There have been case reports of development of prostate cancer in patients during treatment with testosterone, including one case series of twenty patients (Gaylis et al 2005). It is not known whether this reflects an increase in incidence, as prostate cancer is very common and because the monitoring for cancer in patients treated with testosterone is greater. Randomized controlled trials of testosterone treatment have found a low incidence of prostate cancer and they do not provide evidence of a link between testosterone treatment and the development of prostate cancer (Rhoden and Morgentaler 2004). More large scale clinical trials of longer durations of testosterone replacement are required to confirm that testosterone treatment does not cause prostate cancer. Overall, it is not known whether testosterone treatment of aging males with hypogonadism increases the risk of prostate cancer, but monitoring for the condition is clearly vital. This should take the form of PSA blood test and rectal examination every three months for the first year of treatment and yearly thereafter (Nieschlag et al 2005). Age adjusted PSA reference ranges should be used to identify men who require further assessment. The concept of PSA velocity is also important and refers to the rate of increase in PSA per year. Patients with abnormal rectal examination suggestive of prostate cancer, PSA above the age specific reference range or a PSA velocity greater than 0.75 ng/ml/yr should be referred to a urologist for consideration of prostate biopsy.
D-Aspartic acid is a natural amino acid involved in the synthesis and release of testosterone, which research shows can be used as a testosterone booster for infertile men. One 90-day study gave D-Aspartic acid to men with impaired sperm production, and found their sperm count rose from 8.2 million sperm per ml to 16.5 million sperm per ml, more than a 100 per cent increase.

If you're a man who's experiencing symptoms such as decreased sex drive, erectile dysfunction, depressed mood, and difficulties with concentration and memory, and you think low testosterone may be to blame, you can have your levels tested. Since testosterone levels fluctuate throughout the day, you'll probably need more than a blood test to get a true picture of your levels.
You can find a whole bunch of HIIT workouts online, but the one I used during my 90-day experiment was a simple wind sprint routine. On Tuesdays I went to the football field near my house, marked off 40 yards with some cones, and sprinted as fast as I could. I’d slowly walk back to the starting line, giving my body about a minute to rest, and then I’d sprint again. I typically did 40 sets of 40-yard sprints in a workout. I love sprints.
12)  Use Aswaghanda and Collagen Protein:  This adaptogenic herb has been shown to reduce stress hormone, increase DHEA and boost testosterone levels.  You can take the Cortisol Defense to help you get restorative sleep at night which will support your testosterone.  In addition, I personally enjoy using the Organic Bone Broth Collagen in addition to the Amino Strong for a post weight training shake.  This protein powder has all the benefits of collagen protein and it has 500 mg of high potency ashwagandha in each serving!

Tribulus terrestris is an ingredient commonly presented as improving testosterone levels, but has not been found to be more effective than a placebo or possess any testosterone increasing properties. WebMD cautions that it interferes with Lithium and diabetes medications, and in general, not enough is known about tribulus terrestris to recommend a dosage for anyone.


