The medical conditions that cause excess testosterone are rare, argues Drincic. "Many people mistake the symptoms of anabolic steroid abuse with symptoms of high testosterone,” he says. Anabolic steroids, which are sometimes abused by athletes and body builders, are synthetic versions of the male hormone testosterone. They can cause behavior and mood changes that include rage, paranoia, irritability, and poor judgment.
I’ve been reading all these comments and replies here. This was a great article and if it does anything, it should stimulate you to talk to your physician. Your Dr. can take blood and have it annylized, then prescribe the proper direction to take. A lot of people here have been giving free advice, but who knows your system best? Am I going to take advice from someone who doesn’t know anything other than the symptoms I present? I’m not, but what if I’m allergic?
‘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.
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“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.”

If men’s brain, muscles, and bones are being affected daily due to low testosterone, and it is what makes men, men, why aren’t we doing more about this serious health problem? Could there be a political correctness crept in the scientific community that is hindering newly invigorated research in this area? I thought that scientific inquiry suppose to go where the evidence leads. It appears that some honest experts are opening their eyes to this truth.

Testosterone is only one of many factors that influence aggression and the effects of previous experience and environmental stimuli have been found to correlate more strongly. A few studies indicate that the testosterone derivative estradiol (one form of estrogen) might play an important role in male aggression.[66][71][72][73] Studies have also found that testosterone facilitates aggression by modulating vasopressin receptors in the hypothalamus.[74]
Conflicting results have been obtained concerning the importance of testosterone in maintaining cardiovascular health.[29][30] Nevertheless, maintaining normal testosterone levels in elderly men has been shown to improve many parameters that are thought to reduce cardiovascular disease risk, such as increased lean body mass, decreased visceral fat mass, decreased total cholesterol, and glycemic control.[31]
Are you getting enough vitamin D? Vitamin D is an essential nutrient, but it can be difficult for people to know if they are getting the right amount. Some people will be able to get enough vitamin D from sunlight. Others may need to make dietary changes or take supplements. Here, we explain how to get vitamin D from sunlight, food, and supplements. Read now
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.
Known as the "male hormone," testosterone is produced primarily by the testicles. "Beginning around age 30, testosterone levels begin to decline naturally and continue to do so as a man ages," says Holly Lucille, ND, RN, a naturopathic doctor, educator, and author, "sometimes leading to low testosterone symptoms such as depressed moods, decreased sex drive, erectile dysfunction, and difficulties with concentration and memory.”
A previous meta-analysis has confirmed that treatment of hypogonadal patients with testosterone improves erections compared to placebo (Jain et al 2000). A number of studies have investigated the effect of testosterone levels on erectile dysfunction in normal young men by inducing a hypogonadal state, for example by using a GnRH analogue, and then replacing testosterone at varying doses to produce levels ranging from low-normal to high (Buena et al 1993; Hirshkowitz et al 1997). These studies have shown no significant effects of testosterone on erectile function. These findings contrast with a similar study conducted in healthy men aged 60–75, showing that free testosterone levels achieved with treatment during the study correlate with overall sexual function, including morning erections, spontaneous erections and libido (Gray et al 2005). This suggests that the men in this older age group are particularly likely to suffer sexual symptoms if their testosterone is low. Furthermore, the severity of erectile dysfunction positively correlates with lower testosterone levels in men with type 2 diabetes (Kapoor, Clarke et al 2007).

Cross-sectional studies have not shown raised testosterone levels at the time of diagnosis of prostate cancer, and in fact, low testosterone at the time of diagnosis has been linked with more locally aggressive and malignant tumors (Massengill et al 2003; Imamoto et al 2005; Isom-Batz et al 2005). This may reflect loss of hormone related control of the tumor or the effect of a more aggressive tumor in decreasing testosterone levels. One study found that 14% of hypogonadal men, with normal digital rectal examination and PSA levels, had histological prostate cancer on biopsy. It is possible that low androgen levels masked the usual evidence of prostate cancer in this population (Morgentaler et al 1996). Most longitudinal studies have not shown a correlation between testosterone levels and the future development of prostate cancer (Carter et al 1995; Heikkila et al 1999; Stattin et al 2004) but a recent study did find a positive association (Parsons et al 2005). Interpretation of such data requires care, as the presentation of prostate cancer could be altered or delayed in patients with lower testosterone levels.

