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).


“The Andro 400 has been a plus to my daily requirements of energy, stamina and weight loss. I have seen a noticeable reduction in my waistline from a 40" waist to a 37" waist. I am 6'6" and weighed 252, I now weigh 238 and feel much better. Without too much information, my sex drive and performance has been positively enhanced with greater sensitivity and stamina during those intimate times with my wife. Greater sensation, pleasure and results are evident.”

Important future developments will include selective androgen receptor modulators (SARMs). These drugs will be able to produce isolated effects of testosterone at androgen receptors. They are likely to become useful clinical drugs, but their initial worth may lie in facilitating research into the relative importance of testosterone’s action at the androgen receptor compared to at other sites or after conversion to other hormones. Testosterone will remain the treatment of choice for late onset hypogonadism for some time to come.
• In a trial of men with anemia, 58% percent were no longer anemic after a year of therapy, compared to 22% who received a placebo. In addition, testosterone therapy was associated with higher hemoglobin levels. Hemoglobin is a protein in the blood that carries oxygen from the lungs to other areas of the body. It also brings carbon dioxide back to the lungs.

Forged Methyl EAA stands out as it has a special concentrated derivative of D-Aspartic Acid (DAA) which is touted as being 50 times more effective than normal DAA. The formula is so strong that Transform supplements had to put an estrogen blocker as when your testosterone levels get boosted very high, your body will start to convert it to estrogen. It comes with a hefty price tag but many users have considered it to be hands down the strongest on the market.
We kept it simple, and followed the premise of testosterone boosters: testosterone affects muscle gain, weight loss, and libido, so by increasing the amount of testosterone in the body, we can improve on each of those goals. This meant that we looked for ingredients proven to increase testosterone levels, not ingredients that might increase libido or help build muscle mass independently of testosterone (like having a healthy diet and feeling good about yourself). In addition, we dove deep into the specific ingredient lists of our finalists and cross-checked them against WebMD and the National Institutes of Health (NIH) database to make sure that they did not contain ingredients known to be harmful.
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…

if you’re a physician, you’re the real one who’s playing doctor. Stop prescribing low T treatment and let your patients go to a real doctor and not continue suffering. A simple picture of how hormones are created and their pathways will make you understand that E follows T, when we increase T, E2 will follow which negates all the positive effects of treatment. Without understanding this, you better leave the patient alone.


If you have low testosterone, your functional medicine or anti-aging physician will help you diagnose it. There are several different hormones your physician should measure, but the most important two are your free testosterone and estrogen levels, because converting too much testosterone to estrogen is a problem that’s different from not making enough testosterone in the first place. In my case, I wasn’t making very much testosterone, and what I was making my body converted to estrogen way too effectively.

Actually he knows exactly what he is talking about. The fact your a doctor gives zero confidence that you have any knowledge in HRT, in fact I believe it where you wonderful doctors that started the larger opioid epedemic the world has ever seen. Make sure if your considering HRT you see a doctor that specializes in it, otherwise you very well could be getting terrible advice by a doctor with no knowledge of the subject as is the case here. Do your research on the doctor, and make sure you are getting a doctor that specializes in HRT. Don’t forget somebody had to finish at the bottom of the class in med school, and based on this doctors comments he probably was one of them. Doctors can be as dangerous as they are helpful; as we have seen quite clearly with the opioid epidemic being experienced in this country, as I mentioned above. This epidemic was caused 100% by doctors in this country. I own several HRT clinics and employ some of the top doctors in the HRT field. Our doctors put our patients health above all else especially above the all mighty dollar. I assure you the comment by this Dr. claiming the post above makes absolutely no sense (I believe it makes no sense to him, because he has zero knowledge on the subject) is dead wrong, and the poster was pretty much right on point with what he said.