A large number of trials have shown the positive effects of testosterone treatment on markers of bone formation and increased bone density in hypogonadal men treated with testosterone.1,4,6,8,13 Not surprisingly, the effects may take several years to fully develop. At present no data on the role of testosterone in preventing fracture in men with hypogonadism are available.
At the National Population and Family Development Board in Malaysia, men between the ages of 31 and 52 were given two capsules of the herb (E. longifolia) in Andro400 every day for three weeks. They reported erections were stronger and, in some cases, lasted longer. Overall, they felt more virile. Their levels of testosterone doubled within three weeks.5
55+ million men in america between 40 and 70 years of age is a large enough group to warrant interest in a thorough study of the aged male delivery system and other sex related issues. There is a good chance there are 55 million women out there wishing for some kind of help also. Those are significant numbers, about 1/3 of the total population and the lions share of the income producers. And the best the medical community can do is speculate at the real cause for a significant cancer? Perhaps prostate cancer is the real cause of global warming, there is no real science unless there is a real paycheck?
In my late 20’s, I visited an anti-aging doctor who was one of the pioneers of what we now call functional medicine. I got a full hormone test. Shockingly, my testosterone was lower than my mother’s. No wonder I felt crappy and was overweight. My other sex hormones were out of whack too, especially my estrogen levels. They were high because the little testosterone I did make my body converted into estrogen. I went on a mix of topical replacement testosterone cream, plus small doses of pharmaceuticals like clomid and arimidex in order to keep my other sex hormones functioning properly.
Zinc: Another potent ingredient to add to any testosterone booster is zinc. This study shows how zinc is able to prevent a decline in testosterone levels during intense and hard workouts performed by wrestlers. Researchers found that the group who was administered with a placebo had a reduction in testosterone, as opposed to the group who were supplemented with zinc. The placebo group had a notable drop in their testosterone count during this process. Zinc has also been shown to increase the number of free testosterone and lower SHBG.
Elevated testosterone levels have been demonstrated to increase the growth of body muscles and contribute to better activation of the nervous system, resulting in more power and strength, a better mood, enhanced libido, and many other benefits.[3] Previous researches done on the anabolic role of testosterone and its impact on muscular strength in training-induced adaptations has provided rather conflicting findings, and a positive correlation between testosterone-mediated responses and both functional performance and body composition was found.[4,5] There are a number of naturally occurring substances that can boost testosterone levels in the body. Foods containing such substances are known as testosterone-foods; and they tend to be rich in vitamins, antioxidants, and minerals like zinc, which plays a key role in testosterone production.[2,6-8]
I’ve been on testosterone replacement for over 3 years and at first I did the shots and my mood swings were ridiculous, my skin broke out on my chest and shoulders, and my henatocrit went to 55%. I finally got fed up with doing shots every two weeks and switched to Gel and it’s been so much better. It actually increases my levels which is rare for most men. I do 12.5 mg, three pumps a day, and this keeps My level between 500 and 600. My hematocrit is 48.5 and no mood swings.

Testosterone may decrease your chances of Alzheimer’s Disease. Several studies have linked low testosterone levels to an increased risk of Alzheimer’s disease.  In a 2010 study by the University of Hong Kong, researchers studied 153 Chinese men who were recruited from social centers. They were at least 55 years and older, lived in the community, and didn’t have dementia. Of those men, 47 had mild cognitive impairment — or problems with clear thinking and memory loss.


Tarig Elraiyah, Mohamad Bassam Sonbol, Zhen Wang, Tagwa Khairalseed, Noor Asi, Chaitanya Undavalli, Mohammad Nabhan, Osama Altayar, Larry Prokop, Victor M. Montori, Mohammad Hassan Murad; The Benefits and Harms of Systemic Dehydroepiandrosterone (DHEA) in Postmenopausal Women With Normal Adrenal Function: A Systematic Review and Meta-analysis, The Journal of Clinical Endocrinology & Metabolism, Volume 99, Issue 10, 1 October 2014, Pages 3536–3542, https://doi.org/10.1210/jc.2014-2261
Alphamax XT’s testosterone boosting formula is so potent that they had to include an estrogen blocker in the formula. User’s have reported that the product’s effects rivals a hardcore pre-workout in terms of aggression and intensity. When the workout is done user’s have also been reporting accelerated muscle recovery, fat loss, and increased muscle definition.

