your Inner Strength: Maximizing Testosterone Levels in Men

Testosterone is often associated with masculinity and plays a crucial role in men’s overall health and well-being. From maintaining muscle mass to influencing libido and energy levels, testosterone is a hormone that deserves our attention. In this blog post, we will delve into the ways you can maximize testosterone levels and unlock your inner strength.

View More
Testosterone Levels in Men - Blog Images-02

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

Introduction:
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.

View More
Testosterone Levels in Men - Blog Images-03

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.

View More
Testosterone Levels in Men - Blog Images-04

Unlocking Your Potential: Testosterone Optimization for Optimal Health in Men

Introduction:
Testosterone plays a pivotal role in men’s overall health and well-being. From maintaining muscle mass to influencing mood, energy levels, and sexual function, optimizing testosterone levels is key to unlocking your full potential. In this blog post, we will explore the importance of testosterone optimization and discuss practical strategies for achieving optimal health in men.

View More
Testosterone Levels in Men - Blog Images-05

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.

View More
Testosterone Levels in Men - Blog Images-06

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

Testosterone, often hailed as the primary male hormone, plays a significant role in men’s health and well-being. From vitality to performance, its influence extends beyond the realm of masculinity. Let’s explore the various aspects of men’s health that are impacted by testosterone.

View More

References

  1. Barrett-Connor E., von Muhlen DG., Kritz-Silverstein D. Bioavailable testosterone and depressed mood in older men: the Rancho Bernardo study. J Clin Endocrinol Metab. 1999;84:573–577.
  2. Delhez M., Hansenne M., Legros JJ. Andropause and psychopathology: minor symptoms rather than pathological ones. Psychoneuroendocrinology. 2003;28:863–874.
  3. Kanayama G., Hudson JI., Pope HG Jr. Long-term psychiatric and medical consequences of anabolic-androgenic steroid abuse: a looming public health concern? Drug Alcohol Depend. 2008;98:1–12.
  4. Barrett-Connor E, Von Mühlen DG, Kritz-Silverstein D. Bioavailable testosterone and depressed mood in older men: the Rancho Bernardo Study. J Clin Endocrinol Metab. 1999 Feb;84(2):573-7. doi: 10.1210/jcem.84.2.5495. PMID: 10022418.
  5. J Clin Endocrinol Metab, 1996 Oct, 81(10):3578-83, “Testosterone replacement therapy improves mood in hypogonadal men–a clinical research center study”.
  6. Zarrouf FA, Artz S, Griffith J, Sirbu C, Kommor M. Testosterone and depression: systematic review and meta-analysis. J Psychiatr Pract. 2009;15(4):289-305.
  7. Pope HG, Cohane GH, Kanayama G, Siegel AJ, Hudson JI. Testosterone gel supplementation for men with refractory depression: a randomized, placebo-controlled trial. Am J Psychiatry. 2003;160(1):105-11.
  8. Seidman SN, Rabkin JG. Testosterone replacement therapy for hypogonadal men with SSRI-refractory depression. J Affect Disord. 1998;48(2-3):157-61.
  9. Wooderson SC, Gallagher P, Watson S, Young AH. An exploration of testosterone levels in patients with bipolar disorder. BJPsych open. 2015;1(2):136-138. doi:10.1192/bjpo.bp.115.001008.
  10. Kawahara K, Jono T, Nishi Y, Ushijima H, Ikeda M. Effects of testosterone therapy on bipolar disorder with Klinefelter syndrome. General hospital psychiatry. 2015; 37(2):192.e1-2.
  11. Berglund LH, Prytz HS, Perski A, Svartberg J. Testosterone levels and psychological health status in men from a general population: the Tromsø study. Aging Male. 2011;14:37–41.
  12. Available from http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.157.11.1884.
  13. van Honk J, Peper JS, Schutter DJ. Testosterone reduces unconscious fear but not consciously experienced anxiety: implications for the disorders of fear and anxiety. Biological psychiatry. 2005; 58(3):218-25.
  14. Cooper MA, Ritchie EC. Testosterone replacement therapy for anxiety. The American journal of psychiatry. 2000; 157(11):1884.
  15. White HD, Robinson TD. A novel use for testosterone to treat central sensitization of chronic pain in fibromyalgia patients. Int Immunopharmacol. 2015 Aug;27(2):244-8. doi: 10.1016/j.intimp.2015.05.020. Epub 2015 May 21. PMID: 26004314.
  16. Roger S. Kirby; Culley C. Carson; Michael G. Kirby; Alan White (29 January 2009). Men’s Health, Third Edition. Taylor & Francis. ISBN 978-0-415-44733-1.
  17. Eberhard Nieschlag; Hermann M. Behre; Susan Nieschlag (26 July 2012). Testosterone: Action, Deficiency, Substitution. Cambridge University Press. pp. 241–. ISBN 978-1-107-01290-5.
  18. Cai X, Tian Y, Wu T, Cao CX, Li H, Wang KJ. Metabolic effects of testosterone replacement therapy on hypogonadal men with type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. Asian J Androl. 2014 Jan-Feb;16(1):146-52. doi: 10.4103/1008-682X.122346. PMID: 24369149; PMCID: PMC3901874.
  19. Kapoor D, Goodwin E, Channer KS, Jones TH. Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hypercholesterolaemia in hypogonadal men with type 2 diabetes. Eur J Endocrinol. 2006;154(6):899-906.
  20. Boyanov MA, Boneva Z, Christov VG. Testosterone supplementation in men with type 2 diabetes, visceral obesity and partial androgen deficiency. Aging Male. 2003;6(1):1-7.
  21. Kalinchenko SY, Tishova YA, Mskhalaya GJ, Gooren LJ, Giltay EJ, Saad F. Effects of testosterone supplementation on markers of the metabolic syndrome and inflammation in hypogonadal men with the metabolic syndrome: the double-blinded placebo-controlled Moscow study. Clin Endocrinol (Oxf) 2010;73:602–612.
  22. Heufelder AE, Saad F, Bunck MC, Gooren L. Fifty-two-week treatment with diet and exercise plus transdermal testosterone reverses the metabolic syndrome and improves glycemic control in men with newly diagnosed type 2 diabetes and subnormal plasma testosterone. J Androl. 2009;30:726–733.
  23. Jones TH, Arver S, Behre HM, et al. Testosterone replacement in hypogonadal men with type 2 diabetes and/or metabolic syndrome (the TIMES2 Study) Diabetes Care. 2011;34:828–837.
  24. Muraleedharan V, Marsh H, Kapoor D, Channer KS, Jones TH. Testosterone deficiency is associated with increased risk of mortality and testosterone replacement improves survival in men with type 2 diabetes. Eur J Endocrinol. 2013;169:725–733.
  25. Jones TH. Effects of testosterone on Type 2 diabetes and components of the metabolic syndrome. Journal of diabetes. 2010; 2(3):146-56.
  26. Anaissie J, Roberts NH, Wang P, Yafi FA. Testosterone Replacement Therapy and Components of the Metabolic Syndrome. Sexual medicine reviews. 2017; 5(2):200-210.
  27. Available from http://www.mdmag.com/medical-news/testosterone-replacement-therapy-linked-to-reducing-blood-sugar-levels.
  28. Lee CH, Kuo SW, Hung YJ. The effect of testosterone supplement on insulin sensitivity, glucose effectiveness, and acute insulin response after glucose load in male type 2 diabetics. Endocrine research. 2005; 31(2):139-48.
  29. Greene R. Sex steroids and brain functioning in the aging male. Aging Male 2001 4 39–43.
  30. Moffat SD, Zonderman AB, Metter EJ, Blackman MR, Harman SM & Resnick SM. Longitudinal assessment of serum free testosterone concentration predicts memory performance and cognitive status in elderly men. Journal of Clinical Endocrinology and Metabolism 2002 87 5001–5007.
  31. Nieschlag E, Swerdloff R, Behre HM, Gooren LJ, Kaufman JM, Legros JJ, Lunenfeld B, Morley JE, Schulman C, Wang C, Weidner W & Wu FC. Investigation, treatment and monitoring of late-onset hypogonadism in males. ISA, ISSAM, and EAU recommendations. European Urology 2005 48 1–4.
