Testosterone

Testosterone is a naturally occurring hormone, found in both men and women.  While its most well known role is the development and maintenance of male sex characteristics and normal sex drive, it exerts many other effects including carbohydrate and fat metabolism, vascular health, sense of well-being, prostate health, and musculoskeletal repair.  Testosterone is useful in the prevention of aging and in the treatment of diabetes, arthritis, heart and vascular disease, and prostatic hypertrophy.  Therefore it is essential for health maintenance in both sexes.

Testosterone can be tested in serum (blood) or saliva.   So-called “normal” ranges have been determined by averaging the serum levels from people of all ages.  This has resulted in a range (approximately 300-1100) that does not represent the optimal level.  Researchers in Europe have demonstrated that a more optimal range for men is the average range for 20 year olds (around 600-1100).    Levels of testosterone normally decline with age, frequently men and women past the age of 45-50 have sub-optimal or even frankly deficient levels.  In men, the “andropause” is analogous to menopause in women.  Menopause is also accompanied by declining testosterone levels.  Testosterone levels are also suppressed by high doses of gluco-corticoids (such as cortisone, prednisone, or cortisol).  Since humans produce higher levels of cortisol under stress, this may also be a factor in suppressing testosterone production.

The goal for testosterone treatment is to correct the deficiency using physiologic replacement doses, in which small doses are used, designed to raise levels to the optimal range.  By doing so, a younger physiologic state can be maintained. There are few known side effects with physiologic replacement of testosterone.  Occasionally, acne, fluid retention, or increased hair growth is noted.  In men, certain types of prostate cancer are sensitive to testosterone that can stimulate tumor growth.  Before administration of testosterone, a prostate exam and a blood test (PSA) to screen for prostate cancer should be done.  If both are normal, then it is safe to begin testosterone therapy.

Testosterone can be administered by several routes.  However, it is important to use natural testosterone, not methyltestosterone or other synthetic derivatives.   For men, testosterone cipionate is given by intramuscular injection and is the most reliable method to assure adequate blood levels.  Topical patches can also be used.  Recently, reliable oral capsules have been compounded by compounding pharmacists in appropriate doses for both men (50 mg. once or twice daily) and women (5-10 mg. once or twice daily).  Topical gels can also be used.  For patients with arthritis, the gel can be rubbed into the affected joints to achieve greater relief of inflammation.

After beginning therapy, it is common to notice decreased fatigue, increased stamina, decreased muscle and joint aches, increased muscle strength, and other improvements.  If you should experience any new symptoms, please report them to the doctor.  Periodic checks of testosterone levels assure that it is within therapeutic range, as well as estrogen levels to determine conversion rate.  In men, PSA levels should be followed every three to six months.