Looking for ingredients that work in the realm of supplements can be like finding a needle in a haystack. Testosterone boosters, like all dietary supplements, are not approved by the Food and Drug Administration prior to marketing. This lack of oversight dates back to the 1994 Dietary Supplement Health and Education Act (DSHEA), which stipulated that purveyors of supplements weren’t required to prove the safety of their products or the veracity of what’s on the labels to the FDA before listing them for sale. Often, there isn’t a lot of scientific backing behind an ingredient, or research has been done solely on animals, not humans.
As you can see, the entire workout is only 20 minutes. Twenty minutes! That really is a beautiful thing. And within those 20 minutes, 75 percent of that time is warming up, recovering or cooling down. You're really only working out intensely for four minutes. It's hard to believe if you have never done this that you can actually get that much benefit from four minutes of exercise. That's all it is.
This has become a common practice despite an Institute of Medicine (IOM) report issued in 2003, indicating insufficient evidence of any benefit derived from testosterone hormone therapy to address expected symptoms of male aging.4  These studies, and 2 others (to be presented in a separate EW research brief) come on the heels of research on the efficacy of prescribing testosterone5 that appeared in the NEJM last year.
Cruciferous vegetables like broccoli are rich in indoles, anti-cancer compounds that indirectly boost testosterone production by breaking down and flushing the system of excess estrogen, which inhibits the production of male sex hormones. As men age, their estrogen levels gradually rise, while testosterone levels fall. Indoles can help strike the balance. In one study, supplementing with indole-3-carbinol from cruciferous vegetables for just 7 days cut the estrogen hormone estradiol in half for men. Another study found indole supplementation significant increased urinary excretion of estrogens among men.

I have had BPH for years. Am in early 60s and recently had a 12 site prostate biopsy after a very slow rise of PSA to 4.5 (over a period of 10 years). There were two sites with PIN (one with outpouching and one was focal). Have been on various form of test replacement…changing methods periodically from test cyp IM, or SQ, with and without HCG or HCG alone. I want to continue a very low dose of either HCG or Test Cyp (10-20mg twice/week). What are your thoughts?

Epidemiological data has associated low testosterone levels with atherogenic lipid parameters, including lower HDL cholesterol (Lichtenstein et al 1987; Haffner et al 1993; Van Pottelbergh et al 2003) and higher total cholesterol (Haffner et al 1993; Van Pottelbergh et al 2003), LDL cholesterol (Haffner et al 1993) and triglyceride levels (Lichtenstein et al 1987; Haffner et al 1993). Furthermore, these relationships are independent of other factors such as age, obesity and glucose levels (Haffner et al 1993; Van Pottelbergh et al 2003). Interventional trails of testosterone replacement have shown that treatment causes a decrease in total cholesterol. A recent meta-analysis of 17 randomized controlled trials confirmed this and found that the magnitude of changes was larger in trials of patients with lower baseline testosterone levels (Isidori et al 2005). The same meta-analysis found no significant overall change in LDL or HDL cholesterol levels but in trials with baseline testosterone levels greater than 10 nmol/l, there was a small reduction in HDL cholesterol with testosterone treatment.

If you think you may have Low T symptoms or are suffering from Andropause (Hypogonadism), don't hesitate to contact a Hormone Therapy Physician at one of our male hormone replacement clinics today. You can get tested for Low T with a fast, easy lab test and start treatment right away with a prescription. Find a Testosterone Doctor & Clinics for hormone testing, diagnoses and treatment.

Testosterone was first used as a clinical drug as early as 1937, but with little understanding of its mechanisms. The hormone is now widely prescribed to men whose bodies naturally produce low levels. But the levels at which testosterone deficiency become medically relevant still aren’t well understood. Normal testosterone production varies widely in men, so it’s difficult to know what levels have medical significance. The hormone’s mechanisms of action are also unclear.

