Most Americans today are sleep deprived, which may be a contributing factor to declining testosterone levels in men. See, our body makes nearly all the testosterone it needs for the day while we’re sleeping. That increased level of T that we experience at night is one of the reasons we wake up with “Morning Wood.” (If you don’t have Morning Wood on a consistent basis, you might have low T).

Our clients love the results and energy they’ve get once their hormonal levels are fully balanced. Because hormones are so important, we’re proud to lend our medical expertise to ensure all our hormonal treatments are tailored to your specific needs. If you’re curious about NHT, you can take a short quiz to see if NHT would be a good fit for your body.
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.
Zaima, N., Kinoshita, S., Hieda, N., Kugo, H., Narisawa, K., Yamamoto, A., ... Moriyama, T. (2016, September). Effect of dietary fish oil on mouse testosterone level and the distribution of eicosapentaenoic acid-containing phosphatidylcholine in testicular interstitium. Biochemistry and Biophysics Reports, 7, 259–265. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5613343/
Transdermal preparations of testosterone utilize the fact that the skin readily absorbs steroid hormones. Initial transdermal preparations took the form of scrotal patches with testosterone loaded on to a membranous patch. Absorption from the scrotal skin was particularly good and physiological levels of testosterone with diurnal variation were reliably attained. The scrotal patches are now rarely used because they require regular shaving or clipping of scrotal hair and because they produce rather high levels of dihydrotestosterone compared to testosterone (Behre et al 1999). Subsequently, non-scrotal patches were developed but the absorptive capacity of non-scrotal skin is much lower, so these patches contain additional chemicals which enhance absorption. The non-scrotal skin patches produce physiological testosterone levels without supraphysiological dihydrotestosterone levels. Unfortunately, the patches produce a high rate of local skin reactions often leading to discontinuation (Parker and Armitage 1999). In the last few years, transdermal testosterone gel preparations have become available. These require daily application by patients and produce steady state physiological testosterone levels within a few days in most patients (Swerdloff et al 2000; Steidle et al 2003). The advantages compared with testosterone patches include invisibility, reduced skin irritation and the ability to adjust dosage, but concerns about transfer to women and children on close skin contact necessitate showering after application or coverage with clothes.
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To get your levels into the healthy range, sun exposure is the BEST way to optimize your vitamin D levels; exposing a large amount of your skin until it turns the lightest shade of pink, as near to solar noon as possible, is typically necessary to achieve adequate vitamin D production. If sun exposure is not an option, a safe tanning bed (with electronic ballasts rather than magnetic ballasts, to avoid unnecessary exposure to EMF fields) can be used.

ALABAMA - ALASKA - ARIZONA - ARKANSAS - CALIFORNIA - COLORADO - CONNECTICUT - DELAWARE - FLORIDA - GEORGIA - HAWAII - IDAHO - ILLINOIS - INDIANA - IOWA - KANSAS - KENTUCKY - LOUISIANA - MAINE - MARYLAND - MASSACHUSETTS - MICHIGAN - MINNESOTA - MISSISSIPPI - MONTANA - NEBRASKA - NEW HAMPSHIRE - NEW YORK - NEW JERSEY - NEW MEXICO - NEVADA - NORTH CAROLINA - NORTH DAKOTA - OHIO - OKLAHOMA - OREGON - PENNSYLVANIA - RHODE ISLAND - SOUTH CAROLINA - SOUTH DAKOTA - TENNESSEE - TEXAS - UTAH - VERMONT - VIRGINIA - WASHINGTON - WASHINGTON DC - WEST VIRGINIA - WISCONSIN - WYOMING


Low testosterone levels can cause mood disturbances, increased body fat, loss of muscle tone, inadequate erections and poor sexual performance, osteoporosis, difficulty with concentration, memory loss and sleep difficulties. Current research suggests that this effect occurs in only a minority (about 2%) of ageing men. However, there is a lot of research currently in progress to find out more about the effects of testosterone in older men and also whether the use of testosterone replacement therapy would have any benefits.