Most studies support a link between adult criminality and testosterone, although the relationship is modest if examined separately for each sex. Nearly all studies of juvenile delinquency and testosterone are not significant. Most studies have also found testosterone to be associated with behaviors or personality traits linked with criminality such as antisocial behavior and alcoholism. Many studies have also been done on the relationship between more general aggressive behavior/feelings and testosterone. About half the studies have found a relationship and about half no relationship.[66] However, later it was found out that testosterone activates dominant, aggressive behavior if at the same time a person has high testosterone and low levels of cortisol in the blood. Conversely, a high level of testosterone and high levels of cortisol do not stimulate dominant behavior. Because cortisol inhibits the action of testosterone.[67][68][69][70] This is probably why the results of the experiments were inconsistent.
Sergeant Steel is arguably the strongest testosterone booster on the market as it combines 16 effectively dosed ingredients that support testosterone increases and estrogen reduction. It’s not often that you come across a product that combines all of the top ingredients and provides you with their proper dosages. Users have been reporting strong increases in libido, strength, sense of well being, muscle hardness, and improved recovery. If you are looking for a no-holds barred test booster, look no further than Sergeant Steel.
The most popular way is to combine with a good tasting protein powder. Advanced BCAA’s taste very bitter due to the high amount of peptides. Peptides taste very bitter. You want to use 1 tsp of Advanced BCAA’s with every serving of protein powder. This will really upgrade the quality of the protein powder by adding BCAA, AND in peptides form. If you are using a whey protein you’ll increase the overall BCAA content by over 20%
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.
Ginger is also often found in joint support supplements. There is little well-designed research, however, ginger was reported to have some effectiveness for relieving joint pain of osteoarthritis (OA) and rheumatoid arthritis probably due to its anti-inflammatory [17,18,21] and anti-oxidant activity [17,18]. In a meta-analysis of five trials (593 patients) ginger was found to be modestly efficacious and reasonably safe for treatment of OA and was able to reduce pain and disability [32].
The potential downside of this positive feedback loop, Coates argues, is that testosterone levels can eventually surge past optimal levels and have the opposite effect – leading to overconfidence and poor decision-making. When this happens to animals, Coates, observed, they “go out in the open, pick too many fights [and] patrol areas that are too large…Risk taking becomes risky behaviour.”

^ David KG, Dingemanse E, Freud JL (May 1935). "Über krystallinisches mannliches Hormon aus Hoden (Testosteron) wirksamer als aus harn oder aus Cholesterin bereitetes Androsteron" [On crystalline male hormone from testicles (testosterone) effective as from urine or from cholesterol]. Hoppe-Seyler's Z Physiol Chem (in German). 233 (5–6): 281–83. doi:10.1515/bchm2.1935.233.5-6.281.
Testosterone boosters are used by many athletes worldwide to achieve a significant muscle mass increase within a short period of time.[1] However; one cannot be completely confident in terms of the quality and efficacy of such products because of several reasons, such as the possibility of bad storage conditions and originating from an unreliable source. Over the years, some consumers of testosterone boosters have complained of kidney and liver abnormalities that could be linked to their use of boosters.[10] Cases of erroneous product administration have occurred in the past as athletes may not follow the instructions on the label fully, which can lead to many side effects.[11] In the present case, a man was admitted to a hospital because of a severe abdominal pain. The pain was later found to be caused by liver injury. The diagnosis confirmed that the levels of the key hepatic enzymes were markedly elevated. The medical complications observed were found to have occurred following the consumption of two courses of a commercial testosterone booster. According to researchers based in the US, about 13% of the annual cases of acute liver failure are attributable to idiosyncratic drug- and/or supplement-induced liver injury.[12] Marked increase in the levels of ALT, AST, and gamma-glutamyl transferase was observed after consuming the first course of the commercial testosterone booster, and they started to decline after the 2nd and 3rd course. This abruptly increases the levels of liver enzymes after the first course may be attributed to the interruption effect of commercial testosterone booster on liver function as a result of the effects of its ingredients.
Cross-sectional studies conducted at the time of diagnosis of BPH have failed to show consistent differences in testosterone levels between patients and controls. A prospective study also failed to demonstrate a correlation between testosterone and the development of BPH (Gann et al 1995). Clinical trials have shown that testosterone treatment of hypogonadal men does cause growth of the prostate, but only to the size seen in normal men, and also causes a small increase in prostate specific antigen (PSA) within the normal range (Rhoden and Morgentaler 2005). Despite growth of the prostate a number of studies have failed to detect any adverse effects on symptoms of urinary obstruction or physiological measurements such as flow rates and residual volumes (Snyder et al 1999; Kenny et al 2000, 2001). Despite the lack of evidence linking symptoms of BPH to testosterone treatment, it remains important to monitor for any new or deteriorating problems when commencing patients on testosterone treatment, as the small growth of prostate tissue may adversely affect a certain subset of individuals.
Every vitamin, mineral, and ingredient that affects the human body can be taken in enough quantities that they are harmful, or toxic, even the ones that — at lower levels — are beneficial or necessary. Unfortunately, testosterone boosters contain a lot of ingredients that are not well understood. This means in addition to not being able to confirm whether certain ingredients increase testosterone, the scientific and medical communities also don’t know at what levels many ingredients become toxic. On the up side, you might need to eat several pounds of a particular leafy plant before it becomes harmful. On the down side, it could be significantly less that pushes you over your body’s limit. We simply don’t know how little or how much the human body can tolerate. We recommend keeping your doctor in the loop when you add any supplement with unproven ingredients into your diet — they’ll be able to help you find and track any undesired side-effects that these ingredients might cause.

