In the recent past, advertisements for testosterone supplementation have been easy-to-encounter on radio and TV.
“Low-T” has fast become a well-known term leading men to believe that many of the problems of aging can be quickly fixed simply with testosterone supplementation.
This universal oversimplification of a very complex issue has led to the use of testosterone and anabolic steroids indiscriminately and in various forms with often dangerous results. While testosterone is a crucial hormone for a man, it is only one player in a very complex orchestra.
Testosterone supplementation is valuable for men that have confirmed low testosterone levels (androgen deficiency). However, due to the wealth of misinformation regarding its ability to fix problems encountered by aging men, it is very much overused by both men and their doctors looking for a quick fix. Testosterone supplementation can be both life-saving and life-threatening.
Unfortunately, due to the media blitz accompanying it and unscrupulous medical practitioners, it has become a panacea for the solution of all-male aging problems.
What is Testosterone?
Testosterone is one member of a family of hormones called the sex-steroid hormones. Other members include progesterone, dehydroepiandrosterone (DHEA,) androstenediol, estriol, estrone, estradiol, and dihydrotestosterone (DHT). The androgens (testosterone, androstenedione, DHT) affect mostly male characteristics, while the estrogens (estriol, estrone, and estradiol) affect mainly female characteristics.
Some, like DHEA and progesterone, are precursors used by the body to build other hormones. Recent research indicates that the male prostate is rich in hormone receptors and sensitive to all hormones’ effects in this family. Testosterone is a vital hormone for the overall health of the human body. It is also a hormone that is particularly critical for male sexual ability, libido, and satisfaction.
Many men succumb to the myth that only men need testosterone and the only woman need estrogen, but every organ in the body has hormone receptors that accept and use hormones that fall on both sides of the gender aisle. But, having too much or too little of any hormone in this family usually leads to undesired symptoms.
Hormones are messenger modules. They travel the bloodstream in both bound and unbound (free) forms. Such bound hormones are not available for use. The free form has an active role in the body. It carries a chemical code that conveys a message of instructions to a organ n the body.
When a free hormone binds to a receptor on an organ, it triggers the organ to react to the hormonal message it brings. Only free hormones bind to receptors on the body’s organs and activate various body functions.
Most laboratory tests for testosterone are done using blood and measure the total value-which is the combination of both free and bound forms. On average, approximately 97 to 98 percent of testosterone in a man’s body is inactive, circulating in the blood bound to a blood protein called Sex Hormone Binding Globulin (SHBG). The two to three percent remaining portion (free value) is actually the only bio-available testosterone left to act on the body’s receptors.
Normal Testosterone for an Adult Male
When an older man visits his doctor complaining about a lack of energy or sexual problems, the doctor almost invariably will order a testosterone blood test for him. Many doctors simply order a total testosterone test without the free component, but it is essential to remember that only free testosterone does the work. Measurement of total testosterone does not tell the full story.
Older men often have total testosterone levels in the normal range but low free testosterone levels. A common symptom of this imbalance is the inability (or reduced ability) to have an orgasm during normal intercourse. Medically, this is known as anorgasmia or delayed orgasm. Survey rates seem to put the prevalence at a rate under 10 percent, but it is clear that millions of men suffer from this condition, and this estimate may be off considerably. 1
Anorgasmia can be caused by very low levels of free testosterone in otherwise healthy men and can also be due to nerve desensitization, particularly for diabetics. Another common symptom of low free testosterone level is a lack of spontaneous erections during the night or early morning. Barring other medical conditions-loss of nocturnal erections is almost always due to low free testosterone levels.
Adequate testosterone is essential for a man to have normal libido, orgasms, and spontaneous erections. Unfortunately, there is no specific value to determine what an adequate or normal level is. What is normal for one man may be woefully insufficient for another. When a man′s testosterone level falls on the low side of normal, replacement therapy may be in order, particularly when he has had a relatively recent loss of nocturnal erections.
However, there are significant differences between how men′s bodies react to testosterone. Some men function fine with few complaints at lower levels, while others begin having significant symptoms if their level falls below a certain personal benchmark.
Another reason for this is that all hormones in this family are interdependent. An out-of-range value is one hormone in the family that may result in symptoms that mimic a different hormone imbalance. This is quite typical for men that have a normal testosterone level alongside an overly high level of one of the estrogens. Such a result may cause symptoms mimicking a low testosterone level.
This is because many organs, including the male prostate, have receptors that will respond to both hormones. Unfortunately, estrogens in a male prostate send a very different message than testosterone.
Excessive estrogen in the male body can negate many effects of free testosterone as well as cause excessive prostate and/or breast growth.