What is your opinion of using depo-testosterone injections on women? I am 44 and have had a complete hyserectomy. My OB/GYN was injecting the hormone when I complained of low libido. Unfortunately, the doctor was asked to leave the practice and his replacement refuses to use the injections on me. Any thoughts or suggestions would be greatly appreciated.
An international consensus document was recently published and provides guidance on the diagnosis, treatment and monitoring of late-onset hypogonadism (LOH) in men. The diagnosis of LOH requires biochemical and clinical components. Controversy in defining the clinical syndrome continues due to the high prevalence of hypogonadal symptoms in the aging male population and the non-specific nature of these symptoms. Further controversy surrounds setting a lower limit of normal testosterone, the limitations of the commonly available total testosterone result in assessing some patients and the unavailability of reliable measures of bioavailable or free testosterone for general clinical use. As with any clinical intervention testosterone treatment should be judged on a balance of risk versus benefit. The traditional benefits of testosterone on sexual function, mood, strength and quality of life remain the primary goals of treatment but possible beneficial effects on other parameters such as bone density, obesity, insulin resistance and angina are emerging and will be reviewed. Potential concerns regarding the effects of testosterone on prostate disease, aggression and polycythaemia will also be addressed. The options available for treatment have increased in recent years with the availability of a number of testosterone preparations which can reliably produce physiological serum concentrations.
TT may help you but it may have adverse (harmful) results. (See discussion of these side effects below.) The Federal Drug Administration (FDA) has said that testosterone drug labels should state that there is a risk for heart disease and stroke for some men using testosterone products. All men should be checked for heart disease and stroke before, and periodically while on, TT. The AUA however, on careful review of evidence-based peer review literature, has stated that there is no strong evidence that TT either increases or decreases the risk of cardiovascular events.
I was depressed, getting fat, and zero libido. My doc did a full blood work up. My Total Testosterone level was 289 ng/dl. He offered TRT but I declined because I knew, at 53, that if I went on TRT my own testosterone production would shut down and at my age I would have a pretty difficult time kick starting it up again. I researched and researched for about a month. I started on Vitamin D 10,000 iu per day ( I knew this was a safe amount because I tested at 26ng/dl and optimum level is anywhere between 40-80ng/dl. I also took 1,200 mg of magnesium, 9mg of Boron and Vitamin K Complex. Tested again 3 months later and blood work showed I was at 720.

“I see people who've been doing things in the gym and they've never been told that it can shut off your own production and it can also irreversibly lower your sperm count,” says Roked. “These are all quite serious issues that even though they may be rare if it happened to you it would cause a big impact on your life, so I'd say it's always best to do things with a specialist, but also for anyone it's not a great idea to take things that aren't needed."
Cross-sectional studies have found a positive association between serum testosterone and some measures of cognitive ability in men (Barrett-Connor, Goodman-Gruen et al 1999; Yaffe et al 2002). Longitudinal studies have found that free testosterone levels correlate positively with future cognitive abilities and reduced rate of cognitive decline (Moffat et al 2002) and that, compared with controls, testosterone levels are reduced in men with Alzheimer’s disease at least 10 years prior to diagnosis (Moffat et al 2004). Studies of the effects of induced androgen deficiency in patients with prostate cancer have shown that profoundly lowering testosterone leads to worsening cognitive functions (Almeida et al 2004; Salminen et al 2004) and increased levels of serum amyloid (Gandy et al 2001; Almeida et al 2004), which is central to the pathogenesis of Alzheimer’s disease (Parihar and Hemnani 2004). Furthermore, testosterone reduces amyloid-induced hippocampal neurotoxity in vitro (Pike 2001) as well as exhibiting other neuroprotective effects (Pouliot et al 1996). The epidemiological and experimental data propose a potential role of testosterone in protecting cognitive function and preventing Alzheimer’s disease.
Margaret, I’m on Trt, and my wife is 43 going through Peri- (early/pre) menopause. She started trying about a drop a day to see if her libido would improve, and it did, dramatically, and also her moods and patience. After about a month of feeling 30again, she started noticing lite facial hair developing, decreased breast size, and return of all previous symptoms. So she went off it. About a month later, she started St.JohnsWart, and everything improved tenfold. Now she feels 20 instead of just 30 on testosterone. She literally glows with smiles and energy, and has an extremely high libido. Maybe try that first. Good luck.
The testosterone booster pills are effective from 4 to 8 hours. To maintain testosterone levels high during the whole day, you need a multiple daily dosing regimen. 2-times daily dosing still not always can improve hormone production to the greatest extent. 3-4-times daily dosing is the best solution to make your body normalize testosterone synthesis and prevent it from decreasing before you take another pill. Don’t forget that the regularity of daily supplement intake is crucial if you really aspire to give a boost to hormone production.
This is over simplified but should offer you some clarity to what you are experiencing – If you are getting Testosterone Cypionate injections every 2 weeks, then you are on the roller coaster. I have great results with weekly injections and some folks need bi-weekly injections. It’s all how your body reacts but every 2 weeks is just plain too far apart as the product is relatively ineffective after 10 days. Measurable at 10 days? Somewhat but still ineffective at that point.
It also had a purpose. It turns out posing in powerful stances causes your testosterone to increase within 20 minutes [13,14]. In those two studies, power posing for just a few minutes also dropped cortisol and boosted confidence. It’s a great way to start your day, or to give yourself an edge before a job interview or a big presentation. They don’t call it “warrior pose” for nothing!
Joe Costello is a Nutrition & Wellness Consultant, certified by the American Fitness Professionals & Associates (AFPA), author, and internet blogger. Joe has more than 9 years of experience in the sports nutrition industry and over 3 years of experience as a supplement and nutrition blogger. As a certified NWC who specializes in dietary supplements, Joe strives to deliver accurate, comprehensive, and research-backed information to his readers. You can find more of Joe’s work including his E-Books about fitness and nutrition at his official website joecostellonwc.com, or connect with him on LinkedIn, Facebook, Instagram, Vimeo, or YouTube.
Treatment is not necessary if your levels fall within the normal range. Testosterone replacement therapy is primarily beneficial for men with low testosterone levels. Don’t purchase testosterone without a prescription. See your doctor if you think you might have low levels of testosterone. A blood test can determine your testosterone levels and help diagnose underlying conditions.
Get some sun – I know many people say you should avoid the sun like a vampire unless you want to get skin cancer but we actually do need some sunlight. This is because the sun is the best source of vitamin D which plays a huge role in testosterone production and other bodily functions. Keep your sun exposure in moderation but do not avoid it altogether.