Sergeant Steel is arguably the strongest testosterone booster on the market as it combines 16 effectively dosed ingredients that support testosterone increases and estrogen reduction. It’s not often that you come across a product that combines all of the top ingredients and provides you with their proper dosages. Users have been reporting strong increases in libido, strength, sense of well being, muscle hardness, and improved recovery. If you are looking for a no-holds barred test booster, look no further than Sergeant Steel.
In summary it’s important to know that this topic is still hotly debated, and there are a lot of inconsistencies in the data. We do know that soy contains phytoestrogens and does seem to have a lot of affects on the body, including some studies that show decreased Testosterone levels. For that reason (and the fact that it tastes like ass) I avoid it, and I recommend you also avoid it (in particular soy isolates!) if you’re seeking higher testosterone.
“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."
ZMA (unnecessary). So when I researched how to increase testosterone, a supplement called ZMA kept popping up. It’s a blend of zinc, magnesium, and vitamin B6. The purported benefits of ZMA include better and deeper sleep which indirectly is supposed to increase testosterone. Zinc and magnesium are necessary minerals in testosterone production, so a mega-dose should be useful, right? Well, no. I bought some and took it during the duration of experiment. I should have done some more research before I made the purchase. While one study in 1998 showed increased strength among athletes taking ZMA, two recent studies (study 1, study 2) have shown that it has absolutely no effect on total or free testosterone levels. Crap. My advice, unless you have a zinc and magnesium deficiency, no need to waste your money on this.
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.
“She” being the key word. I had to quit a female doc because even though my level was down to 200, she thought I just needed more vitamin D! When I tried that and came back a few weeks later and told her there was no change in how I felt she refused to order another blood test, and after that wouldn’t even see me. I would never trust a female doctor with testosterone replacement therapy, as they all seem to have the same shit attitude from what my friends have told me, they treat it like it’s not a real thing even though you better bow down and kiss their asses when it comes to breast cancer and menopause.
2009 had heart attack, placed coronary stent, everything okay. Put on statins to keep lipid levels down to prevent further artery blockage. One year later developed Peyronie’s disease, low sex drive, fatigue, testicles withdrawn and hurting. Testosterone level was 85. Diagnosed with hypogonadism. Started Androgel, felt normal after a couple of weeks. I believe statins is the cause of my low T, you need lipids for hormone transport. Androgel could only bring my T level in the 250 range. Switched to Axiron (better, less messy), and my T level stays around 500 range. I get samples of Testim every now and then, it has a manly woody fragrance that women like. At present, I’m feeling a little fatigue, and mild dehydration. My lab work is always normal, except my red blood cells is always on the high side, almost abnormal. Next week I am going to donate some blood, to bring my RBC count down, and see if that will help.