Testosterone Levels by Age
While the medical community is prone to put numbers on everything, it is quite difficult for anyone to put exact numbers on male testosterone levels, especially for older men. To date, normal testosterone levels have been determined by averaging the levels of large groups of men of all ages. The problem with establishing normal in this manner is that the range can be extensive. 2
For example, testosterone levels vary among men depending on age, time of day when a sample is taken, and the individual’s overall health. Most doctors use a cutoff value of about 300 ng/dL in an adult male to diagnose low testosterone.
The accepted high limit of the normal range for total testosterone for a male about 1100 to 1200 ng/dl, but each laboratory may have slight differences. It is generally agreed that the high limit represents young men.
Reference ranges for testosterone are often grouped by age. Most circulating testosterone is bound to the SHBG protein and unavailable to excite testosterone receptors in the body’s organs. Only the free or unbound portion is active. A normal level for free testosterone is typically between 1.5 to 2.9 percent of the total value.
The wide variation or normal levels produces a problematic situation for the practitioner trying to determine if a man′s symptoms are the result of androgen deficiency or something else. Sexual symptoms can be misleading since they can be due to many other conditions, including vascular disease, chronic alcohol use, obesity, depressive disorders, and various medications, especially antidepressants.
Several studies have suggested that lifestyle intervention and weight loss can increase testosterone levels, especially free testosterone levels.
Men seeking solutions for their bothersome symptoms may find themselves the victim of unscrupulous male treatment centers that earn their revenue from providing discriminant testing and dispensing of medications. Such treatment centers can also offer potential debilitating overtreatment.
The average man produces about 4 to 7 mg of testosterone per day in a circadian pattern. For most men, this results in the highest testosterone levels in the early morning hours, thus, resulting in a spontaneous erection in the early morning. (known in slang as a “morning boner” or “morning wood.”
These spontaneous erections, known as nocturnal tumescence, are usually a good indicator of a reasonable free testosterone level. As men age, the nocturnal erections often disappear. While most men tend to shrug their shoulders and ignore this event, it is a critical marker that something is not properly balanced.
Signs Of Low Testosterone
Low testosterone affects a high percentage of men aged over 45. Symptoms of low testosterone levels in an adult male (medically known as adult-onset androgen deficiency) are as follows:
- Decreased libido (sex drive.)
- Erectile dysfunction
- Difficulties with concentration and memory
- Decrease or loss of body hair and beard.
- Decreased bone or muscle mass.
- Excessive fatigue
- Loss of nocturnal erections
However, many of the above symptoms can be associated with other conditions, benign or not. For example, diabetes and/or obesity can produce any of the above symptoms and may have no relation whatsoever to hormone levels.
Thus, it is crucial to have a thorough examination by a qualified professional prior to instituting any supplement or treatment plan.
Effects Of Abnormal Hormone Levels
Abnormal testosterone levels can be the result of normal male aging as well as the result of various medical conditions and diseases. Most of the literature found on an Internet search is devoted to low androgen levels resulting in sexual problems.
However, men with high levels can suffer many debilitating effects as well. An imbalance of any hormone can profoundly affect other hormones in the family and effects on functioning other than sexual. 3
The exact level of any hormone in the human body is less important than its relationship to related hormones. For example, a high estrogen level (a predominately female hormone) can offset free testosterone (a predominately male hormone), rendering it less physically active. This can, in turn, produce symptoms mimicking low testosterone.
Heavy meat and dairy consumption are known to raise estrogen levels. High estrogen levels, especially in older men, tend to cause enlarged breasts and prostate growth. Hormones do not work in a vacuum; they function more like a complex set where one can profoundly affect the others.
About 20 years ago, bestselling author and hormone balancing expert Dr. John R. Lee published his startling conclusion that synthetic hormones can cause serious side effects, including an increased risk of stroke, cancer, and liver damage. The Women’s Health Initiative study subsequently confirmed his findings, a study that was terminated early due to the indication that it was increasing the risk of stroke and cancer in the participants. 4
Treating Low Testosterone Levels
Past incorrect beliefs that testosterone replacement therapy causes prostate cancer left many medical practitioners reluctant to prescribe it. The latest scientific research shows that a healthy man does not incur the additional risk of prostate or any other cancer by raising his testosterone level to his age’s normal biological range.
Renowned medical oncologist, prostate cancer researcher, and founder of the American Institute for Diseases of the Prostate, near Charlottesville, Virginia, Dr. Charles “Snuffy” Myers, has stated, “There is absolutely no hint that testosterone at high levels correlates with prostate cancer.”
