Dr. Abraham Morgentaler, an associate professor of surgery at Harvard Medical School and the director of Men’s Health Boston, specializes in treating prostate diseases and male sexual and reproductive difficulties. He has developed particular expertise in treating low testosterone levels. In this interview, Dr. Morgentaler shares his views on current controversies, the treatment strategies he uses with his own patients, and why he thinks experts should reconsider the possible link between testosterone-replacement therapy and prostate cancer.
^ Butenandt A, Hanisch G (1935). "Umwandlung des Dehydroandrosterons in Androstendiol und Testosterone; ein Weg zur Darstellung des Testosterons aus Cholestrin" [About Testosterone. Conversion of Dehydro-androsterons into androstendiol and testosterone; a way for the structure assignment of testosterone from cholesterol]. Hoppe-Seyler's Z Physiol Chem (in German). 237 (2): 89–97. doi:10.1515/bchm2.1935.237.1-3.89.
Studies also show a consistent negative correlation of testosterone with blood pressure (Barrett-Connor and Khaw 1988; Khaw and Barrett-Connor 1988; Svartberg, von Muhlen, Schirmer et al 2004). Data specific to the ageing male population suggests that this relationship is particularly powerful for systolic hypertension (Fogari et al 2005). Interventional trials have not found a significant effect of testosterone replacement on blood pressure (Kapoor et al 2006).
Andy – If you take testosterone, your hypothalamus will notice an abundance of testosterone in your system and will instruct your pituitary gland not to send LH and FSH to your testicles. If you’re testicles are not receiving these two hormones, they will stop making testosterone. If you quit testosterone call turkey, you will likely fall back to your baseline level fairly quickly. There is a protocol however to get back to your normal production much quicker should you choose to quit therapy.
Vitamin D3: Vitamin D3 is actually more hormone than it is a vitamin. Vitamin D is taken in by around 10% of our diets and D3 is mostly absorbed from the sun, which can be linked to greater testosterone production. The link between the two is a result from the luteinizing hormone playing its role. Read more about how vitamin D3 effects testosterone — the evidence is staggering.
Ginger (also known as Zingiber officinale, family: Zingiberaceae) has been widely consumed as a dietary spice, delicacy, and as a traditional oriental medicine. The rhizome can be used fresh, dried or powdered. Ginger is often applied for treating nausea due to caused by morning sickness during pregnancy, chemotherapy and seasickness. The ginger rhizome also contains several biologically active compounds such as gingerol, shogaols, gingerdiol and gingerdione .
Ashwagandha is shown to be effective at reducing cortisol which in turn helps with testosterone production. There are also numerous studies showing the effects on improving testosterone in infertile men (ref 80). If you are using the Aggressive Strength product you don't need to supplement with ashwagandha as it's included in the test booster formula. Likewise if you're using Tian Chi (my daily herb drink).
Testosterone increases dominance and the desire for power. The link between testosterone and dominance has been demonstrated in numerous studies. T motivates men to gain and maintain social status. The desire for dominance can be a bad thing if it leads to criminal behavior, but it’s also what fuels the climb for success, motivates men to resist oppression and buck authority, and may even help you with the ladies…
More recently, a study from 2015 noted that consuming 600mg daily of standardized fenugreek extract for eight weeks increased free testosterone levels compared to placebo. The test group also experience an increase the the number of repetitions the could perform in the leg press before reaching failure. And, to top it off, subjects receiving the fenugreek supplement dropped body fat without losing strength.
The Prime Labs Men’s Testosterone Booster made our top spot for testosterone booster caplets. These natural testosterone supplements improve the symptoms of low testosterone, which include low energy, a lack of stamina, a low sex drive, and a decrease in strength. The results include improvement in all of the above and the can also boost your overall mood, making you feel more confident and in control.
The oldest form is an injection, which we still use because it’s inexpensive and because we reliably get good testosterone levels in nearly everybody. The disadvantage is that a man needs to come in every few weeks to get a shot. A roller-coaster effect can also occur as blood testosterone levels peak and then return to baseline. [See “Exogenous vs. endogenous testosterone,” above.]
