Effect Of Testosterone: The Link Between Testosterone And Serious Risks Is Still Murky
Testosterone replacement therapy has traditionally come along with serious warning labels that your risk for heart attack, stroke, and prostate cancer could rise, but this is still very controversialand recent evidence has begun to debunk some of these fears.
In the case of heart attacks and strokes, the concern is that testosterone thickens blood because it binds to androgen receptors that stimulate bone marrow to produce more red blood cells. Thicker blood is linked to a greater risk of heart attack and stroke.
But there isn’t strong evidence to connect these cardiac events to testosterone itself, and some more recent studies actually suggest that normal testosterone levels might actually protect against these risks, says Dr. Morgentaler.
One mechanism at play here could be that reduced body fat is linked to overall better health, and testosterone replacement therapy can encourage this, says Dr. Morgentaler. More research is needed, he says, and to be safe your doctor will monitor your red blood cell count throughout your treatment.
As far as prostate cancer goes, this is fuzzy, too. Because there are androgen receptors in the prostate, testosterone can make it grow. So if you already have an enlarged prostate that makes it difficult to urinate, testosterone could exacerbate the issue, says Dr. Tamler.
Why Does Testosterone Therapy Cause Excess Estrogen In Men
To understand how testosterone and estrogen are related, you need to understand the pathways through which our hormones are synthesized in the body then we will be able to answer,why does testosterone replacement therapy cause excess estrogen in men? First, all our hormones are derived from cholesterol. Then, our bodys enzymes transform the cholesterol into pregnenolone, a neurosteroid. Afterwards, the pregnenolone can then be transformed into either DHEA or progesterone. If it is made into DHEA, then it is changed once again into testosterone.
Testing Your Testosterone Levels
Testosterone exists in the body in many different forms, so it must be tested in two different ways: free testosterone and total testosterone.
Total testosterone is also known as serum testosterone because it is measured through blood serum testing. Your total testosterone level provides an overall profile of your testosterone count. Your doctor can use this test to effectively assess whether you could benefit from bioidentical hormone replacement therapy treatment.
Free testosterone, on the other hand, only accounts for 2% of all testosterone in your body. It is the small portion of testosterone that moves readily through the cells that need testosterone to function properly. A simple blood test can measure your free testosterone level and help your concierge doctor identify the best treatments to reverse your symptoms.
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Oral Testosterone ‘not The Best’
One reason for these “disappointing” results is that oral testosterone supplements may not work as well as supplements such as gels, patches, or injections that provide more stable hormone levels.
“We now think the oral supplement was not the best method of testosterone supplementation to use,” Emmelot-Vonk says. “This is because the level of testosterone was hot high enough for the entire 24-hour period. So maybe it would be better to use a form of testosterone that gives better levels for 24 hours, such as patches or injections.”
Some doctors worry that testosterone supplements may promote prostate cancer. But the Dutch study showed no evidence of prostate abnormality in the six-month study.
Urologist Robert Davis of the University of Rochester, N.Y. offers testosterone supplements to men with low testosterone who complain of symptoms such as erectile dysfunction or low energy. He notes that oral testosterone supplements are not used in the U.S.
Davis says studies may one day show that testosterone supplements can help men without symptoms. But that remains to be demonstrated, he notes.
The Emmelot-Vonk study appears in the Jan. 2 issue of The Journal of the American Medical Association.
SOURCES: Emmelot-Vonk, M.H. The Journal of the American MedicalAssociation, Jan. 2, 2008; vol 299: pp 39-52. Marielle H. Emmelot-Vonk, MD,department of geriatric medicine, University Medical Center Utrecht,Netherlands. Robert Davis, MD, professor of urology, University of Rochester,N.Y.
What Are The Options If Your Testosterone Levels Are Low
Testosterone replacement therapy is currently only FDA approved for men who have been diagnosed with hypogonadism, but its also prescribed off-label for older men who take it in hopes that it will improve their libido. The use of testosterone therapy is increasingly common in the United States, with more than 2 million men receiving the therapy. Not every man benefits from taking testosterone supplements. Testosterone is available in different forms, including topicals such as gels, creams, and patches; injections; and pellets that are surgically placed directly beneath the skin.
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Myth #4 Testosterone Causes Blood Clots And Strokes
In men taking testosterone, the iron-containing molecules that transport oxygen called hemoglobin and hematocrit begin to rise. Some providers suggest that men on testosterone should give blood to prevent blood clots or strokes due to these high iron counts. However, iron doesnt make clots platelets do. Men who are on testosterone have no change in platelets, they are just making more iron.
Causes Of High Estrogen Symptoms
The following factors can affect the balance of testosterone/estrogen in men that lead to high level estrogen symptoms. They include:
Aging. Aging is associated with increased aromatase, which is an enzyme responsible for converting testosterone into estrogen. Aging men actually have higher estrogen levels than women that are postmenopausal.