  32. Sherwin BB. Steroid hormones and cognitive functioning in aging men: a mini-review. Journal of Molecular Neuroscience 2003 20 385–393.
  33. Beauchet O. Testosterone and cognitive function: current clinical evidence of a relationship. European journal of endocrinology. 2006; 155(6):773-81.
  34. Morley, J.E., Kaiser, F., Raum, W.J. et al. Potentially predictive and manipulable blood serum correlates of aging in the healthy human male: Progressive decreases in bioavailable testosterone, dehydroepiandrosterone sulfate, and the ratio of insulin-like growth factor 1 to growth hormone. Proc Natl Acad Sci USA. 1997; 94: 7537–7542.
  35. Chu, L.W., Tam, S., Wong, R.L. et al. Bioavailable testosterone predicts a lower risk of Alzheimer’s disease in older men. J Alzheimers Dis. 2010; 21: 1335–1345.
  36. Ucak, S., Basat, O., and Karatemiz, G. Functional and nutritional state in elderly men with compensated hypogonadism. J Am Med Dir Assoc. 2013; 14: 433–436.
  37. Morley, J.E. Androgens and aging. Maturitas. 2001; 38: 61–71.
  38. Verdile G, Laws SM, Henley D. Associations between gonadotropins, testosterone and β amyloid in men at risk of Alzheimer’s disease. Molecular psychiatry. 2014; 19(1):69-75.
  39. Can testosterone improve memory in men? Study provides initial findings. Available at: http://www.washington.edu/news/1998/06/25/can-testosterone-improve-memory-in-men-study-provides-initial-findings/. Accessed January 29, 2016.
  40. Cherrier MM, Matsumoto AM, Amory JK, et al. Testosterone improves spatial memory in men with Alzheimer disease and mild cognitive impairment. Neurology. 2005;64(12):2063-8.
  41. Ackermann S, Spalek K, Rasch B, et al. Testosterone levels in healthy men are related to amygdala reactivity and memory performance. Psychoneuroendocrinology. 2012;37(9):1417-24.
  42. Available from https://www.health.harvard.edu/press_releases/testosterone-and-memory. Accessed September 16, 2017.
  43. Available from http://oxfordmedicine.com/view/10.1093/med/9780199651672.001.0001/med-9780199651672-chapter-13. Accessed September 16, 2017.
  44. Wahjoepramono EJ, Asih PR, Aniwiyanti V. The Effects of Testosterone Supplementation on Cognitive Functioning in Older Men. CNS & neurological disorders drug targets. 2016; 15(3):337-43.
  45. Jung HJ, Shin HS. Effect of Testosterone Replacement Therapy on Cognitive Performance and Depression in Men with Testosterone Deficiency Syndrome. The World Journal of Men’s Health. 2016;34(3):194-199. doi:10.5534/wjmh.2016.34.3.194.
  46. Hogervorst E, Bandelow S, Moffat SD. Increasing testosterone levels and effects on cognitive functions in elderly men and women: a review. Current drug targets. CNS and neurological disorders. 2005; 4(5):531-40.
  47. Moller MC, Rådestad AF, von Schoultz B, Bartfai A. Effect of estrogen and testosterone replacement therapy on cognitive fatigue. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology. 2013; 29(2):173-6.
  48. Hua JT, Hildreth KL, Pelak VS. Effects of Testosterone Therapy on Cognitive Function in Aging: A Systematic Review. Cognitive and behavioral neurology : official journal of the Society for Behavioral and Cognitive Neurology. 2016;29(3):122-138. doi:10.1097/WNN.0000000000000104.
  49. Kenny AM, Bellantonio S, Gruman CA, Acosta RD, Prestwood KM. Effects of transdermal testosterone on cognitive function and health perception in older men with low bioavailable testosterone levels. The journals of gerontology. Series A, Biological sciences and medical sciences. 2002; 57(5):M321-5.
  50. Kenny AM, Fabregas G, Song C, Biskup B, Bellantonio S. Effects of testosterone on behavior, depression, and cognitive function in older men with mild cognitive loss. The journals of gerontology. Series A, Biological sciences and medical sciences. 2004; 59(1):75-8.
  51. Resnick SM, Matsumoto AM, Stephens-Shields AJ. Testosterone Treatment and Cognitive Function in Older Men With Low Testosterone and Age-Associated Memory Impairment. JAMA. 2017; 317(7):717-727.
  52. O’Connell MD, Ravindrarajah R, Tajar A, Wu FC. Low testosterone in ageing men: a modifiable risk factor for frailty? Trends Endocrinol Metab. 2011 Dec;22(12):491-8. doi: 10.1016/j.tem.2011.08.003. Epub 2011 Oct 4. PMID: 21978496.
  53. O’Connor DB, Archer J, Hair WM, Wu FC. Activational effects of testosterone on cognitive function in men. Neuropsychologia. 2001;39(13):1385-94. doi: 10.1016/s0028-3932(01)00067-7. PMID: 11585606.
  54. Okun MS, Walter BL, McDonald WM, Tenover JL, Green J, Juncos JL, DeLong MR. Beneficial effects of testosterone replacement for the nonmotor symptoms of Parkinson disease. Arch Neurol. 2002 Nov;59(11):1750-3. doi: 10.1001/archneur.59.11.1750. PMID: 12433262.
  55. Markus J. Seibel; Simon P. Robins; John P. Bilezikian (24 July 2006). Dynamics of Bone and Cartilage Metabolism: Principles and Clinical Applications. Academic Press. pp. 677–. ISBN 978-0-08-045626-3.
  56. Tuck SP, Francis RM. Testosterone, bone and osteoporosis. Frontiers of hormone research. 2009; 37:123-32.
  57. Ebeling PR. Androgens and osteoporosis. Current opinion in endocrinology, diabetes, and obesity. 2010; 17(3):284-92.
  58. Golds G, Houdek D, Arnason T. Male Hypogonadism and Osteoporosis: The Effects, Clinical Consequences, and Treatment of Testosterone Deficiency in Bone Health. International Journal of Endocrinology. 2017;2017:4602129. doi:10.1155/2017/4602129.
  59. Falahati-Nini A, Riggs BL, Atkinson EJ, O’Fallon WM, Eastell R, Khosla S. Relative contributions of testosterone and estrogen in regulating bone resorption and formation in normal elderly men. Journal of Clinical Investigation. 2000;106(12):1553-1560.
  60. Behre HM, Kliesch S, Leifke E, Link TM, Nieschlag E. Long-term effect of testosterone therapy on bone mineral density in hypogonadal men. J Clin Endocrinol Metab. 1997 Aug;82(8):2386-90. doi: 10.1210/jcem.82.8.4163. PMID: 9253305.
  61. Clarke BL, Khosla S. Androgens and Bone. Steroids. 2009;74(3):296-305. doi:10.1016/j.steroids.2008.10.003.
  62. Snyder PJ, Peachey H, Hannoush P, et al. Effect of testosterone treatment on bone mineral density in men over 65 years of age. J Clin Endocrinol Metab. 1999;84(6):1966-72.
  63. Exogenous testosterone or testosterone with finasteride increases bone mineral density in older men with low serum testosterone. Available at: http://www.pubfacts.com/detail/14764753/Exogenous-testosterone-or-testosterone-with-finasteride-increases-bone-mineral-density-in-older-men-. Accessed September 17, 2017.
  64. Bhasin S., Cunningham G. R., Hayes F. J., et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology and Metabolism. 2010;95(6):2536–2559. doi: 10.1210/jc.2009-2354.
  65. Watts N. B., Adler R. A., Bilezikian J. P., et al. Osteoporosis in men: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology and Metabolism. 2012;97(6):1802–1822. doi: 10.1210/jc.2011-3045.
  66. Hoppéa E., Bouvard B., Royer M., Chappard D., Audrana M., Legrand E. Is androgen therapy indicated in men with osteoporosis? Joint, Bone, Spine. 2013;80(5):459–465. doi: 10.1016/j.jbspin.2013.03.002.
  67. Permpongkosol S., Khupulsup K., Leelaphiwat S., Pavavattananusorn S., Thongpradit S., Petchthong T. Effects of 8 year treatment of long-acting testosterone undecanoate on metabolic parameters, urinary symptoms, bone mineral density, and sexual function in men with late-onset hypogonadism. The Journal of Sexual Medicine. 2016;13(8):1199–1211. doi: 10.1016/j.jsxm.2016.06.003.
  68. Wang Y. J., Zhan J. K., Huang W., et al. Effects of low-dose testosterone undecanoate treatment on bone mineral density and bone turnover markers in elderly male osteoporosis with low serum testosterone. International Journal of Endocrinology. 2013;2013:p. 6. doi: 10.1155/2013/570413.570413.
  69. Bouloux P. M., Legros J. J., Elbers J. M., et al. Effects of oral testosterone undecanoate therapy on bone mineral density and body composition in 322 aging men with symptomatic testosterone deficiency: a 1 year, randomized, placebo-controlled, dose-ranging study. The Aging Male. 2013;16(2):38–47. doi: 10.3109/13685538.2013.773420.
