Testosterone levels naturally rise in response to sexual arousal and activity. Men with higher levels of testosterone usually have greater sexual activity. Older men need more testosterone for libido and erectile function. But it’s important to note that erectile dysfunction is often due to other conditions or medications rather than low testosterone levels.
A4M, which stands for “The American Academy of Anti-Aging Medicine” is dedicated to the advancement of tools, technology, and transformations in healthcare that can detect, treat, and prevent diseases associated with aging. They promote the research of practices and protocols that have the potential to optimize the human aging process. The organization is also dedicated to educating healthcare professionals and practitioners, scientists, and members of the public on biomedical sciences, breakthrough technologies, and medical protocols through our advanced education entity: Metabolic Medical Institute (MMI). Their event in Vegas each year is, in my opinion, well worth checking out.

Over time, the testicular “machinery” that makes testosterone gradually becomes less effective, and testosterone levels start to fall, by about 1% a year, beginning in the 40s. As men get into their 50s, 60s, and beyond, they may start to have signs and symptoms of low testosterone such as lower sex drive and sense of vitality, erectile dysfunction, decreased energy, reduced muscle mass and bone density, and anemia. Taken together, these signs and symptoms are often called hypogonadism (“hypo” meaning low functioning and “gonadism” referring to the testicles). Researchers estimate that the condition affects anywhere from two to six million men in the United States. Yet it is an underdiagnosed problem, with only about 5% of those affected receiving treatment.

I am 50 yrs old. I tried to go the route my urologist provide of 50mgs of injectable test weekly. No man can live on that dose. For the past five years I have self administered injectable cyponate at the rate of 250 mgs to 750 mgs weekly. Non stop , no breaks. I have polycythemia from these injections. I give blood every 8 weeks to combat this. I have administered 10 X the recommended dose with no bad side effects. I get full blood work done yearly. Doctors are so scared they will get sued if something happens that they wont give you enough. Its a shame.
If you have low testosterone and are prescribed testosterone therapy by your doctor, it does not increase your risk for getting prostate cancer. However, in some patients with existing prostate cancer, adding testosterone hormone therapy can make the cancer grow faster. Men with low testosterone levels are actually more likely to get prostate cancer than men with normal prostate levels. You need to discuss these details with your physician and make the best decision for you.

The problem with testosterone therapy is several reasons you may have to stop taking it.Despite what you hear the chance of enlarged prostate is very real.It happened to me.Also blood too thick only cure by phlebotomy(having blood drawn more often than you will probably want to be harpooned to thin blood.) I didn’t sleep well either(especially as trips to bathroom got more frequent from BPH)then you really need several labs getting estradiol and testosterone levels correct and hcg and arimidex in the mix also (or Clomid) but dht issues are very real and not addressed in most try protocol.finisteride has many bad side effects as does avodart. Testosterone therapy is great for some people but if you’re low normal like I was I wish I would have left well enough alone. Our bodies have a lot more hormones to balance than just testosterone and estradiol and the crash can be a little rough if you have to stop. Be smart and have Clomid,Adex,and hcg on hand just in case.Good luck to all on trt(and those stopping it)
Inaccurate or misinterpreted test results can either falsely diagnose or miss a case of testosterone deficiency. Your testosterone level should be measured between 7 am and 10 am, when it's at its peak. Confirm a low reading with a second test on a different day. It may require multiple measurements and careful interpretation to establish bioavailable testosterone, or the amount of the hormone that is able to have effects on the body. Consider getting a second opinion from an endocrinologist.
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In females, this test can find the reason you’re missing periods, not having periods, or having a hard time getting pregnant. Doctors can also use it to diagnose polycystic ovary syndrome (PCOS). That’s a hormone problem that can cause irregular periods and make it hard to get pregnant. A testosterone test can also reveal if you might have a tumor in your ovaries that affects how much of the hormone your body produces.

The sad truth, is that these purported testosterone support products were completely and utterly useless. They did absolutely nothing for testosterone production due to the simple fact that they didn’t contain any ingredients shown in human research trials to actually support testosterone production. Sure, they included all sorts of ancient herbs and botanical extracts that worked well in rats, but nary a compound that would actually benefit a real live human being.