Fat to Muscle Ratio. Also with aging you lose lean muscle tissue and have an increase in fat tissue. The fat tissue contains aromatase converting testosterone into estrogen. Fat can also become a reservoir for estradiol storage. Both factors can lead to an increase in estrogen levels in men.
Testosterone Therapy. Men can make too much estrogen when treated with inject able forms of testosterone. Even natural testosterone therapy such as bioidentical can increase levels of estrogen especially when used for obesity or in excess.
Inaccurate Feedback. Men can get an inaccurate feedback, misleading the testes and brain into a lesser production of testosterone. This in turn can cause even higher levels of estrogen and more serious dominance of estrogen.
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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
- 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.
Administering treatment for hypogonadism as the result of a disease differs from treating late-onset hypogonadism in older men.
The Effects Of Testosterone On The Body
Testosterone is an important male hormone. A male begins to produce testosterone as early as seven weeks after conception. Testosterone levels rise during puberty, peak during the late teen years, and then level off. After age 30 or so, its normal for a mans testosterone levels to decrease slightly every year.
Most men have more than enough testosterone. But, its possible for the body to produce too little testosterone. This leads to a condition called hypogonadism. This can be treated with hormonal therapy, which requires a doctors prescription and careful monitoring. Men with normal testosterone levels should not consider testosterone therapy.
Testosterone levels affect everything in men from the reproductive system and sexuality to muscle mass and bone density. It also plays a role in certain behaviors.
Low Testosterone can contribute to DE and low testosterone supplements could help fix your DE issue.
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Effect Of Testosterone: In Rare Cases Your Breasts May Enlarge
In all menwhether youre taking T or notsome testosterone is converted into the hormone estradiol, a form of estrogen. And in men who have more breast tissue by nature, the T they’re taking that’s naturally converted into estradiol could stimulate this breast tissue to grow.
This is called gynecomastia, says Dr. Morgentaler, and it’s relatively uncommonhe says he doesn’t even see one case a year.
If this does happen, though, your doctor will likely stop treatment for a month or two to allow your breast tissue to go back to normal, and then start you back up with T along with a drug that blocks the conversion of testosterone to estradiol.
Fat And Muscle Changes
Men generally have less body fat than women. This is partly related to testosterone, which regulates fat distribution and muscle maintenance in your body. With low T, youll likely notice an increase in body fat, especially around your midsection.
Your hormones also help regulate muscle growth. So, with low T, you may feel like youre losing muscle size or strength. However, this only occurs if your low T is prolonged and severe.
Testosterone shots can help regulate fat distribution, but you shouldnt expect significant weight changes from hormone therapy alone. As for muscle maintenance, testosterone therapy has been found to help increase muscle mass, but not strength.
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When And How Should A Low Testosterone Be Treated
Testosterone replacement shouldn’t be used to treat a naturally occurring, age-related decline in this hormone or simply for a low T number, says Dr. Bhasin, but if a man has a testosterone deficiency or classical hypogonadism, the benefits of treating the condition with testosterone is favorable and outweighs any risks.
According to Dr. Bhasin, over the last two to three years there has been greater availability of high quality lab providing good results for testosterone levels, which until recently has been a problematic when trying to make a firm diagnosis.
To confirm the existence of low testosterone requiring treatment, the patient should have two separate blood tests on nonconsecutive days in the early morning that are analyzed by reliable laboratories certified by the Centers for Disease Control and Prevention, Dr. Bhasin told EndocrineWeb.
A normal range for testosterone levels is 300 ng/dL to 1,000 ng/dL, with the Endocrine Society considering low testosterone below 263 ng/dL, says Dr. Bhasin.
Your doctors should also determine if you shows signs or symptoms of a testosterone deficiency. One problem with the symptoms for testosterone deficiency is many are incredibly nonspecific Dr. Mulhall cautions, which is why getting accurate testosterone levels is vital.
How Does Low Testosterone Differ From A Hormonal Deficiency
Testosteronea hormone produced primarily in testicles but also to a lesser extent by the ovaries and adrenal cortexis essential for a variety of physical, cognitive, sexual, and metabolic functions in men. This sex hormone usually peaks in adolescence and early adulthood. As men age, the ability to produce testosterone begins to decline such that testosterone levels begin to drop about 1 to 3 percent a year beginning around age 40 years.
This natural decline, however, does not imply that a man is testosterone deficient or a candidate for testosterone therapy.1,2 A deficiency in this hormone only occurs in cases where there is a low level of testosterone along with specific symptoms or signs.
Testosterone deficiency is a very specific clinical condition that is defined by the presence of a set of specific signs and symptoms that occur as a result of decreased production of testosterone by the testes in men, says Dr. Bhasin. Its extremely important that testosterone is used only as Food and Drug Administration-approved treatment for this condition.