  70. Rodriguez-Tolra J., Torremade J., di Gregorio S., Del Rio L., Franco E. Effects of testosterone treatment on bone mineral density in men with testosterone deficiency syndrome. Andrologia. 2013;1(4):570–575. doi: 10.1111/j.2047-2927.2013.00090.x.
  71. Jo DG, Lee HS, Joo YM, Seo JT. Effect of testosterone replacement therapy on bone mineral density in patients with Klinefelter syndrome. Yonsei medical journal. 2013; 54(6):1331-5.
  72. Kim SH. Testosterone Replacement Therapy and Bone Mineral Density in Men with Hypogonadism. Endocrinology and Metabolism. 2014;29(1):30-32. doi:10.3803/EnM.2014.29.1.30.
  73. Lee MJ, Ryu HK, An SY, Jeon JY, Lee JI, Chung YS. Testosterone replacement and bone mineral density in male pituitary tumor patients. Endocrinology and metabolism (Seoul, Korea). 2014; 29(1):48-53.
  74. Tirabassi G, Biagioli A, Balercia G. Bone benefits of testosterone replacement therapy in male hypogonadism. Panminerva medica. 2014; 56(2):151-63.
  75. Shigehara K, Konaka H, Koh E. Effects of testosterone replacement therapy on hypogonadal men with osteopenia or osteoporosis: a subanalysis of a prospective randomized controlled study in Japan (EARTH study). The aging male : the official journal of the International Society for the Study of the Aging Male. 2017; 20(3):139-145.
  76. Available from http://care.diabetesjournals.org/content/30/7/1860.
  77. Patel S. Effect of hormone replacement therapy on bone density in a patient with severe osteoporosis caused by anorexia nervosa. Annals of the Rheumatic Diseases. 1999;58(1):66.
  78. Tracz MJ, Sideras K, Boloña ER. Testosterone use in men and its effects on bone health. A systematic review and meta-analysis of randomized placebo-controlled trials. The Journal of clinical endocrinology and metabolism. 2006; 91(6):2011-6.
  79. Deb P, Gupta SK, Godbole MM. Effects of short-term testosterone replacement on areal bone mineral density and bone turnover in young hypogonadal males. Indian Journal of Endocrinology and Metabolism. 2012;16(6):947-951. doi:10.4103/2230-8210.102997.
  80. Available from http://www.renalandurologynews.com/hypogonadism/trt-for-hypogonadism-may-improve-anemia-bone-mineral-density/article/639492/.
  81. Cleemann L, Hjerrild BE, Lauridsen AL. Long-term hormone replacement therapy preserves bone mineral density in Turner syndrome. European journal of endocrinology. 2009; 161(2):251-7.
  82. Aversa A, Bruzziches R, Francomano D. Effects of long-acting testosterone undecanoate on bone mineral density in middle-aged men with late-onset hypogonadism and metabolic syndrome: results from a 36 months controlled study. The aging male : the official journal of the International Society for the Study of the Aging Male. 2012; 15(2):96-102.
  83. Pawel Szulc, “Biochemical Bone Turnover Markers and Osteoporosis in Older Men: Where Are We?,” Journal of Osteoporosis, vol. 2011, Article ID 704015, 5 pages, 2011. doi:10.4061/2011/704015.
  84. Available from http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2265.2003.01746.x/abstract.
  85. Kubler A, Schulz G, Cordes U, Beyer J, Krause U. The influence of testosterone substitution sson bone mineral density in patients with Klinefelter’s syndrome. Experimental and clinical endocrinology. 1992; 100(3):129-32.
  86. Available from http://www.bone-abstracts.org/ba/0001/ba0001OC5.6.htm.
  87. Karl G. Hofbauer; Stefan D. Anker; Akio Inui; Janet R. Nicholson (22 December 2005). Pharmacotherapy of Cachexia. CRC Press. ISBN 978-1-4200-4895-7.
  88. Gordon S. Lynch (30 November 2010). Sarcopenia – Age-Related Muscle Wasting and Weakness: Mechanisms and Treatments. Springer Science & Business Media. ISBN 978-90-481-9713-2.
  89. Jacob Teitelbaum (2001). From Fatigued to Fantastic!: A Proven Program to Regain Vibrant Health, Based on a New Scientific Study Showing Effective Treatment for Chronic Fatigue and Fibromyalgia. Penguin. pp. 48–. ISBN 978-1-58333-097-5.
  90. Burney BO, Hayes TG, Smiechowska J, et al. Low testosterone levels and increased inflammatory markers in patients with cancer and relationship with cachexia. J Clin Endocrin Metab 2012;97(5):E700-E709.
  91. Yuki A, Otsuka R, Kozakai R. Relationship between low free testosterone levels and loss of muscle mass. Scientific reports. 2013; 3:1818.
  92. Cobo G, Gallar P, Di Gioia C. Hypogonadism associated with muscle atrophy, physical inactivity and ESA hyporesponsiveness in men undergoing haemodialysis. Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia. 2016; 37(1):54-60.
  93. Tenover JS. Effects of testosterone supplementation in the aging male. J Clin Endocrinol Metab. 1992;75:1092–1098.
  94. Morley JE, Perry HM, III, Kaiser FE, et al. Effects of testosterone replacement therapy in old hypogonadal males: a preliminary study. J Am Geriatr Soc. 1993;41:149–152.
  95. Katznelson L, Finkelstein JS, Schoenfeld DA, et al. Increase in bone density and lean body mass during testosterone administration in men with acquired hypogonadism. J Clin Endocrinol Metab. 1996;81:4358–4365.
  96. Ly LP, Jimenez M, Zhuang TN, et al. A double-blind, placebo-controlled, randomized clinical trial of transdermal dihydrotestosterone gel on muscular strength, mobility, and quality of life in older men with partial androgen deficiency. J Clin Endocrinol Metab. 2001;86:4078–4088.
  97. Kenny AM, Prestwood KM, Gruman CA, et al. Effects of transdermal testosterone on bone and muscle in older men with low bioavailable testosterone levels. J Gerontol A Biol Sci Med Sci. 2001;56:M266–M272.
  98. Gullett NP, Hebbar G, Ziegler TR. Update on clinical trials of growth factors and anabolic steroids in cachexia and wasting. Am J Clin Nutr 2010;91(supplement):1143-1147S.
  99. Nicholas H. Fiebach; Lee Randol Barker; John Russell Burton; Philip D. Zieve (2007). Principles of Ambulatory Medicine. Lippincott Williams & Wilkins. pp. 425–. ISBN 978-0-7817-6227-4.
  100. Berger JR, Pall L, Hall CD, Simpson DM, Berry PS, Dudley R. Oxandrolone in AIDS-wasting myopathy. AIDS (London, England). Dec 1996;10(14):1657-1662.
  101. Wang C, Nieschlag E, Swerdloff R, Behre HM, Hellstrom WJ, Gooren LJ. et al; European Association of Urology; European Academy of Andrology; American Society of Andrology. Investigation, treatment, and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA, and ASA recommendations. Eur Urol. 2009;55:121–30. doi: 10.1016/j.eururo.2008.08.033.
  102. Morley JE. Androgens and aging. Maturitas. 2001;38:61–71. doi: 10.1016/S0378-5122(00)00192-4.
  103. Srinivas-Shankar U, Roberts SA, Connolly MJ, O’Connell MD, Adams JE, Oldham JA, et al. Effects of testosterone on muscle strength, physical function, body composition, and quality of life in intermediate-frail and frail elderly men: a randomized, double-blind, placebo-controlled study. J Clin Endocrinol Metab. 2010;95:639–50. doi: 10.1210/jc.2009-1251.
  104. Page ST, Amory JK, Bowman FD, Anawalt BD, Matsumoto AM, Bremner WJ, et al. Exogenous testosterone (T) alone or with finasteride increases physical performance, grip strength, and lean body mass in older men with low serum T. J Clin Endocrinol Metab. 2005;90:1502–10. doi: 10.1210/jc.2004-1933.
  105. Kenny AM, Kleppinger A, Annis K, Rathier M, Browner B, Judge JO, et al. Effects of transdermal testosterone on bone and muscle in older men with low bioavailable testosterone levels, low bone mass, and physical frailty. J Am Geriatr Soc. 2010;58:1134–43. doi: 10.1111/j.1532-5415.2010.02865.x.
  106. Travison TG, Basaria S, Storer TW, Jette AM, Miciek R, Farwell WR, et al. Clinical meaningfulness of the changes in muscle performance and physical function associated with testosterone administration in older men with mobility limitation. J Gerontol A Biol Sci Med Sci. 2011;66:1090–9. doi: 10.1093/gerona/glr100.