Hypogonadism is highly prevalent amongst men with diabetes mellitus type 2 or symptoms of the metabolic syndrome, including insulin resistance, impaired glucose regulation, obesity, and hypertension.1,6,13,14,17,18 Low testosterone in many men with diabetes remains undiagnosed and untreated, and current guidelines recommend measurement of testosterone levels in such patients and, equally, that such chronic diseases should be investigated and treated in men with hypogonadism.1,6 It is not yet fully known whether diabetes is a cause or a consequence of low testosterone, and the full effects of testosterone administration on glycemic control in hypogonadal men with diabetes are unclear. However, there are indications that treating hypogonadism may have benefits on metabolic status in men with diabetes, and there is evidence that testosterone replacement therapy has a beneficial effect on risk factors for diabetes such as central obesity, insulin sensitivity, glucose control and blood lipid profiles in hypogonadal men with type 2 diabetes.14,19,20
DAA (D-Aspartic Acid): When it comes to potent ingredients, D-Aspartic Acid is probably one the most potent ones currently available for boosting testosterone levels. This ingredient is used by sportsmen and bodybuilders alike to boost performance and gains, while it has also been shown to aid infertile men. DAA works with the brain, which stimulates the release of the luteinizing hormone that produces testosterone and also the secretion of growth hormone. Testosterone Synthesis also increases along with the other effects.
All the active substances available in TestoGen are fully natural. And their efficacy and safety is science-backed. So, if you don’t have individual sensitivity to the supplement ingredients and purchase the product directly from the manufacturer instead of purchasing from unknown suppliers, the likelihood of side effects during the supplementation is minimal. And the customer feedback proves this.
Looking purely at the biochemical numbers, The Endocrine Society* considers low testosterone to be a total testosterone level of less than 300 ng/dl, and I think that’s a reasonable guide. But no one quite agrees on a number. It’s not like diabetes, where if your fasting glucose is above a certain level, they’ll say, “Okay, you’ve got it.” With testosterone, that break point is not quite as clear.
Xenoestrogen is a chemical that imitates estrogen in the human body. When men are exposed to too much of this estrogen-imitating chemical, T levels drop significantly. The problem is xenoestrogen is freaking everywhere — plastics, shampoos, gasoline, cows, toothpaste. You name it and chances are there are xenoestrogen in it. The ubiquitous nature of this chemical in our modern world is one reason some endocrinologists believe that testosterone levels are lower in men today than in decades past. It’s also a reason doctors say the number of boys born with hypospadias — a birth defect in which the opening of the urethra is on the underside of the penis and not at the tip — has doubled. Note to expecting parents: make sure mom stays away from xenoestrogens during the pregnancy.
In fact, there is increasing evidence of the potential benefits of testosterone replacement therapy on multiple cardiovascular risk factors. This evidence recently has been comprehensively reviewed by Traish et al. in the Journal of Andrology.16 Although the full effects of testosterone replacement therapy on cardiovascular risk are yet to be established, the balance of emerging evidence from clinical studies suggests that testosterone replacement therapy in hypogonadal men may improve endothelial function, reduce proinflammatory factors, reduce hypertension, and improve the lipid profile.
It also has vitamin B6. One study called out folate and vitamins B6 and B12 as important nutrients for athletes to achieve optimal health and performance. Vitamin B6 is commonly found in food, like fortified cereals, and as with magnesium, it’s possible to have too much vitamin B6. The NIH recommends an upper daily limit for adults of 100mg per day. Beast Sports comes well under this limit at 10mg per day, but still well above the minimum recommended dose of 1.7mg needed to see benefits.
We reviewed the ingredient lists of our supplements and cut three that prescribed us an overdose of magnesium. While it’s possible to stay under the 350mg daily limit of supplemental magnesium by taking fewer pills than the manufacturer recommends, we were concerned that any manufacturer would advise you to exceed the recommended safety limit for magnesium intake by almost a third.
Keep in mind that you can use virtually any type of equipment you want for this – an elliptical machine, a treadmill, swimming, even sprinting outdoors (although you will need to do this very carefully to avoid injury) -- as long as you're pushing yourself as hard as you can for 30 seconds. But do be sure to stretch properly and start slowly to avoid injury. Start with two or three repetitions and work your way up, don't expect to do all eight repetitions the first time you try this, especially if you are out of shape.