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:

^ Mehta PH, Jones AC, Josephs RA (Jun 2008). "The social endocrinology of dominance: basal testosterone predicts cortisol changes and behavior following victory and defeat" (PDF). Journal of Personality and Social Psychology. 94 (6): 1078–93. CiteSeerX 10.1.1.336.2502. doi:10.1037/0022-3514.94.6.1078. PMID 18505319. Archived from the original (PDF) on April 19, 2009.
The basis for my thinking that T levels could be boosted by cold baths came from a post I wrote a few years ago on the benefits of cold showers. One benefit I found in my research was that they could increase testosterone levels. I mentioned a 1993 study done by the Thrombosis Research Institute in England that found increased T levels after taking a cold shower. Here’s the thing. I can’t find a link to the original source and I can’t find any other studies that support this claim! So without supporting research, I’m unsure of the effects of cold showers on testosterone.

“I'm having great results. Everybody is seeing a difference. People say, “You look good! Did you lose weight? What are you taking?” I'm 59, and I'm bringing my belt down a couple different notches. I couldn't break 180 lbs for nothing, no matter what I tried. Now it's 175 lbs. and she's going from there. I was just doing it for the belly -- no matter what I just couldn't get rid of the belly (until now). And I'm not as tired as I used to be.“

Studies have demonstrated reduced testosterone levels in men with heart failure as well as other endocrine changes (Tappler and Katz 1979; Kontoleon et al 2003). Treatment of cardiac failure with chronic mechanical circulatory support normalizes many of these changes, including testosterone levels (Noirhomme et al 1999). More recently, two double-blind randomized controlled trials of testosterone treatment for men with low or low-normal serum testosterone levels and heart failure have shown improvements in exercise capacity and symptoms (Pugh et al 2004; Malkin et al 2006). The mechanism of these benefits is currently unclear, although a study of the acute effects of buccal testosterone given to men with chronic cardiac failure under invasive monitoring showed that testosterone increased cardiac index and reduced systemic vascular resistance (Pugh et al 2003). Testosterone may prove useful in the management of cardiac failure but further research is needed.

A: According to the NIH, normal values for testosterone levels in men can range from 300 to 1,200ng/dL. There can be many different causes of low testosterone including age, diseases, accidents, and medications. Symptoms of low testosterone may include: loss of sex drive, erectile dysfunction, depressed mood, and difficulty concentrating. Low testosterone levels may also bring around body changes including: hair loss, decrease in blood cells possibly leading to anemia, fragile bones, and a decrease in muscle mass. There are different testosterone replacement therapies including patches, such as Androderm; gels, such as Androgel and Testim; and injections, such as testosterone cypionate. Only your health care provider can decide if and what kind of testosterone replacement therapy is appropriate for you. Testosterone replacement therapy is not right for everyone. Patient with certain prostate issues or breast cancer should not take testosterone. For more specific information, consult with your doctor for guidance based on your health status and current medications, particularly before taking any action. Kristen Dore, PharmD
As you can see, the entire workout is only 20 minutes. Twenty minutes! That really is a beautiful thing. And within those 20 minutes, 75 percent of that time is warming up, recovering or cooling down. You're really only working out intensely for four minutes. It's hard to believe if you have never done this that you can actually get that much benefit from four minutes of exercise. That's all it is.

Finally, we looked at the proprietary blends of our remaining boosters, and dug into their ingredient lists. Supplements frequently include ingredients known for their “folk-lore” value; they’re believed to work, even when there isn’t any scientific background to prove it. Though we didn’t ding points if an ingredient wasn’t proven to be good (just so long as it wasn’t proven to be bad), we didn’t want to include any ingredient with evidence of causing harm.

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.
Sleep apnea is another frequently listed contraindication to testosterone treatment. There have been a few reports of the development, or worsening, of sleep apnea during testosterone therapy (Matsumoto et al 1985) but sleep apnea is actually associated with lower serum testosterone levels (Luboshitzky et al 2002). The reduction in fat mass during treatment with testosterone could potentially be beneficial for sleep apnea, so many specialists will still consider patients for treatment with appropriate monitoring. It is wise to take a clinical history for sleep apnea during testosterone treatment in all men and perform sleep studies in those who develop symptoms.
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.
The testicles produce an enzyme called 11ßHSD-1 which protects your testosterone molecules from the effects cortisol.  During times of prolonged stress and chronically elevated cortisol, there simply is too much cortisol for 11ßHSD-1 to handle.  This results in testosterone molecules being destroyed inside the gonads before they even enter the bloodstream (8, 9).