  107. Dos Santos MR, Sayegh AL, Bacurau AV. Effect of Exercise Training and Testosterone Replacement on Skeletal Muscle Wasting in Patients With Heart Failure With Testosterone Deficiency. Mayo Clinic proceedings. 2016; 91(5):575-86.
  108. Matsumoto AM. Andropause: clinical implications of the decline in serum testosterone levels with aging in men. J Gerontol A Biol Sci Med Sci. 2002 Feb;57(2):M76-99. doi: 10.1093/gerona/57.2.m76. PMID: 11818427.
  109. Cigarrán S, Pousa M, Castro MJ. Endogenous testosterone, muscle strength, and fat-free mass in men with chronic kidney disease. Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation. 2013; 23(5):e89-95.
  110. Ashby J, Goldmeier D, Sadeghi-Nejad H. Hypogonadism in Human Immunodeficiency Virus-Positive Men. Korean Journal of Urology. 2014;55(1):9-16. doi:10.4111/kju.2014.55.1.9.
  111. Rabkin JG, Wagner GJ, Rabkin R. A double-blind, placebo-controlled trial of testosterone therapy for HIV-positive men with hypogonadal symptoms. Arch Gen Psychiatry. 2000;57(2):141-7.
  112. Coodley GO, Coodley MK. A trial of testosterone therapy for HIV-associated weight loss. AIDS. 1997;11(11):1347-52.
  113. Kong A, Edmonds P. Testosterone therapy in HIV wasting syndrome: systematic review and meta-analysis. The Lancet. Infectious diseases. 2002; 2(11):692-9.
  114. Bhasin S, Storer TW, Javanbakht M, et al. Testosterone Replacement and Resistance Exercise in HIV-Infected Men With Weight Loss and Low Testosterone Levels. JAMA : the journal of the American Medical Association. 2000;283(6):763-770.
  115. Blick G, Khera M, Bhattacharya RK, Kushner H, Miner MM. Testosterone replacement therapy in men with hypogonadism and HIV/AIDS: results from the TRiUS registry. Postgraduate medicine. 2013; 125(2):19-29.
  116. El-Sakka AI, Hassoba HM. Age related testosterone depletion in patients with erectile dysfunction. J Urol. 2006 Dec;176(6 Pt 1):2589-93. doi: 10.1016/j.juro.2006.08.005. PMID: 17085165.
  117. Andrade ES, Clapauch R, Buksman S. Short term testosterone replacement therapy improves libido and body composition. Arquivos brasileiros de endocrinologia e metabologia. 2009; 53(8):996-1004.
  118. Khera M, Bhattacharya RK, Blick G, Kushner H, Nguyen D, Miner MM. Improved sexual function with testosterone replacement therapy in hypogonadal men: real-world data from the Testim Registry in the United States (TRiUS). The journal of sexual medicine. 2011; 8(11):3204-13.
  119. Seidman SN, Roose SP. The sexual effects of testosterone replacement in depressed men: randomized, placebo-controlled clinical trial. Journal of sex & marital therapy. 2006; 32(3):267-73.
  120. Celik O, Yücel S. Testosterone Replacement Therapy: Should It Be Performed in Erectile Dysfunction? Nephro-urology Monthly. 2013;5(4):858-861. doi:10.5812/numonthly.11523.
  121. Cunningham GR, Hirshkowitz M, Korenman SG, Karacan I. Testosterone replacement therapy and sleep-related erections in hypogonadal men. The Journal of clinical endocrinology and metabolism. 1990; 70(3):792-7.
  122. Shabsigh R. Testosterone therapy in erectile dysfunction and hypogonadism. The journal of sexual medicine. 2005; 2(6):785-92.
  123. Ullah MI, Riche DM, Koch CA. Transdermal testosterone replacement therapy in men. Drug Design, Development and Therapy. 2014;8:101-112. doi:10.2147/DDDT.S43475.
  124. Wang C, Swerdloff RS, Iranmanesh A, Dobs A, Snyder PJ, Cunningham G, Matsumoto AM, Weber T, Berman N; Testosterone Gel Study Group. Transdermal testosterone gel improves sexual function, mood, muscle strength, and body composition parameters in hypogonadal men. J Clin Endocrinol Metab. 2000 Aug;85(8):2839-53. doi: 10.1210/jcem.85.8.6747. PMID: 10946892.
  125. Blute M, Hakimian P, Kashanian J, Shteynshluyger A, Lee M, Shabsigh R. Erectile dysfunction and testosterone deficiency. Front Horm Res. 2009;37:108-122. doi: 10.1159/000176048. PMID: 19011292.
  126. Rizk PJ, Kohn TP, Pastuszak AW, Khera M. Testosterone therapy improves erectile function and libido in hypogonadal men. Curr Opin Urol. 2017;27(6):511-515. doi:10.1097/MOU.0000000000000442.
  127. long-acting testosterone undecanoate formulation versus testosterone enanthate on sexual function and mood in hypogonadal men. Eur J Endocrinol. 2009 May;160(5):815-9. doi: 10.1530/EJE-08-0830. Epub 2009 Feb 18. PMID: 19225035.
  128. Aversa A, Isidori AM, De Martino MU, Caprio M, Fabbrini E, Rocchietti-March M, Frajese G, Fabbri A. Androgens and penile erection: evidence for a direct relationship between free testosterone and cavernous vasodilation in men with erectile dysfunction. Clin Endocrinol (Oxf). 2000 Oct;53(4):517-22. doi: 10.1046/j.1365-2265.2000.01118.x. PMID: 11012578.
  129. Podlasek CA, Mulhall J, Davies K, et al. Translational Perspective on the Role of Testosterone in Sexual Function and Dysfunction. J Sex Med. 2016;13(8):1183-1198. doi:10.1016/j.jsxm.2016.06.004.
  130. Shabsigh, R. Hypogonadism and erectile dysfunction: the role for testosterone therapy. Int J Impot Res 15, S9–S13 (2003). https://doi.org/10.1038/sj.ijir.3901030.
  131. Korenman SG, Viosca S, Garza D, Guralnik M, Place V, Campbell P, Davis SS. Androgen therapy of hypogonadal men with transscrotal testosterone systems. Am J Med. 1987 Sep;83(3):471-8. doi: 10.1016/0002-9343(87)90757-1. PMID: 3310622.
  132. Yassin, A.A. and Saad, F. (2008), Testosterone and Erectile Dysfunction. Journal of Andrology, 29: 593-604. https://doi.org/10.2164/jandrol.107.004630.
  133. Chatterjee R, Wood S, McGarrigle HH, Lees WR, Ralph DJ, Neild GH. A novel therapy with testosterone and sildenafil for erectile dysfunction in patients on renal dialysis or after renal transplantation. J Fam Plann Reprod Health Care. 2004 Apr;30(2):88-90. doi: 10.1783/147118904322995438. PMID: 15086991.
  134. Anderson RA, Bancroft J, Wu FC. The effects of exogenous testosterone on sexuality and mood of normal men. J Clin Endocrinol Metab. 1992 Dec;75(6):1503-7. doi: 10.1210/jcem.75.6.1464655. PMID: 1464655.
  135. Traish AM. Benefits and Health Implications of Testosterone Therapy in Men With Testosterone Deficiency. Sex Med Rev. 2018 Jan;6(1):86-105. doi: 10.1016/j.sxmr.2017.10.001. Epub 2017 Nov 8. PMID: 29128268.
  136. Glenn R. Cunningham, Alisa J. Stephens-Shields, Raymond C. Rosen, Christina Wang, Shalender Bhasin, Alvin M. Matsumoto, J. Kellogg Parsons, Thomas M. Gill, Mark E. Molitch, John T. Farrar, David Cella, Elizabeth Barrett-Connor, Jane A. Cauley, Denise Cifelli, Jill P. Crandall, Kristine E. Ensrud, Laura Gallagher, Bret Zeldow, Cora E. Lewis, Marco Pahor, Ronald S. Swerdloff, Xiaoling Hou, Stephen Anton, Shehzad Basaria, Susan J. Diem, Vafa Tabatabaie, Susan S. Ellenberg, Peter J. Snyder, Testosterone Treatment and Sexual Function in Older Men With Low Testosterone Levels, The Journal of Clinical Endocrinology & Metabolism, Volume 101, Issue 8, 1 August 2016, Pages 3096–3104, https://doi.org/10.1210/jc.2016-1645.
  137. Mikhail N. Does testosterone have a role in erectile function? Am J Med. 2006 May;119(5):373-82. doi: 10.1016/j.amjmed.2005.07.042. PMID: 16651047.
  138. Guay AT. Testosterone and erectile physiology. Aging Male. 2006 Dec;9(4):201-6. doi: 10.1080/13685530601051155. PMID: 17178555.
  139. Muraleedharan V, Jones TH. Testosterone and the metabolic syndrome. Therapeutic Advances in Endocrinology and Metabolism. 2010;1(5):207-223. doi:10.1177/2042018810390258.
  140. Wang C, Jackson G, Jones TH, et al. Low Testosterone Associated With Obesity and the Metabolic Syndrome Contributes to Sexual Dysfunction and Cardiovascular Disease Risk in Men With Type 2 Diabetes. Diabetes Care. 2011;34(7):1669-1675. doi:10.2337/dc10-2339.
  141. Rao PM, Kelly DM, Jones TH. Testosterone and insulin resistance in the metabolic syndrome and T2DM in men. Nature reviews. Endocrinology. 2013; 9(8):479-93.