Whats been happening over the past couple of years is that there has been a rise in off-label use of testosterone to treat a variety of age-related conditions and symptoms that dont qualify as a testosterone deficiency, he says.
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Depression Mood Cognition And Well
The indications for the use of testosterone in cognitive and psychological impairment are still unclear; however, studies of healthy older men with testosterone deficiency have yielded interesting results. Neuropsychological testing has revealed improvements in spatial cognition26 and spatial and verbal memory27 with testosterone replacement. No positive effects on mood or depression have been clearly demonstrated for hypogonadal men.10,18 Two trials19,20 have demonstrated improvements in quality of life.
The Pros And Cons Of Testosterone Therapy
The number of men who take testosterone has dropped dramatically in the past few years, in part because of growing awareness of the risks that may accompany it. Should you avoid it?
Testosterone, a hormone, helps men maintain muscle, bone health, libido, and the ability to perform in the bedroom. But beginning in their mid-30s, men lose an average of just under 2% per year. Eventually, that drop could lead to hypogonadism, or low testosterone. This happens to 1 in 5 men in their 60s, and the likelihood rises as men get older. Testosterone replacement treatment aims to boost those low levels back up.
But TRT has had its ups and downs in the past 2 decades. From 2001 to 2013, prescriptions rose by 300% following marketing efforts that proclaimed it could restore energy, alertness, mental focus, and sexual function. Then, over the next 3 years, the number of men taking it dropped by half as studies revealed potential risks, particularly to heart health.
âI do see some men who are more hesitant to take testosterone supplementation,â says Michael Eisenberg, MD, director of the Stanford Male Reproductive Medicine and Surgery Program at Stanford Health Care in Palo Alto, CA. âWe talk about the risks, as thatâs what weâve gotten more information on in recent years.â
However, Eisenberg stresses that men with very low testosterone have a higher chance of developing heart disease, osteoporosis, and other problems if they go untreated.
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Reduce Bad Ldl Cholesterol
As part of its heart-healthy benefits, balanced testosterone can even reduce the bad LDL cholesterol in your system. This occurs as a fortunate side effect of insulin resistance reversal and improved lean body mass. A healthier body can produce more of the good HDL cholesterol that lowers triglycerides and eliminates dangerous LDL cholesterol through the liver.
Increase Lean Mass While Reducing Visceral Fat
Testosterone is responsible for building lean muscle mass. Low T prevents the maintenance of lean muscle mass and causes weight gain instead, but increasing your testosterone reverses this phenomenon. Higher testosterone levels enable the body to continue building lean mass while also stopping the insulin resistance associated with visceral fat accumulation and diabetes. For best results, combine testosterone therapy with weight training and regular exercise.
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Why Do Women Need Testosterone Therapy
When you think about hormone replacement therapy for women, the first thought that usually comes to mind is the typical estrogen therapy that is used to treat menopausal symptoms. However, when a woman is going through menopause, along with estrogen depletion, she is also losing her ability to produce adequate amounts of testosterone. A woman with low testosterone, will have trouble producing new blood cells, maintaining her libido or sex drive, and will find it harder to build muscle and burn fat.
When this is the case she will show the signs of low testosterone. The signs and symptoms of low testosterone in woman include:
- Feeling tired or sluggish
- Mental fog
- Loss of bone density
Current research indicates that women who are on estrogen replacement for menopausal symptoms, can also benefit when testosterone therapy is added as an adjunct to estrogen replacement in these women. Testosterone, when used in this way, seems to specifically help with the sexual wellness issues typical of post-menopausal women. According to Dr. Alan Malabanan, assistant professor of medicine at Harvard Medical School, Studies of postmenopausal women have found that taking testosterone increases sexual desire and pleasure compared with a placebo .
Understanding How Testosterone Affects Men
The complex effects of testosterone, investigators found, depend partly on its conversion in the body to a type of estrogen. The insights will help guide the development of better ways to diagnose and treat men who dont produce enough natural testosterone.
Testosterone is a sex hormone that plays important roles in the body. In men, its thought to regulate sex drive , bone mass, fat distribution, muscle mass and strength, and the production of red blood cells and sperm. A small amount of circulating testosterone is converted to estradiol, a form of estrogen. As men age, they often make less testosterone, and so they produce less estradiol as well. Thus, changes often attributed to testosterone deficiency might be partly or entirely due to the accompanying decline in estradiol.
Testosterone was first used as a clinical drug as early as 1937, but with little understanding of its mechanisms. The hormone is now widely prescribed to men whose bodies naturally produce low levels. But the levels at which testosterone deficiency become medically relevant still arent well understood. Normal testosterone production varies widely in men, so its difficult to know what levels have medical significance. The hormones mechanisms of action are also unclear.
The researchers are conducting follow-up clinical trials to address the effects of testosterone replacement both on the measures in this study and others, such as bone and prostate health.
by Harrison Wein, Ph.D.
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