I have tried pellets, I went from 5 grams/day gel, to 10 grams, had little change due to work schedule and no energy made it difficult to manage daily. Levels got down to 78 at one point. Testo pellets worked great but it took 10 to make a difference and it brought me up to the 300-400 range. My body rejected 3 pellets and expelled them. Tried axiron, didn’t work, natesto, which the doc never heard off next, a Nasal spray which helped but the bottle ran out 5 days early either by my mistake or dosage problems. Back to 10 grams Testim AG ($360 after deductible) which helps if i could stay consistent but I’m 28. With a job, and health insurance, deductible issues I can not afford 800 dollars a month, 360 after deductible. Recent levels of FSH/LH are .7 and 1.2 (low). Total testosterone 114, free 18.9, and bioavalability at 39.6 (low). I had a MRI of my pituitary gland today, and get results next week. Hoping to start depo T next week as I return to work. If I can recommend anything to anyone, is make sure it’s affordable, you have the time or energy to apply/administer, and understand most people will not understand what you are going through. 2 killers of testosterone are chronic stress and lack of sleep. In 3 years of treatment I wish I came to this man’s article and others and read up prior because I’m on the brink of losing everything I’ve worked for due to hypogonadism. Wish you all results and good health, and thank you for a great article!
In the hepatic 17-ketosteroid pathway of testosterone metabolism, testosterone is converted in the liver by 5α-reductase and 5β-reductase into 5α-DHT and the inactive 5β-DHT, respectively. Then, 5α-DHT and 5β-DHT are converted by 3α-HSD into 3α-androstanediol and 3α-etiocholanediol, respectively. Subsequently, 3α-androstanediol and 3α-etiocholanediol are converted by 17β-HSD into androsterone and etiocholanolone, which is followed by their conjugation and excretion. 3β-Androstanediol and 3β-etiocholanediol can also be formed in this pathway when 5α-DHT and 5β-DHT are acted upon by 3β-HSD instead of 3α-HSD, respectively, and they can then be transformed into epiandrosterone and epietiocholanolone, respectively. A small portion of approximately 3% of testosterone is reversibly converted in the liver into androstenedione by 17β-HSD.
Miscellaneous: Sleep: (REM sleep) increases nocturnal testosterone levels. Behavior: Dominance challenges can, in some cases, stimulate increased testosterone release in men. Drugs: Natural or man-made antiandrogens including spearmint tea reduce testosterone levels. Licorice can decrease the production of testosterone and this effect is greater in females.
Dr. Darryn Willoughby, a professor of health, human performance and recreation and the director of the Exercise and Biochemical Nutrition Laboratory at Baylor University, told us that even in studies where there was an increase in testosterone, it was only around 15–20 percent. “In men with clinically normal testosterone levels, this modest increase will most likely not be anabolic enough to improve exercise performance,” he says. So if you have normal testosterone levels, and are simply trying to get an extra edge in gaining muscle, losing weight, or some extra time in the bedroom — you might see some results from taking a testosterone booster. But really, these will be most useful for men with low testosterone trying to get back to a healthy testosterone range.
The prevalence of biochemical testosterone deficiency increases with age. This is partly due to decreasing testosterone levels associated with illness or debility but there is also convincing epidemiological data to show that serum free and total testosterone levels also fall with normal aging (Harman et al 2001; Feldman et al 2002). The symptoms of aging include tiredness, lack of energy, reduced strength, frailty, loss of libido, decreased sexual performance depression and mood change. Men with hypogonadism experience similar symptoms. This raises the question of whether some symptoms of aging could be due to relative androgen deficiency. On the other hand, similarities between normal aging and the symptoms of mild androgen deficiency make the clinical diagnosis of hypogonadism in aging men more challenging.