This doesn’t mean Super Test is perfect — we take a closer look at some of its ingredients below — but it beats out the competition. Every other supplement we looked at either didn’t have all four ingredients, overdosed us on vitamins or minerals (a good way to develop kidney and liver problems), contained ingredients that would harm us, or some combination thereof.
The biggest problem with supplementing your testosterone levels is it can shut off your own natural production and it can also permanently lower your sperm count. Taking testosterone boosters may also leave you open to some of the other unwanted side effects, like acne, male pattern baldness, mood swings and aggressive behaviour. To give yourself the best possible chance of avoiding these side effects, you need to see an expert before going for boosters.
There is a large body of evidence linking the onset and/or progression of cardiovascular disease to low testosterone levels in men. It is now apparent that an increased cardiovascular risk and accelerated development of atherosclerosis occurs not only in elderly men or men with obesity or type 2 diabetes mellitus, but also in non-obese men with hypogonadism.14 Current best evidence from systematic review of randomized controlled trials suggests that testosterone use in hypogonadal men is relatively safe in terms of cardiovascular health and do not produce unfavorable elevations in blood pressure or glycemic control, and does not adversely effect lipid profiles.4,15
“We need carbs, fats, and proteins to have optimal T levels,” says Howse. A healthy amount of carbs, for example, keeps cortisol levels low (more on why this is important to come). Meanwhile, dietary fats produce cholesterol, which our body can later convert into testosterone. And, finally, protein supports body composition by enhancing muscle repair and growth and increasing satiety.
Hello everyone. First off, thank you Dr. Abraham Morgentaler, for the excellent and refreshing article. I do not intend to spill my guts about symptoms or values on here as it has already been done so many times over. I will say that I am an RN BSN and have been on HRT for going on 6 yrs. I live in Oklahoma and when I first started noticing symptoms I knew something was wrong and began to do research myself. With an initial level of 241 no doctor here at that time, would even consider HRT as I was only 35ish at the time.

However, testosterone is only one of many factors that aid in adequate erections. Research is inconclusive regarding the role of testosterone replacement in the treatment of erectile dysfunction. In a review of studies that looked at the benefit of testosterone in men with erection difficulties, showed no improvement with testosterone treatment. Many times, other health problems play a role in erectile difficulties. These can include:
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.
The science backs up the soldier’s self discovery, in fact, exposure to radiation (whether it’s from an army radar or the cell phone in your pocket, or the wifi router in your house) has been shown to lower sperm quality, fertility and testosterone. This is true not only for military personnel (88, 89,90) but all males living in a modern world (91).
There have been a number of smaller studies on men receiving testosterone-replacement therapy, and if you look at the results cumulatively, the rate of prostate cancer in these men was about 1% per year. If you look at men who show up for prostate cancer screening, same sort of age population, the rate tends to be about the same. You have to be cautious in comparing studies and combining the results, but there’s no signal in these results that testosterone-replacement therapy creates an unexpectedly high rate of prostate cancer.
The maximum hormone concentration in the blood is reported immediately after the workout. And the effect lasts throughout the day. However, it’s important to ensure that your physical activity is moderate. The matter is that too much high-intensity exercise can give an undesirable result. But even if for any reason you can’t attend a gym, it’s not a problem. Just move as much as possible during the day. Even simple walking will be of great benefit.