  142. García-Cruz E, Leibar-Tamayo A, Romero J. Metabolic syndrome in men with low testosterone levels: relationship with cardiovascular risk factors and comorbidities and with erectile dysfunction. The journal of sexual medicine. 2013; 10(10):2529-38.
  143. Cunningham GR. Testosterone and metabolic syndrome. Asian Journal of Andrology. 2015;17(2):192-196. doi:10.4103/1008-682X.148068.
  144. Corona G, Monami M, Rastrelli G. Testosterone and metabolic syndrome: a meta-analysis study. The journal of sexual medicine. 2011; 8(1):272-83.
  145. Akishita M, Fukai S, Hashimoto M. Association of low testosterone with metabolic syndrome and its components in middle-aged Japanese men. Hypertension research : official journal of the Japanese Society of Hypertension. 2010; 33(6):587-91.
  146. Rebuffescrive M, Marin P, Bjorntorp P. Effect of testosterone on abdominal adipose-tissue in men. Int J Obesit. 1991;15:791–5.
  147. Jones TH, Arver S, Behre HM, et al. Testosterone replacement in hypogonadal men with type 2 diabetes and/or metabolic syndrome (the TIMES2 study). Diabetes Care. 2011;34(4):828-37.
  148. Marin P, Holmang S, Gustafsson C, Jonsson L, Kvist H, Elander A. Androgen treatment of abdominally obese men. Obes Res. 1993;1:245–51.
  149. Saad F, Gooern LJ, Haider A, Yassin A. A dose-response study of testosterone on sexual dysfunction and features of the metabolic syndrome using testosterone gel and parenteral testosterone undecanoate. J Androl. 2008;29:102–5.
  150. Jones H, Howell J, Channer K. Testosterone improves glycaemic control, insulin resistance, body fat and sexual function in men with the metabolic syndrome and/or type 2 diabetes: A Multicentre European Clinical Trial: the TIMES2 Study. Endocrine Abstracts. 2010;21:6.
  151. Hromadová M, Hácik T, Riecanský I. Concentration of lipid, apoprotein-B and testosterone in patients with coronarographic findings. Klin Wochenschr. 1985 Oct 15;63(20):1071-4. doi: 10.1007/BF01739675. PMID: 4068611.
  152. Available from https://www.alliedacademies.org/articles/cortisol-testosterone-ratio-and-homocysteine-levels-in-patients-with-acute-myocardial-infarction.html.
  153. Jeppesen LL, Jørgensen HS, Nakayama H, Raaschou HO, Olsen TS, Winther K. Decreased serum testosterone in men with acute ischemic stroke. Arterioscler Thromb Vasc Biol. 1996 Jun;16(6):749-54. doi: 10.1161/01.atv.16.6.749. PMID: 8640402.
  154. Francomano D, Lenzi A, Aversa A. Effects of five-year treatment with testosterone undecanoate on metabolic and hormonal parameters in ageing men with metabolic syndrome. Int J Endocrinol 2014. 2014 527470.
  155. Yassin DJ, Doros G, Hammerer PG, Yassin AA. Long-term testosterone treatment in elderly men with hypogonadism and erectile dysfunction reduces obesity parameters and improves metabolic syndrome and health-related quality of life. J Sex Med. 2014;11:1567–76.
  156. Traish AM, Haider A, Doros G, Saad F. Long-term testosterone therapy in hypogonadal men ameliorates elements of the metabolic syndrome: an observational, long-term registry study. Int J Clin Pract. 2014;68:314–29.
  157. Bhattacharya RK, Khera M, Blick G, Kushner H, Nguyen D, et al. Effect of 12 months of testosterone replacement therapy on metabolic syndrome components in hypogonadal men: data from the Testim Registry in the US (TRiUS) BMC Endocr Disord. 2011;11:18.
  158. Cassimatis DC, Crim MT, Wenger NK. Low Testosterone in Men with Cardiovascular Disease or Risk Factors: To Treat or Not To Treat? Current treatment options in cardiovascular medicine. 2016; 18(12):75.
  159. Nettleship JE, Jones RD, Channer KS, Jones TH. Testosterone and coronary artery disease. Frontiers of hormone research. 2009; 37:91-107.
  160. Morris PD, Channer KS. Testosterone and cardiovascular disease in men. Asian journal of andrology. 2012; 14(3):428-35.
  161. Malkin CJ, Pugh PJ, Morris PD, Asif S, Jones TH, et al. Low serum testosterone and increased mortality in men with coronary heart disease. Heart. 2010;96:1821–5.
  162. Hak AE, Witteman JC, de Jong FH, Geerlings MI, Hofman A, Pols HA. Low levels of endogenous androgens increase the risk of atherosclerosis in elderly men: the Rotterdam study. J Clin Endocrinol Metab. 2002;87:3632–3639.
  163. Muller M, van den Beld AW, Bots ML, Grobbee DE, Lamberts SW, van der Schouw YT. Endogenous sex hormones and progression of carotid atherosclerosis in elderly men. Circulation. 2004;109:2074–2079.
  164. Sharma R, Oni OA, Gupta K, et al. Normalization of testosterone level is associated with reduced incidence of myocardial infarction and mortality in men. Eur Heart J. 2015;36(40):2706-15.
  165. Testosterone for secondary prevention in men with ischaemic heart disease?. QJM. 2003;96(7):521.
  166. Rosano GM, Leonardo F, Pagnotta P, Pelliccia F, Panina G, Cerquetani E, della Monica PL, Bonfigli B, Volpe M, Chierchia SL. Acute anti-ischemic effect of testosterone in men with coronary artery disease. Circulation. 1999 Apr 6;99(13):1666-70. doi: 10.1161/01.cir.99.13.1666. Erratum in: Circulation 2000 Feb 8;101(5):584. PMID: 10190874.
  167. Hackett G. An update on the role of testosterone replacement therapy in the management of hypogonadism. Ther Adv Urol. 2016 Apr;8(2):147-60. doi: 10.1177/1756287215617648. Epub 2015 Dec 9. PMID: 27034727; PMCID: PMC4772354.
  168. Pugh PJ, Jones TH, Channer KS. Acute haemodynamic effects of testosterone in men with chronic heart failure. Eur Heart J. 2003 May;24(10):909-15. doi: 10.1016/s0195-668x(03)00083-6. PMID: 12714022.
  169. Webb CM, Mcneill JG, Hayward CS, De zeigler D, Collins P. Effects of testosterone on coronary vasomotor regulation in men with coronary heart disease. Circulation. 1999;100(16):1690-6.
  170. Toma M, McAlister FA, Coglianese EE, Vidi V, Vasaiwala S, Bakal JA, et al. Testosterone supplementation in heart failure: a meta-analysis. Circ Heart Fail. 2012;5:315–321.
  171. Jones RD, Hugh Jones T, Channer KS. The influence of testosterone upon vascular reactivity. European journal of endocrinology. 2004; 151(1):29-37.
  172. Akinloye O, Blessing Popoola B, Bolanle Ajadi M, Gregory Uchechukwu J, Pius Oparinde D. Hypogonadism and metabolic syndrome in nigerian male patients with both type 2 diabetes and hypertension. International journal of endocrinology and metabolism. 2014; 12(1):e10749.
  173. Reckelhoff JF, Roman RJ. Androgens and hypertension: Role in both males and females? Hypertension. 2011;57(4):681-682. doi:10.1161/HYPERTENSIONAHA.110.162750.
  174. Torkler S, Wallaschofski H, Baumeister SE. Inverse association between total testosterone concentrations, incident hypertension and blood pressure. The aging male : the official journal of the International Society for the Study of the Aging Male. 2011; 14(3):176-82.
  175. Janjgava S, Zerekidze T, Uchava L, Giorgadze E, Asatiani K. Influence of testosterone replacement therapy on metabolic disorders in male patients with type 2 diabetes mellitus and androgen deficiency. European Journal of Medical Research. 2014;19(1):56. doi:10.1186/s40001-014-0056-6.
  176. Marin P, Holmang S, Jonsson L. The effects of testosterone treatment on body composition and metabolism in middle-aged obese men. International journal of obesity and related metabolic disorders: journal of the International Association for the Study of Obesity. 1992; 16(12):991-7.
  177. Huisman HW, Schutte AE, Van Rooyen JM, Malan NT, Malan L, Schutte R, Kruger A. The influence of testosterone on blood pressure and risk factors for cardiovascular disease in a black South African population. Ethn Dis. 2006 Summer;16(3):693-8. PMID: 16937606.
  178. Fogari R, Preti P, Zoppi A, Fogari E, Rinaldi A, Corradi L, Mugellini A. Serum testosterone levels and arterial blood pressure in the elderly. Hypertens Res. 2005 Aug;28(8):625-30. doi: 10.1291/hypres.28.625. PMID: 16392765.