Always worry of side effects i.e. prostate cancer! Also feels like I am doping like a pro-cyclist (hate cheaters) Without it my muscles and joints stiffens so painfully, fuzzy and somewhat depressed, when pushing very hard while exercising the sensations become bizarre and again so incredibly painful — it feels so good after the injection if I had waited too long!
Testosterone may help you woo a woman. In the animal kingdom, higher testosterone levels have long been shown to be associated with a male’s dominance in the competition for mates. But a recent study has shown this is true for human males as well. When a pair of men were instructed to compete for the affection of an attractive female undergraduate, the men’s assertiveness, ability to control the conversation, and ultimately, their chances of having the woman say she “clicked” with them most, were positively associated with their pre-competition testosterone levels. So there is truth to the idea that men with swagger get the girl, and this self-assuredness may be partly rooted in T.
Lets touch on these individually. Gluten has been shown to increase prolactin levels in male mice (48 & 49). Increased prolactin levels in males leads to all sorts of horrible things: Man Boobs (50), High inflammation (51), and most importantly, higher prolactin levels have been shown to be testosterone lowering and lead to shrinking of the testicle (52).

During the second trimester, androgen level is associated with sex formation.[13] This period affects the femininization or masculinization of the fetus and can be a better predictor of feminine or masculine behaviours such as sex typed behaviour than an adult's own levels. A mother's testosterone level during pregnancy is correlated with her daughter's sex-typical behavior as an adult, and the correlation is even stronger than with the daughter's own adult testosterone level.[14]


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.

^ Southren AL, Gordon GG, Tochimoto S, Pinzon G, Lane DR, Stypulkowski W (May 1967). "Mean plasma concentration, metabolic clearance and basal plasma production rates of testosterone in normal young men and women using a constant infusion procedure: effect of time of day and plasma concentration on the metabolic clearance rate of testosterone". The Journal of Clinical Endocrinology and Metabolism. 27 (5): 686–94. doi:10.1210/jcem-27-5-686. PMID 6025472.
With the ever-increasing interest in IGF-1, a growing number of legal, over-the-counter supplements have emerged which are aimed at amplifying the body’s own supply of this age-reversing hormone. The most common tend to be in the form of deer antler velvet extracts, delivered as a spray, due to the naturally occurring IGF-1 contained in the velvet itself.
Lets touch on these individually. Gluten has been shown to increase prolactin levels in male mice (48 & 49). Increased prolactin levels in males leads to all sorts of horrible things: Man Boobs (50), High inflammation (51), and most importantly, higher prolactin levels have been shown to be testosterone lowering and lead to shrinking of the testicle (52).
I am sorry but if you are a doctor you really are making it obvious that it’s possible for doctors to know nothing about this problem.What kind of Doctor are you? Or did you get a doctorate in some obscure field? Are you a reverend doctor by chance? I think for the sake of people who need this help you should quit talking out your ass .I won’t say you are wrong.You have already proved you don’t know anything useful about HRT and I doubt you are a doctor.
Testosterone is a steroid from the androstane class containing a keto and hydroxyl groups at the three and seventeen positions respectively. It is biosynthesized in several steps from cholesterol and is converted in the liver to inactive metabolites.[5] It exerts its action through binding to and activation of the androgen receptor.[5] In humans and most other vertebrates, testosterone is secreted primarily by the testicles of males and, to a lesser extent, the ovaries of females. On average, in adult males, levels of testosterone are about 7 to 8 times as great as in adult females.[6] As the metabolism of testosterone in males is greater, the daily production is about 20 times greater in men.[7][8] Females are also more sensitive to the hormone.[9]
When testosterone and endorphins in ejaculated semen meet the cervical wall after sexual intercourse, females receive a spike in testosterone, endorphin, and oxytocin levels, and males after orgasm during copulation experience an increase in endorphins and a marked increase in oxytocin levels. This adds to the hospitable physiological environment in the female internal reproductive tract for conceiving, and later for nurturing the conceptus in the pre-embryonic stages, and stimulates feelings of love, desire, and paternal care in the male (this is the only time male oxytocin levels rival a female's).[citation needed]
“I can't tell you how good the product is! I'm in the best shape of my life. I used to take blood pressure medication and I don't even take that anymore. It's changed every aspect of my life. I was a 40 waist and I'm down to a 36. I'm 54 years old, and people tell me I look better than I ever have, and I look like I'm in my early 40s! And I'm telling you it's the Andro. This product is so much better than even the advertisements! From taking Andro400 I immediately notice a burst of energy . . . and my skin color, my sexual advancements, my energy, plus the weight loss, the toning of the body, and the increase strength and endurance . . . it's like night and day where I was then and where I am now, and Andro400 has made the difference. And my wife also takes it, 1 pill every other day, and she has experienced an amazing transformation in her body alone, with her hair, her complexion, and as well as in the gym. It's an outstanding product. My customers, my friends, my family, everybody is noticing the difference!” 