A: Androderm comes in the form of a transdermal patch and is used for testosterone replacement therapy in patients who have insufficient levels of testosterone. Testosterone is a hormone produced in the body that plays a key role in many physiological processes in men. In some men, however, the body does not produce enough of the hormone, resulting in a variety of symptoms including decreased libido, erectile dysfunction, muscle loss, anemia and depression, among others. Androderm helps treat these symptoms and raise low testosterone levels by delivering therapeutic amounts of the hormone, which are absorbed through the skin. According to the prescribing information for Androderm, depression was a reported side effect of the medication. Other common side effects of Androderm include itching and redness at the application site, prostate abnormalities, headache, and burning or hardening of the skin at the application site. Less common side effects of Androderm include reduced libido (sex drive), fatigue, high blood pressure, anxiety, confusion, increased appetite, and body pain. For more specific information, consult with your doctor for guidance based on your health status and current medications, particularly before taking any action. Your physician can determine if your dosage of the medication needs to be adjusted or if an alternative medication should be considered. Lori Poulin, PharmD


14. Volek JS, Volk BM, Gómez AL, Kunces LJ, Kupchak BR, Freidenreich DJ, Aristizabal JC, Saenz C, Dunn-Lewis C, Ballard KD, Quann EE, Kawiecki DL, Flanagan SD, Comstock BA, Fragala MS, Earp JE, Fernandez ML, Bruno RS, Ptolemy AS, Kellogg MD, Maresh CM, Kraemer WJ. Whey protein supplementation during resistance training augments lean body mass. J Am Coll Nutr. 2013;32(2):122-35. PMID: 24015719
It's important to understand that your body requires saturated fats from animal and vegetable sources (such as meat, dairy, certain oils, and tropical plants like coconut) for optimal functioning, and if you neglect this important food group in favor of sugar, grains and other starchy carbs, your health and weight are almost guaranteed to suffer. Examples of healthy fats you can eat more of to give your testosterone levels a boost include:
Shilajit in its natural state has no chemical definition. In order to yield a consistent and efficacious form of shilajit, the shilajit is obtained from carefully selected rocks and is put through a patented technology where it is purified and standardized. This form of shilajit is now assured of optimal levels of bioactive components such as fulvic acid and dibenzo-pyrones, and is known as the patented PrimaVie.
However, if you have normal testosterone levels and are looking for a boost, for strength gaining purposes, then D-Aspartic acid use may prove less fruitful. A study published in Nutrition Research showed that when the booster was given to men who resistance trained four times a week, their body composition and muscle strength was no different to men who took part in resistance training without the aid of D-Aspartic acid.
Regardless of the method of testosterone treatment chosen, patients will require regular monitoring during the first year of treatment in order to monitor clinical response to testosterone, testosterone levels and adverse effects, including prostate cancer (see Table 2). It is recommended that patients should be reviewed at least every three months during this time. Once treatment has been established, less frequent review is appropriate but the care of the patient should be the responsibility of an appropriately trained specialist with sufficient experience of managing patients treated with testosterone.

