Testosterone replacement therapy (TRT) helps to restore some affected functions of low testosterone. We provide TRT in the form of injections.
Testosterone is the key male sex hormone that regulates fertility, muscle mass, fat distribution, and red blood cell production.
When levels of testosterone drop below levels that are healthy, they can lead to conditions like hypogonadism or infertility. There are, however, sources from which people with low testosterone can boost their levels.
Low testosterone is becoming more and more common. The number of prescriptions for testosterone supplements has increased fivefold since 2012.
This article will explore what testosterone does and whether men should worry about decreasing levels of the hormone as they grow older.
Fast facts on testosterone
- Testosterone regulates a number of processes in the male body.
- Levels of testosterone tend to drop as men age.
- Prohormone supplements do not have any effect on testosterone levels.
- Testosterone supplements are prescribed only for specified conditions, and not to counteract the natural, age-related drop in testosterone levels.
- Testosterone replacement therapy (TRT) is also available. Sometimes it is risky if used without proper indications.
What is testosterone?
Testosterone is the hormone responsible for the development of male sexual characteristics. Hormones are chemical messengers that trigger necessary changes in the body. Females also produce testosterone, usually in smaller amounts.
It is a type of androgen produced primarily by the testicles in cells called the Leydig cells.
In men, testosterone is thought to regulate a number of functions alongside sperm production. These include:
- sex drive;
- bone mass;
- fat distribution;
- muscle size and strength;
- red blood cell production.
Without adequate amounts of testosterone, men become infertile. This is because testosterone assists the development of mature sperm.
Despite being a male sex hormone, testosterone also contributes to sex drive, bone density, and muscle strength in women. However, an excess of testosterone can also cause women to experience pattern baldness and infertility.
The brain and pituitary gland control testosterone levels. Once produced, the hormone moves through the blood to carry out its various important functions.
Testosterone imbalances
Testosterone decreases naturally with age. It is important to receive tests to determine whether any imbalances are due to an active condition.
High or low levels of testosterone can lead to dysfunction in the parts of the body normally regulated by the hormone.
When a man has low testosterone or hypogonadism, he may experience:
- reduced sex drive;
- erectile dysfunction;
- low sperm count;
- enlarged or swollen breast tissue.
Over time, these symptoms may develop in the following ways:
- loss of body hair;
- loss of muscle bulk;
- loss of strength;
- increased body fat.
Chronic, or ongoing, low testosterone may lead to osteoporosis, mood swings, reduced energy, and testicular shrinkage.
Causes can include:
- testicular injury, such as castration;
- infection of the testicles;
- medications, such as opiate analgesics;
- disorders that affect the hormones, such as pituitary tumors or high prolactin levels;
- chronic diseases, including type 2 diabetes, kidney and liver disease, obesity, and HIV/AIDS;
- genetic diseases, such as Klinefelter syndrome, Prader-Willi syndrome, hemochromatosis, Kallman syndrome, and myotonic dystrophy.
Too much testosterone, on the other hand, can lead to the triggering of puberty before the age of 9 years. This condition would mainly affect younger men and is much rarer.
In women, however, high testosterone levels can lead to a deep voice, oily skin, and menstrual irregularities, as well as:
- growth and swelling of the clitoris;
- changes in the body shape;
- reduction in breast size;
- acne;
- facial hair growth around the body, lips, and chin.
Recent studies have also linked high testosterone levels in women to the risk of uterine fibroids.
Testosterone imbalances can be detected with a blood test and treated accordingly.
Testosterone levels and aging
Testosterone levels naturally decrease as a man ages.
The effects of gradually lowering testosterone levels as men age have received increasing attention in recent years. It is known as late-onset hypogonadism.
After the age of 40, the concentration of circulating testosterone falls by about 1.6 percent every year for most men. By the age of 60, the low levels of testosterone would lead to a diagnosis of hypogonadism in younger men.
About 4 in 10 men have hypogonadism by the time they reach 45 years old. The number of cases in which older men have been diagnosed as having low testosterone increased 170 percent since 2012.
Low testosterone has been associated with increased mortality in male veterans. Late-onset hypogonadism has become a recognized medical condition, although many of the symptoms are associated with normal aging.
The following are symptoms of late-onset hypogonadism:
- diminished erectile quality, particularly at night;
- decreased libido;
- mood changes;
- reduced cognitive function;
- fatigue, depression, and anger;
- a decrease in muscle mass and strength;
- decreased body hair;
- skin changes;
- decreased bone mass and bone mineral density;
- increase in abdominal fat mass.
As well as sexual dysfunction, late-onset hypogonadism has also been associated with metabolic disease and cardiovascular disease.
The degree to which testosterone levels decline varies between men, but a growing number of men experience the effects of reduced testosterone levels. Life expectancy has increased, and many men now live beyond the age of 60 years.
As a result, a higher number of men see the effects of age-related testosterone depletion.
Treatment
Administering treatment for hypogonadism as the result of disease differs from treating late-onset hypogonadism in older men.
Testosterone replacement therapy
Testosterone replacement therapy (TRT) can help restore some affected functions of low testosterone.
Studies have shown that TRT mainly impacts bone strength and hemoglobin levels in the blood, but not mental sharpness.
The treatment can be administered by:
- skin gels and patches
- injections
- tablets that are absorbed through the gums
If improper dosage or administration occurs, this can trigger side effects, including:
- increased red blood cell count;
- prostate and breast enlargement;
- acne;
- in rare cases, breathing difficulties during sleep;
- increased risk of cardiovascular disease, although this is subject to debate.
