Advanced Testosterone Therapy for Men
Revitalize your libido, your energy and your life. Testosterone therapy can improve energy levels, low libido, and erection problems. Testosterone therapy can also improve blood sugar regulation in diabetic patients.
As we age our total testosterone may be in the “normal” range or become low but the free testosterone (also known as bio-available testosterone) declines. Your testosterone levels began to decline about 1% per year starting when you turned 30 years old.
- Do you have a decrease in libido (sex drive)?
- Do you lack energy?
- Is your strength or endurance decreased?
- Have you lost height?
- Have you noticed decreased “enjoyment of life”?
- Are you sad or grumpy?
- Are your erections less strong?
- Have you noticed a recent deterioration in your ability to play sports?
- Do you fall asleep after dinner?
- Has there been a deterioration in your work performance?
If you answered “yes” to questions #1 or #7 or any 3 other questions, you may have low testosterone.
A reduction of your total testosterone and or free testosterone can lead to many symptoms, such as:
- Lack of Energy: “The couch is calling me”
- Loss of Muscle Mass
- Increase in Body Fat (Weight Gain)
- Changes in Hair and Skin Texture
- Thinning or Loss of Hair
- Dry Blotchy Skin
- Depression and Mood Swings
- Short Tempered
- Decreased Interest To Do Things
- Decreased Libido (Sex Drive)
- Decreased Sexual Performance (Erectile Dysfunction)
- Difficulty or Inability to Achieve or Maintain an Erection
- Loss of Erectile Strength
- Increase in the Refractory Period (Time to Achieve Another Erection After Climaxing)
- Loss of Vitality and Sense of Well-Being: “I don’t feel like I used to”, “I just don’t feel right”
- Decreased Cardiac Output
Not surprisingly, about 40% of men after the age of 45 start experiencing problems with their erections. However, when you have low testosterone you can benefit from testosterone therapy whether you have erectile dysfunction or not.
How is low testosterone diagnosed?
Your age and other health history will help us to determine what lab tests we may want to do initially. For most male patients as an initial screen we measure your total testosterone, free testosterone, and PSA levels. For younger male patients it is more important to measure luteinizing hormone (LH). If you have diabetes then we may measure estradiol (E2) with the initial labs because it tends to be higher in those with metabolic diseases and can easily be reduced with medications like anastrazole, an aromatase inhibitor that prevents testosterone from converting to estrogen. This conversion occurs in fat cells and other cells in your body.
Men who have received testosterone therapy before without seeing major benefits may be converting too much testosterone is to estrogen and thus preventing the benefits.
What does testosterone replacement therapy involve?
There are a number of treatment options that will be determined by your age and medical history. These may include testosterone injections or testosterone cream, human chorionic gonadotropin (HCG, supports endogenous testosterone production and helps regulate other hormones), anastrazole (reduces estrogen levels), and other hormones, nutrients, and therapies as indicated by lab tests and signs and symptoms.
Other Questions For Low Testosterone Symptoms
- Have you been diagnosed with osteoporosis?
- Do you have chronically dry skin?
- Are you losing body hair, especially on the legs?
- Are you balding?
- Do you experience an unexplainable unhappiness?
- Have you become more irritable?
- Do you have less ability to cope with stress?
- Are you more emotional?
- Does your body temperature fluctuate easily?
- Do you experience hot flushes?
- Do you have chronic pain?
- Have you gained weight gradually without an obvious cause?
- Are you experiencing difficulty losing weight?
- Are you retaining fat in your abdomen (increased belly fat)?
- Do you produce less semen so your ejaculation quantity is reduced?
- Have you been diagnosed with insulin resistance, diabetes, or metabolic syndrome?
If you answered yes to any of the above questions then you are more likely to have low testosterone.
Many of the symptoms of low testosterone can come on gradually over time so that it is hard for us to know what we are losing because the change is so slow. It may be others around us who point it out that we are having a problem but connecting the dots can be difficult for those unfamiliar with the symptoms of low testosterone.
