Stress less – I know this is easier said than done but if you can reduce your stress levels it will help your testosterone production. This is because stress makes your body produce cortisol which has many negative effects on the body including being a testosterone killer. Try meditating, exercising, deep breathing and other lifestyle changes to keep stress down and cortisol in check.
Mental status changes including excess aggression are a well known phenomenon in the context of anabolic steroid abuse (Perry et al 1990). An increase in self-reported aggressive behaviors have also been reported in one double blind placebo controlled trial of testosterone in young hypogonadal men (Finkelstein et al 1997), but this has not been confirmed in other studies (Skakkebaek et al 1981; O’Connor et al 2002). Aggression should therefore be monitored but in our experience is rarely a significant problem during testosterone replacement producing physiological levels.
The T Trials will serve as a prelude to lengthier and more robust trials in the future. More results from the T Trials are now coming in and overall results were mixed, with testosterone replacement associated with some benefits and some risks. More research needs to be done to figure out the balance of these potential benefits and risks as well as the precise clinical utility of testosterone treatment.
Some anti-aging physicians also use sublingual ( taken under the tongue) forms of non-bioidentical testosterone like oxandrolone. I took oxandrolone with a physician’s guidance for about two weeks, and I got pimples and hair loss. I quit and was bummed that it didn’t generate enough impact to write a blog post about it. I have continued to recommend bioidentical testosterone since.
If you’re an older man with low testosterone and interested in taking testosterone, this decision should be carefully considered with your physician. Your physician will be able to better assess the balance of your conditions and whether hormone replacement could put you at potential risk. It's a bad idea for anybody to engage in hormone supplementation without the supervision of a physician. Just because hormones occur naturally in the body does not mean that they can be taken without negative effects.
The regulation of testosterone production is tightly controlled to maintain normal levels in blood, although levels are usually highest in the morning and fall after that. The hypothalamus and the pituitary gland are important in controlling the amount of testosterone produced by the testes. In response to gonadotrophin-releasing hormone from the hypothalamus, the pituitary gland produces luteinising hormone which travels in the bloodstream to the gonads and stimulates the production and release of testosterone.

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.