A recent study, for example, suggests that TRT provides an extra benefit for overall mortality and stroke for men whose testosterone levels have normalized with TRT.
Benefits of Testosterone Therapy
What can you expect from testosterone treatment? Many men report improvement in energy level, sex drive, and quality of erections. Testosterone also increases bone density, muscle mass, and insulin sensitivity in some men.
Men also often report an improvement in mood from testosterone replacement. Whether these effects are barely noticeable, or a major boost, is highly individualized.
Is HGH effective at increasing testosterone?
The benefits of growth hormone therapy can be intriguing, regardless of whether you’re struggling with hypogonadism or you’re experiencing low T for the first time as you’re entering andropause. However, does HGH treatment help increase testosterone?
Well, HGH does affect body composition, which is something many men complain about when they’re suffering from low testosterone. HGH, more specifically, causes your body to increase muscle mass and burn fat.
Researchers have found that combining HGH with testosterone therapy substantially increases bone mineral density, lean mass, and fat loss in men and women who are experiencing a documented HGH deficiency.
Other investigations recently show low HGH doses are enough to substantially affect cholesterol levels for individuals who are deficient and body composition. This is good news, at face value and certain smaller research indicates HGH could improve lean body mass in older individuals who don’t have an HGH deficiency as well.
According to another study, growth hormone works like a gonadotropin, stimulating testosterone as well as oestradiol secretions by Leydig cells. It regulates T3-induced secretion or LH of these steroids, depending on how intense their stimulation is.
Gonadorelin and Hypogonadism Diagnosis
Gonadorelin is a medicine that is the same as gonadotropin-releasing hormone (GnRH) that is naturally released from the hypothalamus gland. GnRH causes the pituitary gland to release other hormones (luteinizing hormone [LH] and follicle-stimulating hormone [FSH]). LH and FSH control development in children and fertility in adults.
Gonadorelin is used to test how well the hypothalamus and the pituitary glands are working. In men, LH stimulates the testicles to produce the hormone testosterone and FSH stimulates the testicles to produce sperm.
Gonadorelin is given by injection to check whether the pituitary gland is producing LH and FSH in the correct levels. This can help in the diagnosis of various hormonal disorders, including infertility, delayed puberty, and hypogonadism.
How is it given?
- The gonadorelin is given as a single injection either under the skin or into a vein.
- Blood samples to measure the levels of LH and FSH in the blood are usually taken 15 minutes before the gonadorelin injection, immediately before the injection, and then at 15, 30, 45, 60, and 120 minutes after the injection.
Anastrozole (Arimidex) for Men on Testosterone Therapy
Most men think of estrogen as exclusively a female hormone, but men also produce it. In fact, testosterone is the precursor of estradiol, an estrogen, and the primary female sex hormone. Testosterone is converted into estradiol via the aromatase enzyme.
Because testosterone can be converted into estradiol, taking testosterone via testosterone replacement therapy (TRT) can potentially elevate estrogen levels. Fortunately, most men on standard TRT dosages do not experience high estradiol levels. Nevertheless, genetically predisposed men may experience symptoms associated with high levels, which may lead to certain unwanted side effects.
What is the role of estradiol in men?
Many men assume that estradiol is simply “bad”. They think that because estradiol is one of the primary female hormones and because high levels may cause gynecomastia and/or edema, estradiol should be reduced as much as possible. However, this is not true.
While high levels cause certain side effects in genetically susceptible, estradiol plays many important roles in men. For example, it plays an important role in determining bone mineral density in men. Low levels may well be the major cause of bone loss in elderly men.
Low estradiol levels are associated with increased fat and decreased sexual desire and erectile function compared to higher levels.
What are high estradiol levels in men?
The definition of high estradiol levels in men varies by laboratory and type of analytical method. Unfortunately, there is also no consensus on what type of test (regular or ultrasensitive) is best.
Some labs use an electrochemiluminescence immunoassay methodology and define high estradiol as equal to or above 42.6 pg/mL.
Side Effects of High Estradiol Levels in Men
As mentioned, testosterone replacement therapy dosages that do not raise testosterone above normal generally do not lead to high estradiol levels. Consequently, the feminizing effects associated with high levels are generally not seen with TRT dosages. Unfortunately, genetically predisposed men on TRT may experience symptoms associated with high estrogen levels.
Symptoms of high estradiol levels in men include two of the most common side effects of testosterone therapy. These include 1) gynecomastia (male breast development and enlargement) and 2) edema (fluid retention in the extremities).
Co-administration of Anastrozole (Arimidex)
The Endocrine Society’s Clinical Practice Guidelines for Testosterone Therapy in Adult Men with low testosterone does not address the potential issue of high estradiol levels during TRT. As such, The Endocrine Society does not recommend for or against any treatments that lower estradiol levels. Also, there is currently a lack of guidelines as to the critical level whereby intervention is needed to treat high levels.
Notwithstanding the foregoing, some physicians do treat men on TRT with high estradiol levels by co-administering anastrozole – estrogen blocker (brand name Arimidex) with TRT at 0.25 mg per day or 0.5 mg every other day.
Anastrozole is an aromatase-inhibiting drug that comes in the form of a pill and is taken orally. It inhibits the ability of the aromatase enzyme to convert testosterone to estrogen. Thus, it lowers the level of circulating estradiol quite effectively.
Please get in touch if you’d love to learn the cost of the therapy, the term of the treatment within different customized plans and lab tests required.