Hello..was prescribe andro gel 1.62 for about 2 years..borderline low..At time 54 year old now 57..a year ago switched doctors..new doctor would not prescribe andro gel..without me stopping use and then being checked after 6 months..it’s been a year..by the way felt great while on it much more energy. .did notice some hair receding. .but felt stronger..my question is..by using andro gel ..did I turn off my body’s natural ability to make testosterone as using andro gel..if so what do I need to do too turn my body on if my doctor does not renew therapy. .by way the past without andro gel…little too no energy..weight gain of 40 lbs..especially around the belly..thank you for your time and reply
^ Mehta PH, Jones AC, Josephs RA (Jun 2008). "The social endocrinology of dominance: basal testosterone predicts cortisol changes and behavior following victory and defeat" (PDF). Journal of Personality and Social Psychology. 94 (6): 1078–93. CiteSeerX 10.1.1.336.2502. doi:10.1037/0022-35188.8.131.528. PMID 18505319. Archived from the original (PDF) on April 19, 2009.
With ingredients like Fenugreek, Ashwagandha, Shilajit, and Boron Citrate, you can expect to see some increases in lean muscle mass thanks to the hike in free and total testosterone levels as well as its ability to suppress cortisol, a natural hormone that can reduce the body’s ability to use fat stores as energy. True GRIT Test Booster does not contain proprietary blends, so you can actually see the exact dosage you are getting from each ingredient listed.
I’m currently 64 y.o. After close to 10 years of twice-weekly injections of 20 units of testosterone cypionate my PSA gradually increased from 4.4 to more than 16. My urologist has performed 4 biopsies and one prostate MRI over that time, all of them negative. The last was 15 months ago. Early last year, after my fluctuating PSA reached 16, I discontinued the injections for about 6 months. My PSA dropped back to 6.1, and by the end of that time, my testosterone levels were about 240 but my libido seemed almost non-existent. I resumed the injections at a reduced level, 15 units, and 3 months later, the testosterone level was in the 700 range but the PSA was back to 16. My doctor told me to discontinue the injections pending another biopsy when I’m 65 in June.(I can’t afford another one immediately because of a high insurance deductible and previous family medical bills.) I am now gradually reducing the injections to 10 units once weekly, in hopes of limiting the withdrawal. Am I playing with fire or doing the right thing and have you had other patients with similar histories?
Studies conducted in rats have indicated that their degree of sexual arousal is sensitive to reductions in testosterone. When testosterone-deprived rats were given medium levels of testosterone, their sexual behaviors (copulation, partner preference, etc.) resumed, but not when given low amounts of the same hormone. Therefore, these mammals may provide a model for studying clinical populations among humans suffering from sexual arousal deficits such as hypoactive sexual desire disorder.
One study that compared athletes to non-active individuals found that supplementing with 22 mg magnesium per pound of body weight of the course of four weeks raised testosterone levels in both groups. And two separate studies, one on a group of men over the age of 65 and a second on a younger 18-30 year old cohort, present the same conclusion: levels of testosterone (and muscle strength) are directly correlated to the levels of magnesium in the body.
My genetic make-up is 47XXY. I was diagnosed in September, 1976, and have been on some kind of T-therapy since – injections, pills, gels, patches, pellets, now back on injections. At this time, now, I inject 1/2cc deep IM, every 7-8 days. I suffered a blood clot between my knee and my groin (right leg) in January, 2017. I am now on Eliquis through June, 2017. My blood has always been quick to coagulate. I’ve read through all of this, and only found mention of blood clots sporadically in relation to T-therapy. I’m 70 yoa, have never had a problem before. Can you give me any info I can pass along to my doctor? Thank you.
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.
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?
Some people can get away with more of a barebones approach to boosting their testosterone levels. MET-Rx Tribulus 750 has been around for years and has been used by many to help get their testosterone levels back within the normal range. The product has been laboratory tested and has been deemed safe for use by athletes, bodybuilders, and gym rats alike.
The researchers found that the dose of testosterone required to produce different effects in the body varied widely. The influence of testosterone and estradiol also differed. As the testosterone gel dose was reduced, the scientists showed, reductions in lean mass, muscle size, and leg-press strength resulted from decreases in testosterone itself. In contrast, increases in body fat were due to the related declines in estradiol. Both testosterone and estradiol levels were associated with libido and erectile function.