On average, a man’s body contains seven or eight times as much testosterone as a woman. These levels are not constant over our lifetime. Our testosterone levels peak around age 25. At around age 30, a change happens. Our sex binding globulin (SHBG) starts to increase, binding our total testosterone, making it too big to cross over the cellular membrane. Therefore, if we can simply check a man’s total testosterone level, it might look adequate, but the body can’t use it. We must check either free testosterone or ideally, bioavailable testosterone levels. Some smaller laboratories, however, only have the ability to test free testosterone levels. The test result we would like to see is a number in the upper -third of the normal range; this is optimal. However, half of healthy men between the ages of 50-70 will have a baseline testosterone level that’s below the lowest level seen in healthy men who are 20-40 years of age. Journal of Clinical Endocrinology Metabolism 71;963-969.
Allow me to say this in a different way. The primary laboratory that I use in my practice is Quest, and the normal range for total testosterone in men between ages of 18 and 70 is 250- 827. This is both a very wide age range and a very wide “normal” range. Thus, a I have always said in my articles, I prefer to determine dosages clinically (titrated to my patient’s satisfaction). From 70 years of age and above, Quest’s normal range is just 30-110. Can anyone out there believe this? Apparently, once a man turns 70, it is okay for him to suffer from Osteoporosis, dementia, brain aging, heart aging (increased heart attacks and strokes), decreased intelligence, Alzheimer’s disease, loss of drive and competitive edge, stiffness and pain in muscles and joints, deteriorating connective tissue to include drooping of the face and rest of the body, a falling level of fitness, anemia, irritability, depression, mood changes, fatigue, erectile dysfunction, decreased desires and fantasies, etc..
Many doctors look at a 50-year old’s testosterone levels and although they may be in the normal range, most of them are at the lower end of normal, yet the doctors say that this is appropriate. However, if that 50 yrs. old man were actually 20 yrs. old and showed the same doctor the lower end of normal range results for a 20 yrs. old, the doctor would be very concerned and let the patient know they were deficient. Why is it that the medical community seems to be uninterested in men and women beyond their reproductive years?
Women access the medical community much more frequently than men. When they are not feeling well, they are much more likely to get the help they need. Men are taught by our society to be tough and “suck it up “and not complain. Women do complain about the effects of menopause: hot flashes, irritability and mood changes. And because they access the medical care community more often than men do, there are all types of hormones and replacements for women.
Andropause. Or male menopause, is a gradual decline that takes years, even decades, whereas a woman’s menopause is sudden with immediate dramatic effects. What is the cause of Andropause? Decreased bioavailable testosterone.
It’s important that we men remember where the highest concentration of testosterone receptors are found. Number one for testosterone receptors is the arteries in the heart. The testosterone undergoes a change to estradiol which causes arteries to release nitrous oxide and open the arteries.
The second highest concentration of testosterone receptors is the brain where again, nitrous oxide is released. The surface of the brain is covered with smaller and smaller arteries as we get further from the center of the brain, and as we get older, we lose brain tissue as the arteries on the periphery close because they are really tiny and therefore, we lose short term memory function. An Alzheimer's patient can tell you what he said to his wife 60 yrs. ago but cannot recall what he ate for breakfast that day.
The third highest concentration is in your bones. You need testosterone to have strong thick bones and prevent osteoporosis.
The fourth highest receptor concentration is in the muscle and connective tissue, which is necessary for fuller lips, tighter skin and more lean muscle mass (which is also more metabolically active, thus creating anti-inflammatory and thus anti-aging benefits).
The fifth place are the fat cells. Fat cells have more testosterone receptors than we do below the belt. If we can remember, before puberty, we were one big blob. After puberty, however, we had a six-pack as well as broadening of the shoulders, chest and arms. We also had less fat around the waist and thighs.
The sixth place for testosterone receptor concentration is below the waist in the penis, which releases nitrous oxide, which helps the length, girth and erectile function. One of the major things that testosterone helps with is the refractory period of intercourse. Most men tell me that they are hardly every had fantasies, or once they did have intercourse with their wives, it would be a long time before they were ready for another session. However, with testosterone replacement, they tell me that sexual frequency and satisfaction has increased dramatically. A study that I read at one time pertained to the question of frequency in respect to one’s age. For men (and women who release oxytocin, which is an anti-inflammatory hormone and anti-aging hormone), one study found that men who engaged in intercourse with their wives at least twice per week looked 10 years younger and lived nearly 10 years longer than age-matched controls.
If going to the gym daily, training hard and eating clean does not give you a 6 pack like it did when you were younger. You must look at your testosterone levels with a qualified doctor that treats patients for this.
Perhaps the most important aspect of testosterone in a man’s body is that all our arteries convert it to estradiol. The woman anti-cancer hormone.