  179. Wickramatilake CM, Mohideen MR, Pathirana C. Association of serum testosterone with lipid abnormalities in patients with angiographically proven coronary artery disease. Indian Journal of Endocrinology and Metabolism. 2013;17(6):1061-1065. doi:10.4103/2230-8210.122624.
  180. Bobjer J, Naumovska M, Giwercman YL, Giwercman A. High prevalence of androgen deficiency and abnormal lipid profile in infertile men with non-obstructive azoospermia. International journal of andrology. 2012; 35(5):688-94.
  181. Han K-S, Ahn TY. AB173. Effect of testosterone replacement therapy on lipid profile in the patients with testosterone deficiency syndrome. Translational Andrology and Urology. 2014;3(Suppl 1):AB173. doi:10.3978/j.issn.2223-4683.2014.s173.
  182. Zgliczynski S, Ossowski M, Slowinska-Srzednicka J. Effect of testosterone replacement therapy on lipids and lipoproteins in hypogonadal and elderly men. Atherosclerosis. 1996; 121(1):35-43.
  183. Malkin CJ, Pugh PJ, Jones RD, Kapoor D, Channer KS, Jones TH. The effect of testosterone replacement on endogenous inflammatory cytokines and lipid profiles in hypogonadal men. J Clin Endocrinol Metab. 2004 Jul;89(7):3313-8. doi: 10.1210/jc.2003-031069. PMID: 15240608.
  184. Spector TD, Perry LA, Tubb G, Silman AJ, Huskisson EC. Low free testosterone levels in rheumatoid arthritis.Ann Rheum Dis. 1988 Jan;47(1):65-8.
  185. Rovira-Llopis S, Bañuls C, de Marañon AM. Low testosterone levels are related to oxidative stress, mitochondrial dysfunction and altered subclinical atherosclerotic markers in type 2 diabetic male patients. Free radical biology & medicine. 2017; 108:155-162.
  186. Stella Vodo, Nicoletta Bechi, Anna Petroni, Carolina Muscoli, and Anna Maria Aloisi, “Testosterone-Induced Effects on Lipids and Inflammation,” Mediators of Inflammation, vol. 2013, Article ID 183041, 8 pages, 2013. doi:10.1155/2013/183041.
  187. Dhindsa S, Ghanim H, Batra M, et al. Insulin Resistance and Inflammation in Hypogonadotropic Hypogonadism and Their Reduction After Testosterone Replacement in Men With Type 2 Diabetes. Diabetes Care. 2016;39(1):82-91. doi:10.2337/dc15-1518.
  188. Tremellen K, McPhee N, Pearce K. Metabolic endotoxaemia related inflammation is associated with hypogonadism in overweight men. Basic and Clinical Andrology. 2017;27:5. doi:10.1186/s12610-017-0049-8.
  189. Jimenez-Balderas FJ, Tapia-Serrano R, Fonseca ME, et al. High frequency of association of rheumatic/autoimmune diseases and untreated male hypogonadism with severe testicular dysfunction. Arthritis Research. 2001;3(6):362-367.
  190. James W. Further evidence that low androgen values are a cause of rheumatoid arthritis: the response of rheumatoid arthritis to seriously stressful life events. Annals of the Rheumatic Diseases. 1997;56(9):566.
  191. Spector TD, Perry LA, Tubb G, Silman AJ, Huskisson EC. Low free testosterone levels in rheumatoid arthritis.Ann Rheum Dis. 1988 Jan;47(1):65-8.
  192. Holroyd CR, Edwards CJ. The effects of hormone replacement therapy on autoimmune disease: rheumatoid arthritis and systemic lupus erythematosus. Climacteric: the journal of the International Menopause Society. 2009; 12(5):378-86.
  193. Cutolo M. Sex hormone adjuvant therapy in rheumatoid arthritis. Rheumatic diseases clinics of North America. 2000; 26(4):881-95.
  194. Cutolo M, Balleari E, Giusti M, Intra E, Accardo S. Androgen replacement therapy in male patients with rheumatoid arthritis. Arthritis and rheumatism. 1991; 34(1):1-5.
  195. Malkin CJ, Pugh PJ, Jones RD, Kapoor D, Channer KS, Jones TH. The effect of testosterone replacement on endogenous inflammatory cytokines and lipid profiles in hypogonadal men. The Journal of clinical endocrinology and metabolism. 2004; 89(7):3313-8.
  196. Van Vollenhoven RF, McGuire JL. Estrogen, progesterone, and testosterone: can they be used to treat autoimmune diseases? Cleveland Clinic journal of medicine. 1994; 61(4):276-84.
  197. Barrett-Connor E, Dam TT, Stone K, Harrison SL, Redline S, et al. The association of testosterone levels with overall sleep quality, sleep architecture, and sleep-disordered breathing. J Clin Endocrinol Metab. 2008;93:2602–9.
  198. Luboshitzky R, Zabari Z, Shen-Orr Z, Herer P, Lavie P. Disruption of the nocturnal testosterone rhythm by sleep fragmentation in normal men. J Clin Endocrinol Metab. 2001;86:1134–9.
  199. Schmid SM, Hallschmid M, Jauch-Chara K, Lehnert H, Schultes B. Sleep timing may modulate the effect of sleep loss on testosterone. Clin Endocrinol (Oxf) 2012;77:749–54.
  200. Axelsson J, Akerstedt T, Kecklund G, Lindqvist A, Attefors R. Hormonal changes in satisfied and dissatisfied shift workers across a shift cycle. J Appl Physiol. 2003;95:2099–105.
  201. Reynolds AC, Dorrian JA, Liu PY, Van Dongen HP, Wittert GA, et al. A pilot study on the relationship between sleep restriction, endogenous testosterone and cognitive performance. In: Kennedy GA, Sargent C, editors. Little clock, big clock: Molecular to physiological clocks. Melbourne, Australia: Australasian Chronobiology Society; 2011. pp. 11–6.
  202. Matsumoto AM, Sandblom RE, Schoene RB, Lee KA, Giblin EC, Pierson DJ, Bremner WJ 1985 Testosterone replacement in hypogonadal men: effects on obstructive sleep apnoea, respiratory drives, and sleep. Clin Endocrinol (Oxf) 22:713–721.
  203. Shigehara K, Konaka H, Koh E. Effects of testosterone replacement therapy on nocturia and quality of life in men with hypogonadism: a subanalysis of a previous prospective randomized controlled study in Japan. The aging male : the official journal of the International Society for the Study of the Aging Male. 2015; 18(3):169-74.
  204. Spark RF. Testosterone, diabetes mellitus, and the metabolic syndrome. Curr Urol Rep. 2007 Nov;8(6):467-71.
  205. Laaksonen DE, Niskanen L, Punnonen K, et al. Testosterone and sex hormone-binding globulin predict the metabolic syndrome and diabetes in middle-aged men. Diabetes Care. 2004 May;27(5):1036-41.
  206. Haider A, Gooren LJ, Padungtod P, Saad F. Concurrent improvement of the metabolic syndrome and lower urinary tract symptoms upon normalisation of plasma testosterone levels in hypogonadal elderly men. Andrologia. 2009 Feb;41(1):7-13.
  207. Dhindsa S, Miller MG, McWhirter CL, et al. Testosterone concentrations in diabetic and nondiabetic obese men. Diabetes Care. 2010 Jun;33(6):1186-92.
  208. Glass AR, Swerdloff RS, Bray GA, Dahms WT, Atkinson RL. Low serum testosterone and sex-hormone-binding-globulin in massively obese men. J Clin Endocrinol Metab. 1977;45:1211–9.
  209. Allan CA, McLachlan RI. Androgens and obesity. Curr Opin Endocrinol Diabetes Obes. 2010;17:224–32.
  210. Tajar A, Forti G, O’Neill TW, Lee DM, Silman AJ, et al. Characteristics of secondary, primary, and compensated hypogonadism in aging men: evidence from the European Male Ageing Study. J Clin Endocrinol Metab. 2010;95:1810–8.
  211. Cao J, Chen TM, Hao WJ, Li J, Liu L, et al. Correlation between sex hormone levels and obesity in the elderly male. Aging Male. 2012;15:85–9.
  212. Drewa T, Olszewska-Słonina D, Chlosta P. Testosterone replacement therapy in obese males. Acta poloniae pharmaceutica. 2011; 68(5):623-7.
  213. De Maddalena C, Vodo S, Petroni A, Aloisi AM. Impact of testosterone on body fat composition. Journal of cellular physiology. 2012; 227(12):3744-8.
  214. Saad F, Aversa A, Isidori AM, Gooren LJ. Testosterone as Potential Effective Therapy in Treatment of Obesity in Men with Testosterone Deficiency: A Review. Current Diabetes Reviews. 2012;8(2):131-143. doi:10.2174/157339912799424573.
  215. Yassin A, Doros G. Testosterone therapy in hypogonadal men results in sustained and clinically meaningful weight loss. Clinical Obesity. 2013;3(3-4):73-83. doi:10.1111/cob.12022.
  216. Traish AM. Testosterone and weight loss: the evidence. Current opinion in endocrinology, diabetes, and obesity. 2014; 21(5):313-22.
