Frequently Asked Questions About Testosterone
Testosterone is a growing topic in the health community as well as the general population. There is good and bad information, so you just have to use commonsense. The prostate cancer question is indicative of the variety of answers you get. Our rational as well as scientific evidence, says that if testosterone caused "anything" you'd get it when you were a teenager, when the hormone was at its peak.
1. Does having high levels of free testosterone raise the risk if Prostate Cancer?
Endogenous Sex Hormones and Prostate Cancer: A Collaborative Analysis of 18 Prospective Studies - Abstract
In this collaborative analysis of the worldwide data on endogenous hormones and prostate cancer risk, serum concentrations of sex hormones were not associated with the risk of prostate cancer. 1
2. What is the normal level of testosterone?
Normal Testosterone Levels in Men and Women
Male: 300-1,000 ng/dl
Female: 20-80 ng/dl
Normal value ranges may vary slightly among different laboratories.
Note: ng/dl = nanograms per deciliter
3. If I have a low testosterone level, will taking supplemental testosterone help?
Maybe. Testosterone supplements, either with patches or injections, can raise testosterone levels. They may help to relieve some symptoms and to prevent muscle and bone loss that occurs with aging in men.
5. I have erectile dysfunction may have low testosterone. Will testosterone supplementation or boosting free testosterone help?
6. I am a woman, so why do I need a testosterone test?
Women’s bodies also produce testosterone but in small amounts. It is needed for hormonal balance and to help women’s bodies to function normally. If your body is producing too much testosterone, however, you may have more body hair than average, have abnormal or no menstrual periods, or be infertile. A testosterone test can help your doctor to understand what is causing your symptoms.
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7. Is the amount of body hair directly proportional to the amount of testosterone in my body?
Studies have shown a proportional relationship of testosterone levels to the amount of body hair. The hair growth response to testosterone differs in different parts of the body. Hence, in some men, for example, testosterone promotes hair growth in the abdomen and back while hair growth is suppressed in the scalp, leading to male pattern baldness. Genetics plays a major role in the expression of the 5 alpha reductase enzyme, which converts testosterone to the hair-altering compound dihydrotestosterone, leading to a family tendency towards balding. The drug finasteride (propecia) inhibits the action of 5 alpha reductase, and can reverse male pattern baldness in some men.
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4. What is the difference between free testosterone and bioavailable testosterone?
Testosterone is present in the blood as "free" testosterone (2-3%) or bound testosterone. The latter may be bound to either albumin (a serum protein) or to a specific binding protein called Sex Steroid Binding Globulin (SSBG) or Sex Hormone Binding Globulin (SHBG). The binding of testosterone to albumin is not very tight and is easily reversed; so the term bioavailable testosterone (BAT) refers to the sum of free testosterone plus albumin-bound testosterone. Alternatively, it is the fraction of circulating testosterone that is not bound to SSBG. It is suggested that BAT represents the fraction of circulating testosterone that readily enters cells and better reflects the bioactivity of testosterone than does the simple measurement of serum total testosterone. Also, varying levels of SSBG can result in inaccurate measurements of BAT. Decreased SSBG levels can be seen in obesity, hypothyroidism, androgen use, and nephritic syndrome. Increased levels are seen in cirrhosis, hyperthyroidism, and estrogen use. In these situations, measurement of free testosterone may be more useful. However, technically, free testosterone is difficult to measure accurately.
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What is Total testosterone?
What is Follicle stimulating hormone (FSH)?
What is luteneizing hormone (LH)?
Waht is Sex hormone binding globulin (SHBG)?
What is the difference between Free and bioavailable testosterone?
What causes testosterone deficiency?
As a man ages, the amount of testosterone in his body gradually declines. This natural decline starts after age 30 and continues throughout life. Other causes of lowered testosterone levels include:
Injury or infection to the testicles
Chemotherapy or radiation treatment for cancer
Genetic abnormalities such as Klinefelter's Syndrome (extra X chromosome)
Hemochromatosis (too much iron in the body)
Dysfunction of the pituitary gland (a gland in the brain that produces many important hormones)
Inflammatory diseases such as sarcoidosis (a condition that causes inflammation of the lungs)
Medications, especially hormones used to treat prostate cancer and corticosteroid drugs
Chronic illness
Chronic kidney failure
Liver cirrhosis
Stress
Alcoholism
The significance of testosterone decline is controversial and poorly understood.