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).
I have had BPH for years. Am in early 60s and recently had a 12 site prostate biopsy after a very slow rise of PSA to 4.5 (over a period of 10 years). There were two sites with PIN (one with outpouching and one was focal). Have been on various form of test replacement…changing methods periodically from test cyp IM, or SQ, with and without HCG or HCG alone. I want to continue a very low dose of either HCG or Test Cyp (10-20mg twice/week). What are your thoughts?
Fortunately supplementation of Vitamin D3 has been noted to significantly boost testosterone levels up to 20%.[40,41] This occurs via a reduction in sex-hormone binding globulin (SHBG) and aromatase expression, which limits the breakdown of testosterone into estrogen. It’s also worth mentioning that Vitamin D3 has been shown to raise levels of the anabolic hormone IGF-1.[42,43]
At the National Population and Family Development Board in Malaysia, men between the ages of 31 and 52 were given two capsules of the herb (E. longifolia) in Andro400 every day for three weeks. They reported erections were stronger and, in some cases, lasted longer. Overall, they felt more virile. Their levels of testosterone doubled within three weeks.5

My preference is to start men on testosterone, for a couple of reasons. First, if a man has successful return of his own erections, it’s like a home run for him. He doesn’t have to take a pill in anticipation of having sex. He can have sex whenever he wants. Second, the benefits of testosterone-replacement therapy often go way beyond erectile dysfunction. That may be what brought the patient into the office originally, but then he comes back saying how much better he feels in general, how much more energetic and motivated he is, how his drives on the golf course seem to be going farther, and how his mood is better.
6., 7. JK, Udani, George AA, Musthapa M, Pakdaman MN, and Abas A. "Effects of a Proprietary Freeze-Dried Water Extract of Eurycoma Longifolia (Physta) and Polygonum minus on Sexual Performance and Well-Being in Men: A Randomized, Double-Blind, Placebo-Controlled Study." National Center for Biotechnology Information. U.S. National Library of Medicine, 12 Jan. 2014.
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!

Nutritional developers formulated Nugenix® with Testofen®, a key natural ingredient to help boost “free” testosterone along with resistance training. This key ingredient is carefully extracted from the fenugreek plant. A Testofen® study in Irvine, California indicated positive free testosterone-related results. Nugenix also includes L-Citrulline Malate, Tribulus, Zinc, plus Vitamins B6 and B12 to help promote overall health and performance.*


Also, due to the intake of these synthetic substances, men start behaving in a very excited way, as well as demonstrate high levels of aggression and even violence. So, the men’s behavior may be antisocial. In addition, the men will experience breast enlargement and testicular shrinkage. The other adverse effects include hypertension, tumor growth, heart attacks and strokes, as well as development of liver disorders. It’s obvious that the numerous dangers of steroid use far outweigh a few benefits which they bring.
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.
A: Depo-Testosterone is a brand name medication that contains testosterone cypionate. Depo-Testosterone is given as an intramuscular injection. The medication is indicated for replacement therapy for men that have conditions associated with symptoms of deficiency in the hormone or absence of testosterone produced in the body. Conditions that can be associated with low testosterone include: delayed puberty, impotence and hormonal imbalances. Testosterone is a sex hormone that is naturally produced in the male testicles. In women, small amounts of testosterone is produced in the ovaries and by the adrenal system. Testosterone is available in various medications for testosterone replacement therapy. Different forms of testosterone (e.g. cypionate, enanthate etc) are contained in different brand name medications. Jen Marsico, RPh
There are a lot of test booster blends out there. A lot of them are junk. I have tried to cover the most effective herbs above. As always, I recommend doing your own research and experiment to see if you notice an effect. If you would like one easy herbal solution I recommend starting with Mike Mahlers Aggressive Strength product purely because I have solid anecdotal evidence of its effectiveness. But again, supplements should be seen purely as that - a supplement to a healthy diet, plenty of sleep, hard training with adequate rest.
I am a 43 year old and have undergone pituitary sectioning/surgery twice. Since then i have been using the testoterone gel daily for 12 years without any problem. However, i still have pituitary tumor and also diagnosed with colon cancer. I am thinking of stopping the HRT because i felt it is worsening the illness. I would be glad if you could advice me of the risk of stopping the treatment.
My preference is to start men on testosterone, for a couple of reasons. First, if a man has successful return of his own erections, it’s like a home run for him. He doesn’t have to take a pill in anticipation of having sex. He can have sex whenever he wants. Second, the benefits of testosterone-replacement therapy often go way beyond erectile dysfunction. That may be what brought the patient into the office originally, but then he comes back saying how much better he feels in general, how much more energetic and motivated he is, how his drives on the golf course seem to be going farther, and how his mood is better.
Natural testosterone boosters also help to increase the amount of free testosterone in the body. There are a couple of different ingredients they use that help with this. One of these ingredients is stinging nettle. Stinging nettle is actually able to bind to the globulin in place of testosterone, therefore leaving more free testosterone in the body that is unbound.
Testosterone booster products obtained from trusted sources and administered as per the recommendations of the manufacturer may still present some health risks. The present case provided weak evidence of causality between acute liver injury and a commercial testosterone booster. To guarantee an optimal outcome with no severe side effects, further research is warranted to confirm the present findings and determine whether the effects observed in this case report would be statistically significant in larger samples.
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.