  217. Ng Tang Fui M, Prendergast LA, Dupuis P, et al. Effects of testosterone treatment on body fat and lean mass in obese men on a hypocaloric diet: a randomised controlled trial. BMC Medicine. 2016;14:153. doi:10.1186/s12916-016-0700-9.
  218. Rebuffé-Scrive M, Mårin P, Björntorp P. Effect of testosterone on abdominal adipose tissue in men. International journal of obesity. 1991; 15(11):791-5.
  219. Available from https://www.karger.com/Article/Abstract/176046.
  220. Surampudi P, Swerdloff RS, Wang C. An update on male hypogonadism therapy. Expert opinion on pharmacotherapy. 2014;15(9):1247-1264. doi:10.1517/14656566.2014.913022.
  221. Bhasin S, Storer TW, Berman N. Testosterone replacement increases fat-free mass and muscle size in hypogonadal men. The Journal of clinical endocrinology and metabolism. 1997; 82(2):407-13.
  222. Markova MS, Zeskand J, McEntee B, Rothstein J, Jimenez SA, et al. (2004)A role for the androgen receptor in collagen content of the skin. J Invest Dermatol123:1052-1056.
  223. Baumann L (2002) Acne, in: Cosmetic Dermatology: Principles and Practice, Baumann L, Weisberg E, Mcgraw-Hill, New York.
  224. Roth MY, Page ST. A role for dihydrotestosterone treatment in older men? Asian Journal of Andrology. 2011;13(2):199-200. doi:10.1038/aja.2010.173.
  225. Farthing MJ, Mattei AM, Edwards CR, Dawson AM. Relationship between plasma testosterone and dihydrotestosterone concentrations and male facial hair growth. The British journal of dermatology. 1982; 107(5):559-64.
  226. Celbek G, Turan H, Aydın Y, Ermiş F. A Case of Hypogonadism Presented with Alopecia Universalis. Balkan Medical Journal. 2013;30(3):345-346. doi:10.5152/balkanmedj.2013.8216.
  227. Woodhouse NJ, Sakati NA. A syndrome of hypogonadism, alopecia, diabetes mellitus, mental retardation, deafness, and ECG abnormalities. Journal of Medical Genetics. 1983;20(3):216-219.
  228. Moncada I. Testosterone and men’s quality of life. The aging male: the official journal of the International Society for the Study of the Aging Male. 2006; 9(4):189-93.
  229. Available from https://link.springer.com/referenceworkentry/10.1007%2F978-0-387-78665-0_152.
  230. Guo C, Gu W, Liu M, et al. Efficacy and safety of testosterone replacement therapy in men with hypogonadism: A meta-analysis study of placebo-controlled trials. Experimental and Therapeutic Medicine. 2016;11(3):853-863. doi:10.3892/etm.2015.2957.
  231. Almehmadi Y, Yassin AA, Nettleship JE, Saad F. Testosterone replacement therapy improves the health-related quality of life of men diagnosed with late-onset hypogonadism. Arab Journal of Urology. 2016;14(1):31-36. doi:10.1016/j.aju.2015.10.002.
  232. Hajjar RR, Kaiser FE, Morley JE. Outcomes of long-term testosterone replacement in older hypogonadal males: a retrospective analysis. J Clin Endocrinol Metab. 1997;82:3793–6.
  233. Hackett G, Cole N, Bhartia M, Kennedy D, Raju J, Wilkinson P. Testosterone replacement therapy with long-acting testosterone undecanoate improves sexual function and quality-of-life parameters vs. placebo in a population of men with type 2 diabetes. The journal of sexual medicine. 2013; 10(6):1612-27.
  234. Boston University Medical Center. “Long-term testosterone therapy improves urinary, sexual function and quality of life.” ScienceDaily. ScienceDaily, 15 August 2017.
  235. William N. Taylor, M.D. (16 January 2002). Anabolic Steroids and the Athlete, 2d ed. McFarland. pp. 31–. ISBN 978-0-7864-1128-3.
  236. Nicolae Sfetcu (2 May 2014). Health & Drugs: Disease, Prescription & Medication. Nicolae Sfetcu. pp. 1157–. GGKEY:JPFE1Q59083.
  237. Karkazis K, Jordan-Young R (April 11, 2014). “The Trouble With Too Much T”. New York Times. Retrieved April 12, 2014.
  238. Kimberly Mueller; Josh Hingst (2013). The Athlete’s Guide to Sports Supplements. Human Kinetics. pp. 91–. ISBN 0-7360-9369-9.
  239. Larry J. Siegel; Brandon C. Welsh (14 May 2010). Juvenile Delinquency: The Core. Cengage Learning. pp. 257–. ISBN 0-495-80986-1.
  240. Mechanism of Action of Anabolic-androgenic Steroids. ProQuest. 2008. pp. 4–. ISBN 978-0-549-65265-6.
  241. Facts On File, Incorporated (2007). Drugs and Sports. Infobase Publishing. pp. 111–. ISBN 978-1-4381-2444-5.
  242. Linda E. Swayne; Mark Dodds (8 August 2011). Encyclopedia of Sports Management and Marketing. SAGE Publications. pp. 610–. ISBN 978-1-5063-2037-3.
  243. Edmund Vincent Cowdry (1944). A textbook of histology: functional significance of cells and intercellular substances. Lea & Febiger.
  244. A4M American Academy of Anti-Aging Medicine (13 March 2015). Anti-Aging Therapeutics Volume XVI. A4M American Academy of Anti-Aging Medicine. pp. 98–. ISBN 978-1-934715-17-8.
  245. Aharon W. Zorea Ph.D. (25 April 2014). Steroids. ABC-CLIO. pp. 25–. ISBN 978-1-4408-0300-0.
  246. David Levinson; Karen Christensen (1999). Encyclopedia of World Sport: From Ancient Times to the Present. Oxford University Press. pp. 110–. ISBN 978-0-19-513195-6.
  247. Danielle Sarver Coombs; Bob Batchelor (2013). American History Through American Sports: From Colonial Lacrosse to Extreme Sports. ABC-CLIO. pp. 2–. ISBN 978-0-313-37988-8.
  248. Thomas M. Hunt (15 January 2011). Drug Games: The International Olympic Committee and the Politics of Doping, 1960–2008. University of Texas Press. pp. 54–. ISBN 978-0-292-73957-4.
  249. Edith Fairman Cooper (2002). The Emergence of Crack Cocaine Abuse. Nova Publishers. pp. 63–. ISBN 978-1-59033-512-3.
  250. William David Hager; Linda Carruth Hager (1 September 1998). Stress and the Woman’s Body. Baker Publishing Group. ISBN 978-0-8007-5665-9.
  251. F. Gross (11 December 2013). Protein Metabolism: Influence of Growth Hormone, Anabolic Steroids, and Nutrition in Health and Disease. An International Symposium Leyden, 25th–29th June, 1962. Springer. pp. 212–. ISBN 978-3-642-53147-7.
  252. Gerard Thorne; Phil Embleton (1997). Robert Kennedy’s Musclemag International Encyclopedia of Bodybuilding: The Ultimate A-Z Book on Muscle Building!. Musclemag International. ISBN 978-1-55210-001-1.
  253. Morgentaler A. Testosterone therapy for men at risk for or with history of prostate cancer. Curr Treat Options Oncol. 2006;7(5):363-9.
  254. Roddam AW, Allen NE, Appleby P, Key TJ. Endogenous sex hormones and prostate cancer: a collaborative analysis of 18 prospective studies. J Natl Cancer Inst. 2008;100(3):170-83.
  255. Morgentaler A, Traish AM. Shifting the paradigm of testosterone and prostate cancer: the saturation model and the limits of androgen-dependent growth. Eur Urol. 2009;55(2):310-20.
  256. American Urological Association (AUA) 2015 Annual Meeting: Abstract MP4-09. Presented May 15, 2015.
  257. R. Granata; J. Isgaard (12 June 2014). Cardiovascular Issues in Endocrinology. Karger Medical and Scientific Publishers. pp. 70–. ISBN 978-3-318-02674-0.
  258. Khaw KT, Dowsett M, Folkerd E, et al. Endogenous testosterone and mortality due to all causes, cardiovascular disease, and cancer in men: European prospective investigation into cancer in Norfolk (EPIC-Norfolk) Prospective Population Study. Circulation. 2007;116(23):2694-701.
  259. No Cardiovascular Risk Seen in Latest Testosterone Study. Medscape. Aug 14, 2015.
  260. Lynne M Dunphy; Jill Winland-Brown; Brian Porter; Debera Thomas (19 February 2015). Primary Care: Art and Science of Advanced Practice Nursing. F.A. Davis. pp. 643–. ISBN 978-0-8036-4494-6.
  261. Tenover JL. The androgen-deficient aging male: current treatment options. Rev Urol. 2003;5 Suppl 1:S22-8.
  262. Kathleen Deska Pagana (8 November 2013). Mosby’s Manual of Diagnostic and Laboratory Tests. Elsevier Health Sciences. pp. 477–. ISBN 978-0-323-08949-4.
  263. John Whyte (2 August 2011). Is This Normal?: The Essential Guide to Middle Age and Beyond. Rodale. pp. 194–. ISBN 978-1-60961-122-4.
  264. Eberhard Nieschlag; Hermann Behre (29 June 2013). Andrology: Male Reproductive Health and Dysfunction. Springer Science & Business Media. pp. 102–. ISBN 978-3-662-04491-9.