When I told people that I was doing an experiment to increase my testosterone, the question that people would invariably ask in hushed tones was, “So, did it, you know, improve your sex life?” Honestly, I didn’t see too much change. I had a robust and healthy sex life before the experiment and continued to do so afterwards. I guess I was a bit more randier than usual, but not much. I’d imagine if you had been suffering from low T for a long time and took steps to increase it, you’d likely see improvement in the bedroom department.

Testosterone is used as a medication for the treatment of males with too little or no natural testosterone production, certain forms of breast cancer,[10] and gender dysphoria in transgender men. This is known as hormone replacement therapy (HRT) or testosterone replacement therapy (TRT), which maintains serum testosterone levels in the normal range. Decline of testosterone production with age has led to interest in androgen replacement therapy.[109] It is unclear if the use of testosterone for low levels due to aging is beneficial or harmful.[110]
A testicular action was linked to circulating blood fractions – now understood to be a family of androgenic hormones – in the early work on castration and testicular transplantation in fowl by Arnold Adolph Berthold (1803–1861).[181] Research on the action of testosterone received a brief boost in 1889, when the Harvard professor Charles-Édouard Brown-Séquard (1817–1894), then in Paris, self-injected subcutaneously a "rejuvenating elixir" consisting of an extract of dog and guinea pig testicle. He reported in The Lancet that his vigor and feeling of well-being were markedly restored but the effects were transient,[182] and Brown-Séquard's hopes for the compound were dashed. Suffering the ridicule of his colleagues, he abandoned his work on the mechanisms and effects of androgens in human beings.
Every ingredient can be harmful when taken in significant quantities (we go more into that below), so we pored over each booster’s ingredient list to make sure that they weren’t serving up an overdose. In particular, we took a close look at magnesium and zinc, which have enough scientific background behind them to offer hard upper limits on how much you can safely consume.
Magnesium comes with a strict upper cap. Excess magnesium is hard on your kidneys, and can lead to kidney failure. The NIH recommends that men consume 400-420 mg of magnesium daily, but that they should not exceed 350 mg of supplemental magnesium per day. Because while it’s rare for people to chronically overdose on magnesium through diet (you’d have to eat a lot of almonds and spinach, for example), overdose by supplement is far more common.
In addition to these effects, DHEA supplementation also increases FREE testosterone levels. As you may or may not know, testosterone is found in the body in both free and bound forms. Free testosterone is the biologically active kind that we want more of in order to improve energy, strength, recovery, and sexual function. Bound testosterone is biologically inactive, due to serum hormone-binding globulin (SHBG).
There have been case reports of development of prostate cancer in patients during treatment with testosterone, including one case series of twenty patients (Gaylis et al 2005). It is not known whether this reflects an increase in incidence, as prostate cancer is very common and because the monitoring for cancer in patients treated with testosterone is greater. Randomized controlled trials of testosterone treatment have found a low incidence of prostate cancer and they do not provide evidence of a link between testosterone treatment and the development of prostate cancer (Rhoden and Morgentaler 2004). More large scale clinical trials of longer durations of testosterone replacement are required to confirm that testosterone treatment does not cause prostate cancer. Overall, it is not known whether testosterone treatment of aging males with hypogonadism increases the risk of prostate cancer, but monitoring for the condition is clearly vital. This should take the form of PSA blood test and rectal examination every three months for the first year of treatment and yearly thereafter (Nieschlag et al 2005). Age adjusted PSA reference ranges should be used to identify men who require further assessment. The concept of PSA velocity is also important and refers to the rate of increase in PSA per year. Patients with abnormal rectal examination suggestive of prostate cancer, PSA above the age specific reference range or a PSA velocity greater than 0.75 ng/ml/yr should be referred to a urologist for consideration of prostate biopsy.
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Another point I’d like to make for people worried about a link between high testosterone and prostate cancer is that it just doesn’t make sense. Prostate cancer becomes more prevalent in men as they age, and that’s also when their testosterone levels decline. We almost never see it in men in their peak testosterone years, in their 20s for instance. We know from autopsy studies that 8% of men in their 20s already have tiny prostate cancers, so if testosterone really made prostate cancer grow so rapidly — we used to talk about it like it was pouring gasoline on a fire — we should see some appreciable rate of prostate cancer in men in their 20s. We don’t. So, I’m no longer worried that giving testosterone to men will make their hidden cancer grow, because I’m convinced that it doesn’t happen.