Like other steroid hormones, testosterone is derived from cholesterol (see figure).[128] The first step in the biosynthesis involves the oxidative cleavage of the side-chain of cholesterol by cholesterol side-chain cleavage enzyme (P450scc, CYP11A1), a mitochondrial cytochrome P450 oxidase with the loss of six carbon atoms to give pregnenolone. In the next step, two additional carbon atoms are removed by the CYP17A1 (17α-hydroxylase/17,20-lyase) enzyme in the endoplasmic reticulum to yield a variety of C19 steroids.[129] In addition, the 3β-hydroxyl group is oxidized by 3β-hydroxysteroid dehydrogenase to produce androstenedione. In the final and rate limiting step, the C17 keto group androstenedione is reduced by 17β-hydroxysteroid dehydrogenase to yield testosterone.
With the exception of increasing my fat and cholesterol intake, my diet wasn’t that unconventional. I didn’t follow a strictly low-carb or Paleo diet because recent research has suggested that a diet high in protein and low in carbs actually causes T levels to decrease. With that said, I was judicious with the carbs. I tried to get most of my carbs from veggies and fruit, but I didn’t freak out if my wife made us spaghetti for dinner.
There are positive correlations between positive orgasm experience in women and testosterone levels where relaxation was a key perception of the experience. There is no correlation between testosterone and men's perceptions of their orgasm experience, and also no correlation between higher testosterone levels and greater sexual assertiveness in either sex.[34]
There is a large body of evidence linking the onset and/or progression of cardiovascular disease to low testosterone levels in men. It is now apparent that an increased cardiovascular risk and accelerated development of atherosclerosis occurs not only in elderly men or men with obesity or type 2 diabetes mellitus, but also in non-obese men with hypogonadism.14 Current best evidence from systematic review of randomized controlled trials suggests that testosterone use in hypogonadal men is relatively safe in terms of cardiovascular health and do not produce unfavorable elevations in blood pressure or glycemic control, and does not adversely effect lipid profiles.4,15
Testosterone is the main hormone associated with muscle mass, strength gains, and libido. But that's far from the only thing it does in the body. As Chris Lockwood, Ph.D., explains in the article "All About Testosterone," it impacts everything from mood and memory to bone health—but yes, to be clear, it also makes muscles bigger and stronger, and helps increase endurance and athletic performance.
In addition to conjugation and the 17-ketosteroid pathway, testosterone can also be hydroxylated and oxidized in the liver by cytochrome P450 enzymes, including CYP3A4, CYP3A5, CYP2C9, CYP2C19, and CYP2D6.[159] 6β-Hydroxylation and to a lesser extent 16β-hydroxylation are the major transformations.[159] The 6β-hydroxylation of testosterone is catalyzed mainly by CYP3A4 and to a lesser extent CYP3A5 and is responsible for 75 to 80% of cytochrome P450-mediated testosterone metabolism.[159] In addition to 6β- and 16β-hydroxytestosterone, 1β-, 2α/β-, 11β-, and 15β-hydroxytestosterone are also formed as minor metabolites.[159][160] Certain cytochrome P450 enzymes such as CYP2C9 and CYP2C19 can also oxidize testosterone at the C17 position to form androstenedione.[159]
Pellets. Your doctor will place the testosterone pellets under the skin of your upper hip or buttocks. Your doctor will give a shot of local anesthesia to numb your skin, then make a small cut and place the pellets inside the fatty tissues underneath your skin. This medication dissolves slowly and is released over about 3-6 months, depending on the number of pellets. 
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It is hard to know how many men among us have TD, although data suggest that overall about 2.1% (about 2 men in every 100) may have TD. As few as 1% of younger men may have TD, while as many as 50% of men over 80 years old may have TD. People who study the condition often use different cut-off points for the numbers, so you may hear different numbers being stated.
Oral ginger was reported to accelerate gastric emptying and stimulate gastric motility (spontaneous movements of the stomach that aid in digestion). Most studies report some beneficial effect on gastric emptying time but mostly during some sort of disease state [10,11]. In healthy individuals ginger also seems to increase gastric emptying via antral contraction stimulation [12]. However, Phillips and colleagues [13] reported that ginger is not associated with an effect on gastric emptying. In animals, ginger and its active constituent [6]-Gingerol were reported to enhance gastrointestinal tract transit [14].
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.
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!
So, this past summer I talked with my doctor about starting T injections to see if that would work. I started injection 1 small bottle every 2 weeks. I started some time in later July, 2016. After around the 3 injection I had a blood test and my T level was OVER 800, something like 832. Apparently, my body reacted and took to it very quickly and easily, but the T level was now TOO high. So, I extended the injection interval to 18 days instead of 15 days. I just had another blood test last week and my T level was in the mid 600’s. It’s better now, but my doctor and I want to get that down to around 500, so I’m going to 20-21 days and see what happens.
Now that we know chronic insulin spikes lead to lower Testosterone production, I hope I haven’t sent you running into the low carb camp! There are a few studies out there showing that long term low carb or ketogenic dieting leads to higher cortisol levels (especially with subjects who are training), and decreased testosterone levels (28 & 29). I have used low carb diets in the past with successful results (winning a national bodybuilding title), however the key is to use cyclical carb re-feeds. If you’re going to go on a low carb diet for whatever reason, be sure to work in a large carb reefed once a week.
The unsexy truth is that increasing T naturally simply comes down to making some long-term changes in your diet and lifestyle. As you’ll see, what I did to increase T largely boils down to eating better, exercising smarter, and getting more sleep. That’s pretty much it. But as with most things in life, the devil is in the details, so I’ll share with you exactly what I did and provide research that explains why the things I did helped boost my testosterone.
The one side effect that no one talks about is psychological for me. Because I am 67 years old and suddenly look, feel and act 37 I only want to be around younger people. I have no use associating with people my own age. I have nothing in common and even look different. This year at my class reunion was a glaring example…..no doubt I looked younger than anyone, but it is sooo much more than just very that. My customers are young, all my girlfriends and associates. This all has a large effect on my mind. It’s hard to grasp suddenly looking and acting 30 years younger than your friends. My mind is so confused about how old I really am. I do a lot of adrenalin sports for my age snow ski, wake-surf, wake-board, scuba dive and it is no doubt just a matter of time till I get hurt doing these wild sports. In my mind I’m 37 so I think it’s all normal. This whole experience has been incredible and very positive with the only one psychological effect and no other physical side effect.