The other interesting thing about the study: men’s testosterone levels were lowest in March (at the end of winter) and highest in August (at the end of summer). Sunlight affects your vitamin D production, so you have seasonal dips and peaks. Get a blood test to check your levels, and if you’re low, take a high-quality vitamin D3 supplement. If you’re going to take D3, take vitamin K2 and vitamin A with it. The three work in sync, so you want them all to be balanced. Here are my dosage recommendations.
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.

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.
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).
In males, the testosterone test can help find the reason for sexual problems, like reduced sex drive or erectile dysfunction. If you’re having a hard time getting your partner pregnant, the test can tell if your blood testosterone level is low. It can also screen for problems with the hypothalamus or pituitary gland. This controls how much testosterone your body makes.
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.
Erectile dysfunction is a common finding in the aging male. A prevalence of over 70% was found in men older than 70 in a recent cross-sectional study (Ponholzer et al 2005). Treatment with phosphodiesterase-5 (PDE-5) inhibitors is proven to be effective for the majority of men but some do not respond (Shabsigh and Anastasiadis 2003). The condition is multi-factorial, with contributions from emotional, vascular, neurological and pharmacological factors. The concept of erectile dysfunction as a vascular disease is particularly interesting in view of the evidence presented above, linking testosterone to atherosclerosis and describing its action as a vasodilator.

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.
While steroids like DHEA can be used to boost testosterone, if used in the wrong dosages or by people who don’t need them they can raise T-levels far beyond the normal range, which is what causes accelerated muscle gain. According to Dr. Emil Hodzovic, who is a competitive bodybuilder as well as a doctor with Medichecks, steroids come with “a set of risks, including liver damage, hormone imbalance, high blood pressure, and a higher risk of a stroke or heart attack”.
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.
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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.
A meta-analysis of nine randomized controlled trials [31] evaluated effects of ginger on net changes in blood glucose and lipid concentrations (total cholesterol, triglyceride, low-density lipoprotein cholesterol, high density lipoprotein cholesterol).  In a total of 609 adults with T2DM or hyperlipidemia, ginger supplementation led to significant reductions in plasma levels of total cholesterol, triglycerides, and blood glucose, but non-significant reduction in LDL-c levels.
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?
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.
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.
I know the experiment didn’t simply bring me back to my pre-August levels because of the fact that when I learned that the original test I took can sometimes overestimate your T levels, I took a more accurate test around four months after the start of the experiment (I’ve continued the lifestyle changes made during the experiment) and my total T had gone up again to 826.9 ng/dL.

Much like female hormone replacement, you should never, never ever use conjugated equine estrogen and synthetic progestins. Those two coupled together are evil twins. It is not hormone replacement that is the issue in men or women. The issue is the type of hormone used and doctors not knowing what they are doing. I always use bio-identical hormones. Synthetics are not the proper administration of any hormone program.


February 22, 2018 - Since our last review, the manufacturers of two of our top picks have gone out of business, and some new testosterone boosters have entered the arena. We’ve updated this review to evaluate the current field of testosterone supplements, as well as beef up analysis on what kind of results you can expect from t-boosters. Our only current top pick, Beast Sports Nutrition, is a new player in the industry that contains all four of the ingredients with studies showing a positive effect on testosterone.