Oral/buccal (by mouth). The buccal dose comes in a patch that you place above your incisor (canine or "eyetooth"). The medication looks like a tablet but you should not chew or swallow it. The drug is released over 12 hours. This method has fewer harmful side effects on the liver than if the drug is swallowed, but it may cause headaches or cause irritation where you place it.

Xenoestrogen is a chemical that imitates estrogen in the human body. When men are exposed to too much of this estrogen-imitating chemical, T levels drop significantly. The problem is xenoestrogen is freaking everywhere — plastics, shampoos, gasoline, cows, toothpaste. You name it and chances are there are xenoestrogen in it. The ubiquitous nature of this chemical in our modern world is one reason some endocrinologists believe that testosterone levels are lower in men today than in decades past. It’s also a reason doctors say the number of boys born with hypospadias — a birth defect in which the opening of the urethra is on the underside of the penis and not at the tip — has doubled.  Note to expecting parents: make sure mom stays away from xenoestrogens during the pregnancy.
MuscleTech Pro Series Alpha Test claims you’ll be able to see increases in free testosterone levels in as few as seven days. Its formula is supported by potent ingredients such as Fenugreek, Shilajit, and Boron Citrate. The formulation can also help increase lean muscle mass, strength, as well as overall performance and maintains a peak testosterone-to-cortisol ratio.
Camacho EM1, Huhtaniemi IT, O'Neill TW, Finn JD, Pye SR, Lee DM, Tajar A, Bartfai G, Boonen S, Casanueva FF, Forti G, Giwercman A, Han TS, Kula K, Keevil B, Lean ME, Pendleton N, Punab M, Vanderschueren D, Wu FC; EMAS Group. “Age-associated changes in hypothalamic-pituitary-testicular function in middle-aged and older men are modified by weight change and lifestyle factors: longitudinal results from the European Male Ageing Study.” Eur J Endocrinol. 2013 Feb 20;168(3):445-55. doi: 10.1530/EJE-12-0890. Print 2013 Mar.

The biggest change I made to my diet was increasing my fat and cholesterol intake. There’s a reason why old school strong men would drink raw eggs — studies have suggested that higher fat and cholesterol consumption results in increased levels of total T; men eating low-fat diets typically have decreased testosterone levels. The emphasis on increasing fat and cholesterol consumption meant I got to eat like Ron Swanson for three months — bacon and eggs and steak was pretty much the staple of my diet.