Exercise boosts testosterone in two important ways. First, specific types of exercise actually cause our body to produce more testosterone. We’ll talk more about those in a bit. Second, exercise helps to increase muscle mass and decrease body fat. As we’ve discussed previously, adipose tissue converts testosterone into estrogen. The less fat we get, the more T we have.

In a placebo-controlled study, 27 Division II football players received either a placebo or a ZMA supplement for a total of seven weeks during their scheduled spring practice. At the end of the seven weeks, the players taking the ZMA supplement had a 30 percent increase in testosterone, while the placebo group had a 10 percent decrease. The ZMA group also saw an 11.6 percent increase in strength, compared to only 4.6 percent in the placebo group.[7]

I noticed that you say that those that have prostate cancer should not have testosterone replacement therapy, Why-in light of the studies that say that there is no danger from testosterone therapy to one that had/has prostate cancer? If this is your opinion do you have any suggestions as to what I should do about my symptoms? Does testosterone replacement therapy actually do anything?
Side note, insurance rarely will cover it and cause a long paper trail to even approve it which is unfortunate and disheartening. Especially when it is done out of network. Currently I have found a place to supply all of the aboue sent to my house at approximately $200.00 per month. Still an unfortunate cost for a medical reason that the insurance companies don’t approve. Best of luck to all of you.
Let’s do a quick review of what I shared in the introduction to this series. August of last year was a tough month for me, primarily because of a huge and grueling project we were in the midst of here on the site. I was stressed out and my sleeping, healthy eating habits, and workout regimen all suffered. At the end of the month I got my testosterone levels tested and found that my total T was 383 ng/dL and my free T was 7.2 pg/mL – close to the average for an 85-100-year-old man.

As with cognitive effects, previous studies examining CVD changes following testosterone treatment have been conflicting and inconclusive. Dr. Budoff and his research team used coronary computed tomographic angiography (CCTA) to assess 138 men, including 73 treated with testosterone and 65 receiving placebo, for changes in coronary artery plaque volume after 1 year.
Jeff- I read your post and I can relate to your problem. Perhaps you’ve already received some help but I can tell you this much. I recovered from prostate cancer about 2 yrs ago. My oncologist is also a graduate of Harvard like the doc that wrote this article. He put me on Axiron about 8 months ago after I complained to him of symptoms similar to you. He has no concerns that the T will cause me to get prostate cancer again. I do my 4 month check ups and have my T tested at that time along with my PSA. Everything is normal so far. My T count was initially 50 and now I am in the low 300 range. The Axiron has gotten me back to normal and then some!! I’m 58 and I told him at my last appt that I feel like I’m 40.

Hi Douglas, this is a great question, thanks for reaching out. Apart from having a solid training plan that’s suited to your current level of fitness, and goals, you can also use a quality Testosterone Booster which could give you the lift you need to get back into the gym. If you find it difficult to swallow tablets, you can always empty the capsule into a glass of water, juice, or coffee to make it easier to take.


i have been on T therapy for 32 years now after being diagnosed with Klinefelters. Recently my pharmacy had been non responsive to my request to refill and they flat out refused/declined the request from my doctor which was T powder mixed with a cream base that you place on the shoulder. I asked if I could purchase it with cash and they told me that the FDA is not approving this usage anymore but did not provide an option. Completely out now for close to a week and have been working for five weeks trying to get again. Now what to do, I’m having all kinds of weird feelings including anxiety to the max, nervous, irritable, muscle cramps/pains … I guess they just don’t care that we cannot get something our bodies have adjusted too for many years. Strange thing is I think I have found a compounding pharmacy in Houston Texas that will fill this Rx. I’m not sure how one can do this and another cannot especially if they have compounding capabilities. Now I’m wondering if I can get thru this and stop taking it alltogether however I already know I’m seeing signs of being forgetful, lack of energy and foggy brain. I wonder if this will ever stop. The really bad thing is that I’m traveling for work and cannot get into my doctor’s office. This whole process is not great. I can only imagine what a person must feel taking hard drugs then not getting any all at once.
This paper will aim to review the current evidence of clinical effects of testosterone treatment within an aging male population. As with any other clinical intervention a decision to treat patients with testosterone requires a balance of risk versus benefit. We shall try to facilitate this by examining the effects of testosterone on the various symptoms and organs involved.
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