Ben has mentioned APOE many times, as in this podcast, with the reference in this transcript as something like 34/44. I’ve always assumed that meant a number of different genes that related to APOE having the homozygous or heterzygous mutations. I’ve only been able to find one rs in my 23andme raw data that seems meaningful to this, rs429358. How do you all figure out your APOE status? Are you getting this from one of the other companies that analyzes part of your raw data for you?
The study population in these TTrials included men aged 65 years or older with mean morning serum testosterone concentrations of 275 ng/dL or less and symptoms of impaired sexual function, physical function, or vitality. These trials were placebo-controlled and the testosterone treatment group received 1% testosterone gel at variable doses adjusted to maintain plasma testosterone at levels normal for young men (500-800 ng/dL).
If you haven’t hit your twenties yet then you probably can’t imagine losing your interest in sex. I feel you, Holmes.  At 26, I have a healthy appetite now (partially because I consciously work on elevating my T) but it’s nowhere near where it was when I was 17.  I imagine that things will only get worse by the time I’m 35 which is why it’s important to learn what gets your motor firing now.
Statins are some of the most prescribed drugs in the world for reducing cholesterol levels and preventing heart disease. Various studies in the 1990s, including a study published in the ‘European Journal of Clinical Nutrition,’ supported the claim that Fenugreek could help reduce cholesterol levels[2]. One possible explanation is the high fiber content in fenugreek.  A fiber-rich diet has been shown to help reduce the levels of LDL (‘bad’ cholesterol) in your blood. (Note: The validity of the various studies from the 1990s have been questioned though because of small sample sizes[3])
My entire presentation was focused on 32 different ways to increase testosterone naturally, with no injections or hormone replacement protocols required. I'm not against bioidentical hormone replacement therapy (BHRT), but I do think one should explore as many natural alternatives as possible first. Or, for even more bang for the buck, pair BHRT with the tactics you'll discover in this episode.
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.
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
Watch out for ingredients that interfere with blood clotting If you are taking any kind of blood medication, take aspirin or ibuprofen, or have any kind of blood-related condition, you’ll want to consult your doctor before taking any of these supplements. Fenugreek, Forskolin, and Acetyl-L-carnitine are just a few of the ingredients that can make these situations worse and increase your chances of bruising and bleeding.
Professional-athlete-turned-biohacker Maximilian Gotzler gave a speech about boosting testosterone at the 2015 Bulletproof Conference. He started by leading the room through the Haka, a Maori war dance that New Zealand’s pro rugby team has made popular. The Pasadena Conference Center trembled as over 100 people shouted and stomped in unison. It was awesome.
The reliable measurement of serum free testosterone requires equilibrium dialysis. This is not appropriate for clinical use as it is very time consuming and therefore expensive. The amount of bioavailable testosterone can be measured as a percentage of the total testosterone after precipitation of the SHBG bound fraction using ammonium sulphate. The bioavailable testosterone is then calculated from the total testosterone level. This method has an excellent correlation with free testosterone (Tremblay and Dube 1974) but is not widely available for clinical use. In most clinical situations the available tests are total testosterone and SHBG which are both easily and reliably measured. Total testosterone is appropriate for the diagnosis of overt male hypogonadism where testosterone levels are very low and also in excluding hypogonadism in patients with normal/high-normal testosterone levels. With increasing age, a greater number of men have total testosterone levels just below the normal range or in the low-normal range. In these patients total testosterone can be an unreliable indicator of hypogonadal status. There are a number of formulae that calculate an estimated bioavailable or free testosterone level using the SHBG and total testosterone levels. Some of these have been shown to correlate well with laboratory measures and there is evidence that they more reliably indicate hypogonadism than total testosterone in cases of borderline biochemical hypogonadism (Vermeulen et al 1971; Morris et al 2004). It is important that such tests are validated for use in patient populations relevant to the patient under consideration.