Confirmed low testosterone levels can be treated by supplementing with natural or synthetic testosterone. There are many forms of testosterone therapy, but the most friendly to the body is bio-identical skin cream. Bio-identical means that the formulation of the testosterone molecule is identical to that produced by the human body. All other forms of testosterone supplementation are composed of synthetic testosterone.
The different forms of testosterone therapy include weekly or biweekly injections, skin patches, and pills employing synthetic chemicals that are similar but not identical to natural testosterone. Typically, such products are not completely recognizable by the body.
The different testosterone preparations available include intramuscular formulations, topical gels, solutions, and skin patches. Tablets and implanted subcutaneous pellet formulations are available but are less commonly used.
Intramuscular injections are the most often prescribed option. They are typically administered every 1 to 3 weeks. A serious disadvantage of such injections is the fluctuation in serum testosterone concentration which can trigger the body to attempt to lower the high level.
Hormone injections, skin patches, and pills subject the body to unnatural fluctuations in testosterone, estrogen, and other hormones due to their synthetic composition. In contrast, skin creams using bio-identical formulations permit precise periodic dosing as prescribed by a qualified health care practitioner.
A process called aromatization converts excess testosterone in the body to estrogen. This is counterproductive and can cause other issues. The conversion process and periodic injections cause fluctuating libido, energy level, and mood. Transdermal forms (through skin creams) offer more stable concentrations and better level control.
Normal testosterone levels can usually be reached within a few weeks using a low-dose transdermal cream mixed by a compounding pharmacy to contain about 25 to 50 mg of testosterone per dose. Typically, only about ten percent of the dose is absorbed into the blood, yielding a dosage of about 2.5 to 5 mg of testosterone per day.
With prescription testosterone skin cream, it is important to measure the dosage carefully to simply bring the testosterone level back to normal. Increasing levels beyond a normal biological range can increase the risk of stroke.
Natural bioidentical testosterone cream labeled USP, for United States Pharmacopoeia standard, is available at compounding pharmacies. Bioidentical means that a substance has the same chemical form as that produced by the human body.
Try a Natural Approach First
There are many herbs reputed to increase testosterone levels, sexual libido, or erectile function. Most of them have little backing other than the manufacturer’s claims. Some-like red panex ginseng, ginkgo Biloba, Tribulus Terrestris, saw palmetto, and mucuna pruriens have been studied in humans and appear to have measurable effects on either libido testosterone level or erectile function.
Before supplementing to increase your testosterone level, it is advisable to see your doctor. Low testosterone can be caused by a benign pituitary tumor or other conditions, and it is wise to rule these out first. If your level is low and all medical causes are ruled out, you can then try to increase it with herbs and other natural products. Failing that, a prescription bio-identical testosterone cream can be used. 5
As they age, some men strongly feel the effects of a cumulative decline in testosterone levels and experience significant symptoms, while others barely notice it. For men that feel significant symptoms, restoring testosterone to its biological norm can be rewarding.
Men often silently accept normal aging symptoms like; loss of interest in sex, erectile dysfunction, muscle deterioration, and lack of youthful energy. They don’t always know that such symptoms can easily be from a common problem-poor nutrient status and a resultant hormone imbalance.
As with the rest of the body, hormones are produced by the nutrition the body receives. A poor diet is equivalent to asking your body to produce all the hormones you need without providing it with the raw material with which to build them.
As we age, it becomes more difficult for the body to absorb needed nutrients from food. Combine this with inadequate food and lifestyle choices, and the result is multiple nutrient deficiencies, hormone disruption, and lots of the above-mentioned symptoms.
Before supplementing to increase your level, it is advisable to see your doctor and actually measure both free and total testosterone levels. Low testosterone can be caused by a benign pituitary tumor or other conditions, and it is wise to rule out problems first. If your level is low and all medical causes are ruled out, you can then try to increase it with herbs and other natural products. Failing that, your doctor can prescribe testosterone cream for you.
Consider supplementing if your free testosterone is on the low side and you are having symptoms, even if your total testosterone level is normal. This is particularly true if you are older than sixty. The determinant should be how you feel-not just the laboratory value. Hormones are powerful, and a little can go a long way, but beyond a biological normal, more is not better and can reverse benefits.
One interesting thing about testosterone values is that the high limit of normal for a man over sixty is more than 30 percent below that of a forty-year-old. Aside from being misleading, this may be obsolete. Many experts consider that values for young men are also valid for older men. 6
In more than 25 years of practice, I have found many men who do fine on testosterone levels well below the maximum. Many men also do well on levels bordering on the minimum. The level that is right for a particular man should be wholly determined by how he feels. Laboratory results should be used only as a guideline.
With hormone supplementation, more is not better and could be detrimental.