Testosterone is the primary male sex hormone responsible for male sexual development and for maintaining libido, normal erectile function, mood and normal energy levels. It is secreted by the testes, ovaries and adrenal glands. While estrogen levels in women decline fairly abruptly after menopause, there is a more gradual decline in androgens starting in the 30s to 40s. Androgens (commonly thought of as male sex hormones) include DHEA, DHT, and Androstenedione as well as testosterone. Along with the decline in androgens is a concurrent rise in sex hormone binding globulin (SHBG), a protein that binds to testosterone and prevents its effectiveness. In many men, by the age of 80 the level of testosterone is only one fifth of what it was in youth.
This gradual decline in testosterone has been termed andropause. Symptoms of andropause appear as a gradual decrease in energy, thinning of bone and muscle, increased body fat, depression, a waning interest in sex, difficulty having and maintaining an erection, and decreased sexual enjoyment. Many men also experience fatigue, irritability, aches and pains and stiffness. Testosterone deficiency has also been linked to hypertension, obesity and increased waist-to-hip ratio, which has been associated with an increased risk of heart disease. Bone loss and osteoporosis is not limited to the menopausal female, as men after the age of 60 have a marked increase in the rate of hip fractures, and this rate doubles every decade! Men with abnormally low levels of testosterone (hypogonadal males) are six times more likely to break a hip during a fall than those men with normal testosterone levels.
The functions of testosterone and the benefits of testosterone replacement therapy include:
- Expression of secondary male secondary sexual characteristics: hair growth, muscle growth,
- Improved stamina and exercise capacity
- Decreased excess body fat
- Increased drive and competitiveness
- Improved mood and energy (by the mechanism of increased norepinephrine neurotransmitter in the central nervous system
- Improved sexual interest and libido
- Improved emotional well being
- Increased bone density
- Improved lipid profile and decreased homocysteine, alpha lipoproteins, and LDH as well as increased HDL
- Improved blood flow, especially in the cardiac muscle (heart) due to coronary artery dilatation
- Decreased blood pressure and delayed onset of aging in men, testosterone produces the improved initiation, and maintenance of erection during intercourse, and an increase in morning penile erections
- In women, testosterone produces improved mental stimulation prior to sexual intercourse, moisture of mucous membranes, and increased vaginal and clitoral sensitivity. Some women first experience orgasms or multiple orgasms while on testosterone
- Improved cognitive function and memory
- Decreased insulin resistance
- Improved healing
- Improved symptoms of degenerative arthritis
- Increased red cell count ( should be monitored)
A concern of testosterone replacement therapy in men is a presumed increased risk of prostate cancer. Prostate cancer is the second leading killer of men after heart disease. The prostate gland is a small gland that sit below the urinary bladder and functions by producing and storing sperm. It also functions as the outlet of the bladder. Signs of prostate abnormality include excessive urination especially at night, dribbling or inability to stop the flow of urine, and hesitancy in starting the urine stream. Doctors examine the prostate to help detect prostate cancer early by performing a digital rectal exam (DRE) in which the physician places a gloved finger into the rectum and palpates the prostate gland for abnormalities. Also a blood level of prostate specific antigen (PSA) is drawn where normal is considered 0-4. Testosterone can possibly aggravate benign prostatic hypertrophy (BPH), a noncancerous enlargement of the prostate fairly common after age 40. There is concern that testosterone can promote an undetected cancer. For this reason, all men, especially those on TRT should have a yearly DRE as well as blood PSA tests. The connection between testosterone and prostate cancer is really not clear, as there has been an association between low testosterone levels and prostate cancer. Because of these issues, prostate cancer is a contraindication to testosterone replacement therapy.
Side effects of TRT include:
- Testicular atrophy
- High red blood cell count
- Depression or aggression
- Fluid retention
- Can include reduced HDL cholesterol
Symptoms of testosterone in excess include:
- Weight gain with salt and sugar cravings
- Hypoglycemia and increased insulin resistance
- Unwanted facial hair growth and thinning of hair on the scalp
- Mood swings, anger, agitation, depression and anxiety
- Chronic fatigue
- Impaired memory
- Increased risk of breast cancer
- Fluid retention
- Adverse effect on lipids with decreased HDL and increased triglycerides
- Oily skin and acne
Methods of replacement include intramuscular injection, a pill, a cream or gel applied to the skin, a patch applied to the skin of the scrotum, sublingual lozenges, and pellets surgically implanted under the skin.
Problems with the administration of testosterone include poor effectiveness of the pill, liver toxicity with synthetic testosterones, skin reactions (gels, patches), pain and surgical risk (pellets), and local hair growth with creams. Unfortunately this does not include the risk of hair growth on the scalp! In younger men the testicles can be stimulated to produce more testosterone by subcutaneous injections of HCG (human chorionic gonadotropin). Treatment with HCG can also help prevent testicular atrophy that can be seen with testosterone replacement therapy.
Contact the Center for Modern Aging located locally in Augusta, Georgia to begin your path to improved and healthy testosterone levels today! Call us at (706) 869-2007