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
Testosterone causes prostate cancer. Since the 1940s, it was commonly believed in the medical field that high testosterone levels were the cause of prostate cancer in men. Doctors reached this conclusion because two scientists in 1941 noticed that prostate cancer regressed in a patient after they castrated him and his T levels subsequently declined. This conclusion was based on the results from a single patient!

Eggs often come up in reproductive health discussion. This time we’re talking about dietary eggs, as in omelets, and the role they play in boosting testosterone. The hormone boost from eggs comes primarily from the yolks, which are rich in dietary cholesterol, mono- and saturated fats—nutrients once demonized by health experts that have since proven to positively influence waistlines and hormone-health.
When testosterone and endorphins in ejaculated semen meet the cervical wall after sexual intercourse, females receive a spike in testosterone, endorphin, and oxytocin levels, and males after orgasm during copulation experience an increase in endorphins and a marked increase in oxytocin levels. This adds to the hospitable physiological environment in the female internal reproductive tract for conceiving, and later for nurturing the conceptus in the pre-embryonic stages, and stimulates feelings of love, desire, and paternal care in the male (this is the only time male oxytocin levels rival a female's).[citation needed]

Men can experience a range of symptoms if testosterone decreases more than it should. Low testosterone, or low T, is diagnosed when levels fall below 300 nanograms per deciliter (ng/dL). A normal range is typically 300–1000 ng/dL, according to the U.S. Food and Drug Administration. A blood test called a serum testosterone test is used to determine your level of circulating testosterone.
I highly recommend using a great essential amino acid mix post-exercise in order to boost testosterone.  These essential amino acids and especially the concentrated branched chain amino acids leucine, isoleucine and valine stimulate muscle protein synthesis.  Getting these amino acids in the post-workout window dramatically boosts testosterone production (14).  I like using our Amino Strong and will often recommend a scoop pre-workout and post-workout for the best muscle building, testosterone boosting benefits.
‘Testosterone boosting’ products  - found online, or in health food or body-building shops, these products claim to boost testosterone levels if you buy them. The majority of these products will not have the effect you want and are not worth spending money on. Any of these products that do have a real effect may have a form of prescription medication in which is both dangerous and illegal.
With the help of the three main ingredients, you have the ability to naturally raise your free testosterone levels giving you an increase in strength, muscle mass, stamina, and libido.  NutriSuppz Ultra Test aims to help you sleep better, burn fat easier, and feel energized, and have improved mental alertness.  Another perk of NutriSuppz Ultra Test is that it is a fully transparent profile with no proprietary blends—allowing you to know exactly what you are getting in each dose.
The researchers found that men who received hormone treatment experienced an increase in bone strength and density. Strength increases were greater in the spine than they were in the hip. However, as with other T Trials, more research needs to be done. A larger study over many years would need to be performed to determine whether testosterone could decrease risk of bone fracture.
“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."
The effect excess testosterone has on the body depends on both age and sex. It is unlikely that adult men will develop a disorder in which they produce too much testosterone and it is often difficult to spot that an adult male has too much testosterone. More obviously, young children with too much testosterone may enter a false growth spurt and show signs of early puberty and young girls may experience abnormal changes to their genitalia. In both males and females, too much testosterone can lead to precocious puberty and result in infertility. 
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