Other Peptides

FG Loop Peptide (FGL)

Valproic Acid

5-amino-1MQ

ACE-031

PE-22-28

Success Stories

men testimonial before after

At the age of 60, I look and feel better than I ever have in my entire life! Switching my health program and hormone replacement therapy regimen over to Genemedics was one of the best decisions I’ve ever made in my life! Genemedics and Dr George have significantly improved my quality of life and also dramatically improved my overall health. I hav...
Nick Cassavetes ,60 yrs old Movie Director (“The Notebook”, “John Q”, “Alpha Dog”), Actor and Writer

See All Men’s Testimonials

Call 800-277-4041 for a Free Consultation

What to expect during your consultation:
  • Usually takes 15-30 minutes
  • Completely confidential
  • No obligation to purchase anything
  • We will discuss your symptoms along with your health and fitness goals
  • Free post-consult access for any additional questions you may have

About

Genemedics® Health Institute is a global premier institute dedicated to revolutionizing health and medicine through healthy lifestyle education, guidance and accountability in harmony with functional medicine. Our physician-supervised health programs are personally customized to help you reach your health and fitness goals while looking and feeling better than ever.

Quick Links

Our Services

 Our Locations

genemedics logo

280 North Old Woodward Ave. Suite 210 Birmingham MI 48009,USA

800-277-4041

info@genemedics.com

© Copyright Genemedics Health Institute. All Rights Reserved. Privacy Policy.

Back to Top
-

Free Consultation

STEPS AWAY FROM A YOUNGER. HEALTHIER YOU!

Call 800-277-4041 for a Free Consultation

What to expect during your consultation:

  • Usually takes 15-30 minutes
  • Completely confidential
  • No obligation to purchase anything
  • We will discuss your symptoms along with your health and fitness goals
  • Free post-consult access for any additional questions you may have
Captch Background