Another study in 2015 by Melville and friends gave subjects either three or six grams of DAA per day for a 14 days (2 weeks). Researchers noted that the 3g dose of D-aspartic acid did not result in any meaningful changes in testosterone levels (or any other anabolic hormones for that matter).[3] However, the group of men receiving 6g per day experienced a significant reduction in both total testosterone and free testosterone levels, with no concurrent change in other hormones tested.[3]
For men with low blood testosterone levels, the benefits of hormone replacement therapy usually outweigh potential risks. However, for most other men it's a shared decision with your doctor. It offers men who feel lousy a chance to feel better, but that quick fix could distract attention from unknown long-term hazards. "I can't tell you for certain that this raises your personal risk of heart problems and prostate cancer, or that it doesn't," Dr. Pallais says.
Let me start out by saying that I didn't notice anything for about the first 10 days. After week 2, I had moderate energy increases buy by far the most noticeable difference for me was in the bedroom. After using this product for over a moth now, I normally run out of energy before I run out of "stamina". This will be a permanent regimen for my daily supplements from now on. I take 4 a day. 2 in the morning and 2 about 5pm. I thought about lowering the dosage to see if it had the same effect, but for the price, why? LOL.
I had been on testosterone cyperonate 250-300 mg every 2 weeeksfor one year when diagnosed as having hypercythemic. I was cut of treatments immediately. Scanned from head to toe side to side. All clear. My urologist refuses to resume any HRT as my total testosterone is 701 immunoassay. However, he never mentions my Free % T value of 1.3. The labs range is 1.6-2.9. SHGB =70.6. Albumin 4.1. Is not the Free T we should be concerned with? Do I not need to go “Uologist Hunting”????
Low testosterone levels have a dramatic effect on emotional state. The American Academy of Family Physicians lists depression, impaired cognition and increased fatigue as symptoms of low testosterone production, or hypogonadism. Testosterone replacement therapy for hypogonadal men has successfully reduced negative moods relating to fatigue and depression while increasing feelings of self-esteem. Increasing testosterone in eugonadal men has also shown positive emotional benefits such as increased feelings of self-esteem and reduction of fatigue. The intensity of these benefits is dependent on dosage; a wide body of literature on testosterone increase has shown that at higher dosage aggression, and aggressive response, can become pronounced.
The content here is for information purposes only. By delivering the information contained herein is does not mean preventing, diagnosing, mitigating, treating or curing any type of medical condition or disease. When beginning any natural supplementation regiment or integrative treatment, the advice of professionally licensed healthcare providers is advisable to seek.
“Life for the winner is more glorious. It enters the next round of competition with already elevated testosterone levels, and this androgenic priming gives it an edge that increases its chances of winning yet again. Through this process an animal can be drawn into a positive-feedback loop, in which victory leads to raised testosterone levels which in turn leads to further victory.”
So much to say, take a look at excelmale.com. it is a resource for men like us that give answers, science and dialogue which addresses our questions. It’s a great resource for men like us. Also, I would say to eliminate blue light before bed from tv and pc screens. Simply use blue light blocking glasses or F.lux from the play store. Also get outside in the sun in the AM. The goal is to restore the circadian rhythm which impacts hormone productiion.
Test1fy comes in with one of the most unique formulas containing ingredients that not only support testosterone increases and lean mass gains, but also help in increasing hunger making it the perfect addition to anyone’s natural bulking stack. It is overall a well rounded and potent formula making it perfect for anyone, from newbie to the seasoned veteran.
Ginger rhizome powder was reported to posses an antioxidant and androgenic activity in doses of 50 mg/kg and 100 mg/kg daily [1]. Ginger administration significantly increased serum testosterone levels at 100 mg/kg [1]. There was also an increases in testosterone at 50 mg/kg daily but it failed to reach statistical significance [1]. A study by Kamtchouing et al. [2] also reported significantly increased serum and testicular testosterone levels as well as increase in weight of the testis and testicular cholesterol level in healthy rats. Another study using doses of 500 mg/kg and 1000 mg/kg indicated that extract of Zingiber officinale possesses pro-fertility properties [3]. Compared with the controls there was a dose and duration dependent increases in the serum testosterone levels and seminal quality [3]. At a very high dose (2000 mg/kg for 35 days), ginger led to slightly reduced weights of testes which might be due to negative feedback reaction from androgenic activity [4]. Combination of ginger and zinc appears to further increase testosterone in rats [24].

Research shows that bone density increases with testosterone treatment as long as the dose is high enough. on the effect of testosterone on bone density found increases in spinal and hip bone density. Another of females transitioning into males found that testosterone increased bone mineral density. But it’s unknown if testosterone can help with reducing fracture risk.

In 1927, the University of Chicago's Professor of Physiologic Chemistry, Fred C. Koch, established easy access to a large source of bovine testicles — the Chicago stockyards — and recruited students willing to endure the tedious work of extracting their isolates. In that year, Koch and his student, Lemuel McGee, derived 20 mg of a substance from a supply of 40 pounds of bovine testicles that, when administered to castrated roosters, pigs and rats, remasculinized them.[183] The group of Ernst Laqueur at the University of Amsterdam purified testosterone from bovine testicles in a similar manner in 1934, but isolation of the hormone from animal tissues in amounts permitting serious study in humans was not feasible until three European pharmaceutical giants—Schering (Berlin, Germany), Organon (Oss, Netherlands) and Ciba (Basel, Switzerland)—began full-scale steroid research and development programs in the 1930s.
Testosterone may prove to be an effective treatment in female sexual arousal disorders,[52] and is available as a dermal patch. There is no FDA approved androgen preparation for the treatment of androgen insufficiency; however, it has been used off-label to treat low libido and sexual dysfunction in older women. Testosterone may be a treatment for postmenopausal women as long as they are effectively estrogenized.[52]
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.
Binge drinking on the other hand does impact Testosterone levels – especially on a short term basis. Two studies (22 & 23) show that large acute quantities of alcohol consumption in a short period led to decreases in Testosterone levels by a whooping 20-23% after 24hours! Note however this is drinking to extreme excess! Likewise, chronic alcohol abuse is known to reduce testosterone more notably (as seen in alcoholics).
Another benefit of the increased muscle mass was that I got stronger. My bench press, squat, and deadlift all enjoyed significant gains during my experiment. It’s great to be able to bench press 225 pounds again for 5 sets of 5 like I used to in high school, and I’m on track to beat my maxes on the bench and squat that my 18-year-old self set over 12 years ago.
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.
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.
Testoshred stands out as a muscle hardening testosterone booster as it first combines 3 clinically studied and effective testosterone boosting agents with the powerful estrogen reducer Arimistane. The addition of Arimistane helps to prevent the conversion of testosterone to estrogen resulting in higher testosterone levels, while increasing muscle hardness and reducing body fat.