This is the best BCAA supplement ever created.  You see this is not your typical BCAA supplement that all the other supplement companies sell.  Those products are simply free-form amino acids made by some Chinese manufacturer and packaged in the United States.  Free form amino acid supplements have been around since the 1980’s and they have never been proven to be helpful in building muscle mass.  In fact after whey protein came out in the 90’s it really made BCAA amino acids obsolete because whey protein contains over 30% BCAA.  If you want more BCAA’s simply use another scoop of whey protein instead of BCAA powder.  Its cheaper, tastes better, and contains plenty of BCAA plus all the other amino acids.  Ok so now that I have convinced you that free form BCAA’s supplements are pretty much worthless let me tell you about our new Advanced BCAA’s.
The other problem researchers run into when studying the benefits of testosterone is distinguishing between “cause” and “effect.” Is it T that’s providing all these great health benefits or does simply being healthy give you optimal levels of testosterone? It’s tricky because in some instances the answer is “both.” Testosterone (like all hormones) often plays a part in a “virtuous cycle” that regulates a whole host of  processes in our bodies — as you increase T, you get healthier; as you get healthier, your T levels rise. It can also play a part in a “vicious cycle” — as your T levels go down, your health suffers; as your health suffers, your T levels decrease even more.
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Carbs play a big part in determining your Testosterone levels. Let's start with what to avoid. First, research shows that a large serving of sugar (75g of glucose), decreased Testosterone levels by as much as 25%! (25 & 26). I know this is a pretty extreme dosage, but you may want to avoid massive servings of sugar! Also, men who have Metabolic syndrome have lower Testosterone levels (27). Metabolic syndrome is often brought about by chronic high blood sugar which leads to insulin resistance.
You may be interested in boosting your testosterone levels if your doctor says you have low levels, or hypogonadism, or need testosterone replacement therapy for other conditions. If you have normal testosterone levels, increasing your testosterone levels may not give any additional benefits. The increased benefits mentioned below have only been researched in people with low testosterone levels.
At the present time, it is suggested that androgen replacement should take the form of natural testosterone. Some of the effects of testosterone are mediated after conversion to estrogen or dihydrotestosterone by the enzymes aromatase and 5a-reductase enzymes respectively. Other effects occur independently of the traditional action of testosterone via the classical androgen receptor- for example, its action as a vasodilator via a cell membrane action as described previously. It is therefore important that the androgen used to treat hypogonadism is amenable to the action of these metabolizing enzymes and can also mediate the non-androgen receptor actions of testosterone. Use of natural testosterone ensures this and reduces the chance of non-testosterone mediated adverse effects. There are now a number of testosterone preparations which can meet these recommendations and the main factor in deciding between them is patient choice.
Well, this is another area of confusion and great debate, but I don’t think it’s as confusing as it appears to be in the literature. When most doctors learned about testosterone in medical school, they learned about total testosterone, or all the testosterone in the body. But about half of the testosterone that’s circulating in the bloodstream is not available to the cells. It’s tightly bound to a carrier molecule called sex hormone–binding globulin, which we abbreviate as SHBG.
I have been on Testosterone and semorilin for 3 years now and just wanted to talk on what for me is the BIGGEST side effect NO ONE talks about. In those 3 years I have seen my body transformed in every way. I have such DRIVE and AMBITION I can’t believe it I look and act 30 years younger. I have a GF 25 years younger than me and she can’t keep up! I am very sexually active especially for my age.
Lean beef, chicken, fish, and eggs are some of your options. Tofu, nuts, and seeds have protein, too. Try to get about 5 to 6 ounces per day, although the ideal amount for you depends on your age, sex, and how active you are. When you don't eat enough of these foods, your body makes more of a substance that binds with testosterone, leaving you with less T available to do its job.