What are the symptoms of testosterone deficiency?
Without adequate testosterone a man may lose his sex drive, experience erectile dysfunction, feel depressed, have a decreased sense of well-being, and have difficulty concentrating.
What changes occur in the body due to testosterone deficiency?
Decrease in muscle mass, with an increase in body fat
Changes in cholesterol levels
Decrease in hemoglobin and possibly mild anemia
Fragile bones (osteoporosis)
Decrease in body hair
How do I find out if I have a testosterone deficiency?
The only accurate way to detect the condition is to have your doctor measure the amount of testosterone in your blood. Because testosterone levels fluctuate throughout the day, several measurements will need to be taken to detect a deficiency. Doctors prefer, if possible, to test levels early in the morning since this is when testosterone levels are at their highest.
How is testosterone deficiency treated?
Testosterone deficiency can be treated by:
Intramuscular injections, generally every two or three weeks
Testosterone patch worn either on the body or on the scrotum (the sac that contains the testicles)
Testosterone gel
Mucoadhesive material applied above the teeth twice a day
Each of these options provides adequate levels of hormone replacement; however, they all have different advantages and disadvantages. Talk to your doctor to see which approach may be right for you.
Who shouldn't take testosterone replacement therapy?
Men who have prostate cancer or breast cancer should not take testosterone replacement therapy. All men considering testosterone replacement therapy should undergo a thorough prostate cancer screening prior to starting this therapy.
What are the side effects of testosterone replacement therapy?
In general, hormone replacement therapy is safe. It is associated with some side effects, including:
Acne or oily skin
Mild fluid retention
Stimulation of prostate tissue, with perhaps some increased urination symptoms such as a decreased stream or frequency
Breast enlargement
Worsening of sleep apnea (a sleep disorder that results in frequent night time awakenings and daytime sleepiness)
Decreased testicular size
Laboratory abnormalities that can occur with hormone replacement include:
Changes in cholesterol concentrations
Increase in red blood cell count
Decrease in sperm count, producing infertility (especially in younger men)
If you are taking hormone replacement therapy, regular follow-up appointments with your doctor are important. Like any other medication, directions for administering testosterone should be followed exactly as your doctor orders. If you are unsure or have any questions about testosterone replacement therapy, ask your doctor.
Q. Is Testosterone Replacement Treatment completely safe?
A. No medication can be said to be 100% safe and effective. However provided certain precautions are taken, like checking that your Prostate Specific Antigen ( PSA ) is normal then Testosterone Replacement Therapy is very safe and well tolerated.
Q. I have heard that Testosterone treatment can cause cancer of the prostate. Is this true?
A. No, testosterone treatments do NOT cause cancer of the prostate or of anything else for that matter. Prostate cancer occurs in older men with very low testosterone levels and is rare in younger men with high levels. But where prostate cancer already exists giving testosterone in this situation might serve to accelerate its growth. This is why keeping a close eye on PSA is essential for any man on TRT.
Q. How do I know if I might benefit from or need TRT?
A. Complete our self-assessment Impotence questionnaire link. If your score is above 45 then you may want to consider a trial of TRT. Or if you are suffering for one of the major symptoms like loss of libido and erectile failure then likewise a trial of treatment might be worth considering.
Q. Are there any ‘fringe benefits’ to taking TRT apart from the sexual ones?
A. Yes. Apart from improving you sexually there are a number of potential benefits that are now beginning to emerge for men who have been taking TRT long-term. Among these are:
Improvements to your cardiovascular system.
Improvements to your cognitive function and memory.
Increased mineral bone density to help against fractures.
Increased muscle mass and decreased body fat.
All that said is it a mistake to expect miracles. The benefits from TRT are often subtle and mild and not life transforming but rather life enhancing.