Longitudinal studies in male aging studies have shown that serum testosterone levels decline with age (Harman et al 2001; Feldman et al 2002). Total testosterone levels fall at an average of 1.6% per year whilst free and bioavailable levels fall by 2%–3% per year. The reduction in free and bioavailable testosterone levels is larger because aging is also associated with increases in SHBG levels (Feldman et al 2002). Cross-sectional data supports these trends but has usually shown smaller reductions in testosterone levels with aging (Feldman et al 2002). This is likely to reflect strict entry criteria to cross-sectional studies so that young healthy men are compared to older healthy men. During the course of longitudinal studies some men may develop pathologies which accentuate decreases in testosterone levels.
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]
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!
Another recent development is the production of adhesive tablets which are applied twice daily to the buccal mucosa on the gum above the incisor teeth. The tablets gradually release testosterone into the systemic venous circulation and steady state physiological concentrations are achieved in most patients within two days (Ross et al 2004). Some patients do not like the feeling of the tablet in the mouth or find that there is an abnormal taste in the mouth, but local adverse effects are usually mild and transient (Wang, Swerdloff et al 2004).
In fact, high cortisol deals a crushing blow to testosterone in two ways. During, long-lasting stress, high amounts of cortisol release very often and have a direct negative influence on T levels. Thus, cortisol inhibits testosterone synthesis in the testes and hypothalamus. In addition, the production of cortisol is impossible without cholesterol. But testosterone synthesis also demands cholesterol. Since during stress cholesterol is first of all used for making cortisol, T levels simply plummet.
The use of these supplements can help to burn fat and build muscles. As a result, the health and strength of your muscles and bones improve that ultimately leads to a strong and healthy body. Another prominent feature of Testosterone Booster is that it can help to elevate mood and energy. These supplements contains a powerful blend of natural herbs. These natural herbs have healthful properties. Thus, you can have the energy and stamina to perform your best in the gym. Furthermore, these supplements will also help you to increase your productivity at work because of your improved energy levels.
When it comes to testosterone in the body, most of it is bound testosterone. This means it is testosterone that is bound to either the sex hormone globulin or the protein albumin. The problem is this bound up testosterone goes largely unused by the body and does nothing for you in its bound state. It is the free testosterone that is the testosterone you feel and that makes you manly, this is free flowing in your veins and not bound to anything. This is the kind of testosterone you want, the more the better.
The normal development of the prostate gland is dependent on the action of testosterone via the androgen receptor, and abnormal biosynthesis of the hormone or inactivating mutations of the androgen receptor are associated with a rudimentary prostate gland. Testosterone also requires conversion to dihydrotestosterone in the prostate gland for full activity. In view of this link between testosterone and prostate development, it is important to consider the impact that testosterone replacement may have on the prevalence and morbidity associated with benign prostatic hypertrophy (BPH) and prostate cancer, which are the common conditions related to pathological growth of the prostate gland.