To find the best testosterone booster, we collected every supplement available on BodyBuilding.com, and cross-checked our list against the top results on best of lists like MensFitness, BroScience, and BodyNutrition. We only looked at pills since some of the ingredients in testosterone boosters have a reputation for tasting bad, and powders just prolong the experience. There are a lot — 133 of them to be precise — and they all claim to boost testosterone levels. Testosterone (for men) is “thought to regulate sex drive (libido), bone mass, fat distribution, muscle mass and strength, and the production of red blood cells and sperm.” If a supplement can increase your natural testosterone levels, the rest should follow. As we mentioned above, it’s not that simple, and at best, you’ll experience only a short-lived boost.
After years of low libido,ED and just general lack of energy I found a urogist will to look at my symptoms. Turned out my testosterone level was 135 so I started on testosterone. Had a great improvement on everything I was having issues plus just a lot happier. My Dr. did PSA every 6 months and my PSA over almost 2 years went from 1.16 to 1.67, still pretty low for 56YOA He wanted to do a biopsy and he found 1 out of 12 cores 60%, GS3X3. I had an MRI and found a .5cm cancer, clean margins, perfectly round and dead center of the prostate.I’m doing active surviellance and the DR wants to start me on Finasteride and continue TRT. I like to believe that the years of low testosterone help the cancer to develope and the twice yearly testing of PSA by the doctor because of therapy caught it very early.I’m not too sure about TRT and Finasteride together.
Testosterone is the primary male sex hormone and an anabolic steroid. In male humans, testosterone plays a key role in the development of male reproductive tissues such as testes and prostate, as well as promoting secondary sexual characteristics such as increased muscle and bone mass, and the growth of body hair.[2] In addition, testosterone is involved in health and well-being,[3] and the prevention of osteoporosis.[4] Insufficient levels of testosterone in men may lead to abnormalities including frailty and bone loss.
If you're completely inactive, or if you're completely burned out from overly intense training, neither one is going to help your T-levels. And when it comes to nutrition, eating enough—and getting adequate dietary fats—are both essential for healthy testosterone levels, and for general health.[2] In "All About Testosterone," Chris Lockwood, Ph.D., notes that extreme low-calorie dieting and fasting will hinder testosterone levels from staying at their peak, along with better-known villains like chronic stress.
Before assessing the evidence of testosterone’s action in the aging male it is important to note certain methodological considerations which are common to the interpretation of any clinical trial of testosterone replacement. Many interventional trials of the effects of testosterone on human health and disease have been conducted. There is considerable heterogenicity in terms of study design and these differences have a potential to significantly affect the results seen in various studies. Gonadal status at baseline and the testosterone level produced by testosterone treatment in the study are of particular importance because the effects of altering testosterone from subphysiological to physiological levels may be different from those of altering physiological levels to supraphysiological. Another important factor is the length of treatment. Randomised controlled trials of testosterone have ranged from one to thirty-six months in duration (Isidori et al 2005) although some uncontrolled studies have lasted up to 42 months. Many effects of testosterone are thought to fully develop in the first few months of treatment but effects on bone, for example, have been shown to continue over two years or more (Snyder et al 2000; Wang, Cunningham et al 2004).
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.
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.
Exercise is the original testosterone booster, and it’s one of the most powerful full-body hacks around. Men see a sharp increase in both testosterone and human growth hormone (HGH) after lifting weights, and the boost is greater with shorter rest time between sets (1 minute rest outperforms 3 minutes rest) [9]. With the shorter rest time, women also get a large boost in HGH.