Q. What is the best way to take TRT?
A. At the moment the best way to take testosterone is via a trans-dermal gel. This is applied to a large area of your skin each morning. An injection form is also available called Nebido. This is given as an inter-muscular injection every 10 weeks and avoids the necessity of applying a gel every day. Both treatments are covered under the Cost of Drugs Refund Scheme.
Frequently Asked Questions About Testosterone and the IOM Report
What is testosterone? Testosterone is a vital sex hormone that plays an important role in puberty. But contrary to what some people believe, testosterone isn’t exclusively a male hormone. Women produce small amounts of it in their bodies as well. In men, testosterone is produced in the testes, the reproductive glands that also produce sperm. The amount of testosterone produced in the testes is regulated by the hypothalamus and the pituitary gland.
What is a hormone?
Hormones, such as testosterone, are powerful chemicals that help keep our bodies working normally. The term hormone is derived from the Greek word, hormo, which means to set in motion. And that’s precisely what hormones do. They stimulate, regulate, and control the function of various tissues and organs. Made by specialized groups of cells within structures called glands, hormones are involved in almost every biological process, including sexual reproduction, growth, metabolism, and immune function. These glands, including the pituitary, thyroid, adrenals, ovaries and testes, release various hormones into the body as needed.
Do testosterone levels diminish with age? Does “male menopause occur?”
There is scant evidence that “male menopause,” a condition supposedly caused by diminishing testosterone levels in aging men, exists. As men age, their testes often produce somewhat less testosterone than they did during adolescence and early adulthood, when production of this hormone peaks. But it is important to keep in mind that the range of normal testosterone production is large. Many older men have testosterone levels within the normal range of healthy younger men. Others have levels well below this range. However, the likelihood that a man will ever experience a major shut down of hormone production, similar to a woman's menopause, is remote.
In fact, many of the changes that take place in older men often are incorrectly blamed on decreasing testosterone levels. Some men who have erectile difficulty (impotence), for instance, may be tempted to blame this problem on lowered testosterone. However, in many cases, erectile difficulties are due to circulatory problems, not low testosterone.
Who might benefit from testosterone therapy?
Testosterone therapy remains a scientifically unproven method for preventing or relieving any physical or psychological changes that men with normal testosterone levels may experience as they get older. Except for a relatively few younger and older men with extreme deficiencies, testosterone treatment is not deemed appropriate for most men at this time. For the few men whose bodies make very little or no testosterone—for example, men whose pituitary glands have been destroyed by infections or tumors, or whose testes have been damaged—supplements in the form of patches, injections, or topical gel may offer substantial benefit. Supplements may help a man with exceptionally low testosterone levels maintain strong muscles and bones and increase sex drive.
However, more research is needed to determine what, if any, effects testosterone replacement may have in healthy older men without these extreme deficiencies. For now, the risks and benefits of testosterone therapy for most men who do not have extreme deficiencies of the hormone are unknown, and there is insufficient evidence for making well-informed decisions on whether this therapy is suitable in these individuals.
What are some of the risks of using testosterone therapy?
Investigators are concerned about the long-term harmful effects that supplemental testosterone might have on the aging body. It is not yet known, for instance, if testosterone supplements increase the risk of prostate cancer, the second leading cause of cancer death among men. In addition to potentially promoting new prostate cancers, testosterone also may promote the growth of those that have already developed. Studies also suggest that supplementation might trigger excessive red blood cell production in some men. This side effect might thicken blood and increase a man's risk of stroke.
I know someone who uses testosterone therapy and he says he feels stronger and more “alive” than he has in years. Is there any scientific evidence to support this claim?
Although some older men who have tried these supplements report feeling "more energetic" or "younger,” testosterone supplementation remains a scientifically unproven method for preventing or relieving any physical and psychological changes that men with normal testosterone levels may experience as they get older. Until more scientifically rigorous studies are conducted, the question of whether the benefits of testosterone replacement outweigh any of its potential negative effects will remain unanswered.
Ref
1. Written by
Roddam AW, Allen NE, Appleby P, Key TJ.
Reference
J Natl Cancer Inst. 2008 Feb 6;100(3):170-83.
Testosterone Booster for men over 40.