I am 41, T was tested at 400 last month. I was Very active /hyper growing up. I have felt my strength and energy fade over the last 10 years to the point that i now take a nap in the afternoon. Sexual performance has been on a steep decline since 35 to the point of disfunction with out herbal pills or cialis. Also had 2 kids in last 5 years,(second marriage) , and at times have a hard time tolerating the stresses due to lack of energy to cope with the increased emotional load.
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.
Sportsmen are permitted to use the boosters to trigger the mechanism of testosterone synthesis in the body. These products won a wide popularity among the sportsmen. The matter is that the supplements work by substantially enhancing sports performance, reviving strength, boosting endurance, coping with excessive stress levels, and decreasing time necessary for recovery after exhausting exercises.
This common kitchen spice can actually play a role in testosterone production.  It has been said that through supplementing with ginger, that users have the ability to not only increase testosterone production naturally, but also improve sexual function and drive, improve sperm health, as well as increasing sperm count.  This is great for infertile men as well as those looking for another avenue when it comes to boosting natural testosterone levels.  

A man with shrinking levels of testosterone actually may lose some body hair. Testosterone replacement therapy comes with a few potential side effects, including acne and breast enlargement. Testosterone patches may cause minor skin irritation. Topical gels may be easier to use, but great care must be taken to avoid transferring testosterone to someone else though skin-to-skin contact.
Mood disturbance and dysthymia are part of the clinical syndrome of hypogonadism. Epidemiological studies have found a positive association between testosterone levels and mood, and depressed aging males have lower testosterone levels than controls (Barrett-Connor, Von Muhlen et al 1999). Furthermore, induction of a hypogonadal state during treatment of men for prostate cancer leads to an increase in depression scores (Almeida et al 2004). Trials of testosterone treatment effects on mood have varied in outcome. Data on the effects on men with depression are conflicting (Seidman et al 2001; Pope et al 2003) but there is evidence that testosterone treatment of older hypogonadal men does result in improvements in mood (Wang et al 1996) and that this may occur through changes in regional brain perfusion (Azad et al 2003).
Sexual arousal - boosting testosterone can improve sexual arousal, even if you have normal testosterone levels. Higher levels of testosterone can make it easier for you to get aroused and can boost your sex drive generally. While this doesn’t affect the physical action of your erections, if you are not getting hard because you’re not aroused then boosting testosterone could help.
Watch out for ingredients that interfere with blood clotting If you are taking any kind of blood medication, take aspirin or ibuprofen, or have any kind of blood-related condition, you’ll want to consult your doctor before taking any of these supplements. Fenugreek, Forskolin, and Acetyl-L-carnitine are just a few of the ingredients that can make these situations worse and increase your chances of bruising and bleeding.
Rest and recovery is just as important as exercise, if not more so. Every time you do an intense workout, give yourself a minimum of 2 days to recuperate afterward, if not more. And don’t mix exercise with sleep hacking. If you’re exercising, get at least 8 hours of sleep every night. Your body uses it to rebuild, and you can throw your hormones out of whack if you don’t rest up properly. Here’s a more in-depth guide to Bulletproof weight training, complete with sample workouts.

Use natural grooming products. Most grooming products these days contain parabens, another type of xenoestrogen. And by most, I mean more than 75% of all products. To reduce my exposure as much as possible, I became a hippy during my experiment and started using all natural, paraben-free grooming products. You can find most of these items at most health food stores:
Vitamin D3 has the ability to naturally boost testosterone levels.  Increasing serum vitamin D levels in the body can help increase testosterone production, allowing you to potentially build muscle at a faster rate. If you don’t live in an area of the world that allows for a good amount of sunlight, you could become deficient and could benefit from a vitamin D supplement.
If you haven’t hit your twenties yet then you probably can’t imagine losing your interest in sex. I feel you, Holmes.  At 26, I have a healthy appetite now (partially because I consciously work on elevating my T) but it’s nowhere near where it was when I was 17.  I imagine that things will only get worse by the time I’m 35 which is why it’s important to learn what gets your motor firing now.

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.

In 2003, an Institute of Medicine panel concluded that there was insufficient evidence supporting the benefits of testosterone in older men and recommended further research. Consequently, in 2010, the National Institute of Aging, which is part of the NIH, launched the Testosterone Trials (T Trials) to figure out whether testosterone can help with symptoms associated with low levels of testosterone secondary to older age (i.e., symptomatic hypogonadism).
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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