As a urologist, I tend to see men because they have sexual complaints. The primary hallmark of low testosterone is low sexual desire or libido, but another can be erectile dysfunction, and any man who complains of erectile dysfunction should get his testosterone level checked. Men may experience other symptoms, such as more difficulty achieving an orgasm, less-intense orgasms, a smaller amount of fluid from ejaculation, and a feeling of numbness in the penis when they see or experience something that would normally be arousing.
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.
Maybe someone could help me out here. I am a 21 year old former college football player and have been experiencing low test for a while now, about a year ago i went in to see my doctor, and after becoming an expert over the subject thanks to the internet, i told him that i thought it had to be my testosterone level. So he had me come back the next day and got a level of 107ng/dL. He was shocked to say the least. He referred me to an IDIOT endocrinologist, and he which tested me again and got a level of 187. He said to do nothing for the next 3 MONTHS and levels should be 700-900… Yeah well about 4 months later, which was last week, i had to go in, there is some serious shit wrong with me, physically, mentally, you name it. The level came back at 57ng/dL… They said we need to run further tests… WTF is going on, i am dying here. What do i do people???
A notable study out of Wayne State University in Indiana found that older men who had a mild zinc deficiency significantly increased their testosterone from 8.3 to 16.0 nmol/L—a 93 percent increase—following six months of zinc supplementation. Researchers of the study concluded that zinc may play an important role in modulating serum testosterone levels in normal healthy men.6
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.
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?
Studies have demonstrated reduced testosterone levels in men with heart failure as well as other endocrine changes (Tappler and Katz 1979; Kontoleon et al 2003). Treatment of cardiac failure with chronic mechanical circulatory support normalizes many of these changes, including testosterone levels (Noirhomme et al 1999). More recently, two double-blind randomized controlled trials of testosterone treatment for men with low or low-normal serum testosterone levels and heart failure have shown improvements in exercise capacity and symptoms (Pugh et al 2004; Malkin et al 2006). The mechanism of these benefits is currently unclear, although a study of the acute effects of buccal testosterone given to men with chronic cardiac failure under invasive monitoring showed that testosterone increased cardiac index and reduced systemic vascular resistance (Pugh et al 2003). Testosterone may prove useful in the management of cardiac failure but further research is needed.
Sexual dysfunction and low libido are among the most easily reversible symptoms of hypogonadism. Systematic reviews of randomized, placebo-controlled clinical trials of testosterone in men, including older men (aged 60 years and over) and middle-aged men, with sexual dysfunction and hypogonadism have shown large favourable effects on libido and moderate effects on satisfaction with erectile function.1-5 In men who do not respond sufficiently to testosterone therapy alone, the combination of phosphodiesterase 5-inhibitors and testosterone may be indicated, as there are suggestions that the combination may be synergistic.1
For example, testosterone can increase the hematocrit, the percentage of red blood cells in the bloodstream. If the hematocrit goes up too high, we worry about the blood becoming too viscous or thick, possibly predisposing someone to stroke or clotting events. Although, frankly, in a review that I wrote in the New England Journal of Medicine* where we reviewed as much of this as we could, we found no cases of stroke or severe clotting related to testosterone therapy. Nevertheless, the risk exists, so we want to be careful about giving testosterone to men who already have a high hematocrit, such as those with chronic obstructive pulmonary disease, or those who have a red-blood-cell disorder.
The science is clear: Men’s body fat drains testosterone. We’re not talking pinchable back fat or squishable love handles. We’re talking classic belly fat. In medical parlance, it’s called visceral fat. Unlike fat that lies just beneath the surface of the skin, visceral fat nestles deep in the abdomen around the organs. It’s tenacious, dangerous, and hormonally active. The more visceral fat a man has, the higher his risk of type 2 diabetes, heart disease, high cholesterol, hypertension, insulin resistance, and colon cancer.
Currently available testosterone preparations in common use include intramuscular injections, subcutaneous pellets, buccal tablets, transdermal gels and patches (see Table 2). Oral testosterone is not widely used. Unmodified testosterone taken orally is largely subject to first-pass metabolism by the liver. Oral doses 100 fold greater than physiological testosterone production can be given to achieve adequate serum levels. Methyl testosterone esters have been associated with hepatotoxicity. There has been some use of testosterone undecanoate, which is an esterified derivative of testosterone that is absorbed via the lymphatic system and bypasses the liver. Unfortunately, it produces unpredictable testosterone levels and increases testosterone levels for only a short period after each oral dose (Schurmeyer et al 1983).
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.
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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