In every population of the world, woman out live men because of estradiol. Estradiol causes all of our arteries in the entire body to release nitrous oxide, which opens arteries in the body. We have never heard of a woman having a heart attack or stroke in her 40’s, 50’s and 60’s because of estradiol and nitrous oxide. When we sleep our bodies make HGH which only last about an hour. During that hour it goes to the liver where our bodies make IGF-1 which is how HGH works in us for 17-24 hours. For IGF-1 to be made, it also needs estradiol which we get from testosterone as stated above.
Let’s now talk about safety.
Mortality is considered the risk of dying. In the Journal of Circulation; 2007; 116:2694-2701, a 10-year study on 11,606 men ages 40-79 yrs. old found that high natural testosterone levels resulted in lower mortality due to cardiovascular disease and cancer. Conversely, low testosterone predicts cardiovascular disease.
How about testosterone and brain function? In Hormones and Behavior, 1998;22(2) 85-94, it was found that testosterone replacement therapy resulted in increased cognitive function. Further, in the Journal of Alzheimer’s Disease 2010, Aug 6, a study of 153 men with the average of 72.7 yrs found that higher levels of testosterone lower the risk of developing Alzheimer’s disease.
Now let’s talk about the heart. Four major studies show low testosterone increases the risk of cardiovascular disease, cancer and all causes of mortality. See the Journal of Circulation 2007; 116.2694E701. The Journal of American Geriatrics Society 2004; 52:2077. The Journal of Circulation 2007; 116:2694E70, Heart 2010:96:1821-1825 and Archives of Internal Medicine 2006; 166:1660E54. Also, In the Journal of Circulation, 2000 Oct 17:102(16):1906-11, men using a 5mg patch of testosterone showed a significant reduction in exercise induced myocardial ischemia or angina. Men were able to physically do more before angina ensued, they were less limited, and they had less pain.
In the Journal of American College of Cardiology 2009 Sept 1:54(10):919-27, it is noted that patients with congestive heart failure treated with testosterone experienced improved exercise capacity, improved musculoskeletal performance and improved insulin resistance in a double-blind placebo control randomized study. There are dozens of other studies in major medical peer-reviewed journals that report similar benefits.
How about blood pressure and testosterone? Hypertension 1988 April ;6(4):329-32, noted that there is an inverse relationship between blood pressure and endogenous testosterone. As we’ve mentioned, testosterone increases blood flow and increases nitrous oxide.
There are also multiple studies showing that a decline in testosterone is responsible for frailty syndrome, and in fact, lower free testosterone is a predictor of frailty in older men according to JCEM, Vol. 95, No. 7, page 3165-3172.
Also, The American Journal of Physiology, Physiological Endocrinology Metabolism 2007 found that testosterone supplementation increases growth hormone production during sleep. Growth hormone is what some Hollywood stars and athletes inject daily which costs over $1,000.00 per month. To produce more growth hormone naturally, one can perform interval type aerobics or lift weights, esp. squats.
Diabetes is a major risk factor for heart disease and multiple organ failure, as a diabetic’s blood is thicker. In fact, testosterone protects against the development of diabetes, high blood pressure, high cholesterol (lipids) and cardiovascular disease in aging men. In a study published in The Aging Male, 2003 March; 6 (1):1-7, testosterone treatment caused a decrease in obesity.
What about strength and muscle mass? There is a paradoxical fear among many medi-cal providers who think that giving testosterone will cause prostate cancer, although multiple studies have proven otherwise. In the National Cancer Institute 2008, 100:170-183, in a study that include 3,886 men with prostate cancer and 6,438 controls there were no associations found between testosterone and cancer. In the Journal of prostate cancer, Prostatic Disease 206; 9910: 14-8, It is noted that 16 studies were reviewed, some of which were placebo-controlled, which lasted up to 15 years, and there was no increased risk found over the back-ground prevalence.
Dr. Abraham Morgentaler, Harvard urologist is the world’s foremost authority on testosterone and prostate cancer, and he states, “There is not now, nor has there ever been, a scientific basis for the belief that testosterone causes prostate cancer to grow.”
However, there are some potential adverse effects of testosterone treatment.
1. Increase in red blood cells. The body makes more red blood cells when a man is on testosterone replacement therapy. This raises endurance and increases energy. However, if the hematocrit rises above 55, a man should consider donating blood once or twice a year, or simply lower the testosterone dose.
2. As the aromatase enzyme in men’s fat cells converts testosterone into estrogen, men can develop breasts from too much estrogen. If this starts to be a problem, a doctor can recommend over the counter zinc or Crysyn or can prescribe an estrogen blocker in order to clock the aromatase enzyme
3. Decreased testicular volume. If this occurs, a doctor can either prescribe HCG (the female pregnancy hormone that is currently being used widely for weight loss), twice a week or Clomld 50mg to be taken two times a week.
4. Decreased sperm county.
5. Fluid retention has been reported rarely.
I hope that what I have shared in this column will convince you that testosterone treatment is not only safe but in fact can significantly improve overall health. If you suffer from low testosterone and cannot get the upper one-third of normal testosterone replacement cream, ask your doctor what other form of testosterone he or she can offer you.