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.
Men who watch a sexually explicit movie have an average increase of 35% in testosterone, peaking at 60–90 minutes after the end of the film, but no increase is seen in men who watch sexually neutral films.[43] Men who watch sexually explicit films also report increased motivation, competitiveness, and decreased exhaustion.[44] A link has also been found between relaxation following sexual arousal and testosterone levels.[45]
Vitamin D is arguably the most important vitamin when it comes to testosterone. A study published in the Journal of Clinical Endocrinology examined the relationship between vitamin D supplementation and testosterone levels in men. The authors found that participants with higher levels of vitamin D had significantly higher levels of free testosterone compared to those with insufficient levels of vitamin D.8 Based on these study results, it appears vitamin D has a strong relationship with testosterone levels.
Magnesium comes with a strict upper cap. Excess magnesium is hard on your kidneys, and can lead to kidney failure. The NIH recommends that men consume 400-420 mg of magnesium daily, but that they should not exceed 350 mg of supplemental magnesium per day. Because while it’s rare for people to chronically overdose on magnesium through diet (you’d have to eat a lot of almonds and spinach, for example), overdose by supplement is far more common.

Alphamax XT’s testosterone boosting formula is so potent that they had to include an estrogen blocker in the formula. User’s have reported that the product’s effects rivals a hardcore pre-workout in terms of aggression and intensity. When the workout is done user’s have also been reporting accelerated muscle recovery, fat loss, and increased muscle definition.
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.
Zinc is an essential mineral that plays an important role in improving testosterone levels as well as sperm production. Oysters are rich sources of this mineral. An increase in testosterone levels also helps improve your sexual desire and energy, which means that you are going to derive more pleasure from your sexual encounters besides having higher chances of conceiving.
And remember, saturated fats work best (along with monounsaturated fats – olive oil, almonds, avocados etc.). In fact higher intakes of polyunsaturated fats (canola oil, sunflower oil, soybean oil, safflower oil, margarine etc.) are linked to LOWER testosterone levels (14 & 15). I explore the dangers of PUFA's in a lot more detail in this article - PUFA's: The Worst Thing For Your Health That You Eat Everyday.
When patients ask about risks, I remind them that they already have testosterone in their system and that the goal of testosterone treatment is to restore its concentration back to what it was 10 or 15 years previously. And the molecule itself that we give is identical to the one that their bodies make naturally, so in theory, everything should be hunky-dory. But in practice, there are always some curveballs.
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.

The amount of testosterone synthesized is regulated by the hypothalamic–pituitary–testicular axis (see figure to the right).[133] When testosterone levels are low, gonadotropin-releasing hormone (GnRH) is released by the hypothalamus, which in turn stimulates the pituitary gland to release FSH and LH. These latter two hormones stimulate the testis to synthesize testosterone. Finally, increasing levels of testosterone through a negative feedback loop act on the hypothalamus and pituitary to inhibit the release of GnRH and FSH/LH, respectively.
Hormonal Imbalance can affect your personal and work relationships. Some of the most noticeable symptoms prompting patient's to seek out medical care are a complete lack of energy and sheer fatigue, loss of sex drive, erectile dysfunction or soft erections, loss of lean muscle mass and bone strength, rapid weight gain, excessive adipose fatty tissue, disturbed sleep patterns, depression, moodiness, social withdrawal, reduced ability to recover from workouts, flabby muscles, lack of strength and endurance.
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]
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.

The mechanism of age related decreases in serum testosterone levels has also been the subject of investigation. Metabolic clearance declines with age but this effect is less pronounced than a reduction in testosterone production, so the overall effect is to reduce serum testosterone levels. Gonadotrophin levels rise during aging (Feldman et al 2002) and testicular secretory responses to recombinant human chorionic gonadotrophin (hCG) are reduced (Mulligan et al 1999, 2001). This implies that the reduced production may be caused by primary testicular failure but in fact these changes are not adequate to fully explain the fall in testosterone levels. There are changes in the lutenising hormone (LH) production which consist of decreased LH pulse frequency and amplitude, (Veldhuis et al 1992; Pincus et al 1997) although pituitary production of LH in response to pharmacological stimulation with exogenous GnRH analogues is preserved (Mulligan et al 1999). It therefore seems likely that there are changes in endogenous production of GnRH which underlie the changes in LH secretion and have a role in the age related decline in testosterone. Thus the decreases in testosterone levels with aging seem to reflect changes at all levels of the hypothalamic-pituitary-testicular axis. With advancing age there is also a reduction in androgen receptor concentration in some target tissues and this may contribute to the clinical syndrome of LOH (Ono et al 1988; Gallon et al 1989).
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