I am now 65 & have had Low-T problems since I was about 60. I took topical Testosterone for a few years until insurance stopped covering it. Then I took injections at a Men's Health-Low-T Clinic. Then I was diagnosed with Prostate Cancer & was told to stop taking Testosterone. I underwent radiation treatment to cure the Prostate cancer, but since there is a theory that taking Testosterone can lead to Prostate cancer, I have chosen not to resume taking it. While I am glad to be free of the cancer, I have been feeling extremely fatigued & tired all the time to the point that doing much of anything like a little yard work would leave me exhausted for days.

A large number of trials have demonstrated a positive effect of testosterone treatment on bone mineral density (Katznelson et al 1996; Behre et al 1997; Leifke et al 1998; Snyder et al 2000; Zacharin et al 2003; Wang, Cunningham et al 2004; Aminorroaya et al 2005; Benito et al 2005) and bone architecture (Benito et al 2005). These effects are often more impressive in longer trials, which have shown that adequate replacement will lead to near normal bone density but that the full effects may take two years or more (Snyder et al 2000; Wang, Cunningham et al 2004; Aminorroaya et al 2005). Three randomized placebo-controlled trials of testosterone treatment in aging males have been conducted (Snyder et al 1999; Kenny et al 2001; Amory et al 2004). One of these studies concerned men with a mean age of 71 years with two serum testosterone levels less than 12.1nmol/l. After 36 months of intramuscular testosterone treatment or placebo, there were significant increases in vertebral and hip bone mineral density. In this study, there was also a significant decrease in the bone resorption marker urinary deoxypyridinoline with testosterone treatment (Amory et al 2004). The second study contained men with low bioavailable testosterone levels and an average age of 76 years. Testosterone treatment in the form of transdermal patches was given for 1 year. During this trial there was a significant preservation of hip bone mineral density with testosterone treatment but testosterone had no effect on bone mineral density at other sites including the vertebrae. There were no significant alterations in bone turnover markers during testosterone treatment (Kenny et al 2001). The remaining study contained men of average age 73 years. Men were eligible for the study if their serum total testosterone levels were less than 16.5 nmol/L, meaning that the study contained men who would usually be considered eugonadal. The beneficial effects of testosterone on bone density were confined to the men who had lower serum testosterone levels at baseline and were seen only in the vertebrae. There were no significant changes in bone turnover markers. Testosterone in the trial was given via scrotal patches for a 36 month duration (Snyder et al 1999). A recent meta-analysis of the effects on bone density of testosterone treatment in men included data from these studies and two other randomized controlled trials. The findings were that testosterone produces a significant increase of 2.7% in the bone mineral density at the lumber spine but no overall change at the hip (Isidori et al 2005). These results from randomized controlled trials in aging men show much smaller benefits of testosterone treatment on bone density than have been seen in other trials. This could be due to the trials including patients who are not hypogonadal and being too short to allow for the maximal effects of testosterone. The meta-analysis also assessed the data concerning changes of bone formation and resorption markers during testosterone treatment. There was a significant decrease in bone resorption markers but no change in markers of bone formation suggesting that reduction of bone resorption may be the primary mode of action of testosterone in improving bone density (Isidori et al 2005).
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