Testosterone

Male “Mojo” hormone, but both men and women make testosterone.

It is produced in the adrenal glands, the ovaries, and the testes.


Testosterone deficiencies associated with:

  1. Increased cardiovascular risk
  2. Increased inflammation
  3. Decreased effects seen with fitness (less muscle tone, more central obesity)
  4. Decreased energy
  5. Decreased mood
  6. Increased risk of certain cancers
  7. Increased frailty/bone loss
  8. Decreased libido

Low testosterone also associated with depression/anxiety in men and women

Topical creams/gels and injectable (injected every week or every 2 weeks) are best.


FAQ

What about the risk of prostate cancer?  Although prostate cancer cells have testosterone receptors, these have a “cap”, and are only affected by testosterone to a certain point.  That being said, there was only one patient in a study done in 1941 that developed prostate cancer after testosterone administration, and further studies have not found an increased risk of prostate cancer with testosterone therapy

What about the risk of increased cardiovascular disease?  Studies with accurate and appropriate data have shown no increased risk of cardiovascular disease.  There is a risk of increased red blood cell production (which is why labs are needed to monitor response to therapy), which can increase the risk of clotting if too high (but also increase endurance, giving the “Lance Armstrong effect”)

How long does it take to see results with testosterone therapy?  Most feel/see immediate results, but for some symptoms (such as decreased libido), results may take up to 6 months to see results

Type of testosterone on labs:

Total: This is a combination of bound testosterone (bound to a protein called SHBG –sex hormone binding globulin, and others bound to albumin), and free testosterone
Optimal ranges (not reference ranges): 600-1100 ng/dL (men), 30-80 ng/dL (women)

Bioavailable: This is a combination of free testosterone and albumin-bound (which is a loose bind, meaning the testosterone can leave this protein more easily and be available to “work”)
Optimal ranges: 300-640 pg/ml (men), 8-25 pg/ml (women)

Free testosterone: Testosterone that is not bound to any proteins, which allows it to bind to receptors and activate target cells/organs
Optimal ranges: 20-35 ng/dL (men), 2-8 ng/dL (women)

PSA (prostate specific antigen): This tests for prostate problems, and when elevated can indicate inflammation of the prostate or prostate cancer
Optimal range: Less than 4, with a negative rectal exam

Potential side effects of testosterone therapy:

 
  • Gynecomastia (very rare)
  • Acne
  • Fluid retention (rare)
  • Male pattern hair loss
  • Decreased testicular size (5-10% loss of volume, per studies; rare)
  • Decreased sperm count