Depression and Low Testosterone Symptoms
Mild depression is often a symptom of low testosterone.12 It is highly unlikely anyone could have a “Prozac deficiency”. However, low testosterone appears to be an epidemic in our society that is often under-treated and under- or mis-diagnosed. The clinical picture of depression is something that closely looks like or parallels low testosterone.
Men on SSRIs often get better results when testosterone therapy is added to the treatment program. And men may sometimes do better with only testosterone therapy as anti-depressants have many side-effects which include low libido.
In men, elevated estrogen levels may also increase the symptoms of depression, likely in part due to their ability to affect neurotransmitter receptors in the brain.3 Testosterone may exert part of its beneficial effect on the brain through the dopamine system.4 Many of the drugs used to treat depression effect these two systems. It appears that mild depression is often just one symptom of low testosterone.
Fatigue and Low Testosterone Symptoms
Low testosterone levels can contribute to decreased work performance and testosterone therapy can improve work performance.6 The ability of testosterone replacement therapy to increase testosterone levels as well as work performance may be due to testosterone increasing aggressiveness as well as energy levels. Testosterone also effects reward seeking behaviors so that we focus our efforts on more rewarding activities.
Low testosterone may contribute to fatigue because of the fact that testosterone is very important for erythropoesis (red blood cell production). Without adequate red blood cells you cannot deliver oxygen effectively to different areas of your body and the symptoms and byproducts of anaerobic metabolism (oxygen deprivation) occur. One of these symptoms is fatigue or low energy and Abraham Morganthaler, MD, a Harvard urologist, writes in his book entitled, ‘Testosterone for Life’, that fatigue is more likely to occur towards the end of the day and may present as a simple decreased vigor for life or the well known “the couch is calling” syndrome. If you are feeling like you have become a couch potato after work then you may be experiencing a symptom of low testosterone.
Memory, Brain Function, and Low Testosterone Symptoms
Low testosterone symptoms include brain fog, difficulty concentrating, and problems with short term memory.7 Not surprisingly, low testosterone is a major risk factor for the development of Alzheimer’s disease.8
Diabetes and Low Testosterone Symptoms
Diabetes type 2, which is the acquired form that is preceded by metabolic syndrome or pre-diabetes, is often correlated with low testosterone and its symptoms. Better glucose regulation can be achieved by hormone therapy which usually involves increasing testosterone levels and/or decreasing estrogen levels.910
Body fat serves as a major site in men for converting testosterone to estrogen. The enzyme that does this is called aromatase. The irony is that while testosterone helps regulate blood sugar and prevent insulin resistance, insulin resistance may lead to increased conversion of testosterone to estrogen in body fat (adipose tissue) which leads to low testosterone and low testosterone contributes to poor glucose metabolism. Thus, the downward spiral of diabetes and all the symptoms of this disease as well as low testosterone symptoms can occur.
For many men, erectile dysfunction can be particularly difficult to treat when “caused” by diabetes because of the potential nerve damage and blood vessel damage combined with a reduction in testosterone and increase in estrogen. Luckily, these hormones levels can be optimized and in combination with PDE-5 inhibitors help restore the function of the penis. Lifestyle changes would make a lot of sense for those truly committed to treating the cause when diabetes type 2 or insulin resistance is present.
Patients who have diabetes and an unfavorably high estradiol to testosterone ratio appear to have increased risk of heart attack.11
Erectile Dysfunction and Low Testosterone
There are many factors that can lead to erectile dysfunction and it occurs in varying degrees of severity. It can take several years of hormone disregulation to cause the problem. There is often a severe imbalance in the conversion of testosterone to estrogen. While testosterone may be in the normal range, often “low normal”, estrogen levels may be high normal. This imbalance contributes to poor blood flow function in the penis. Estrogen is correlated with increase venous leakage in the penis, also know as an inability to maintain an erection for the desired time frame. Also contributing to this is decreased testosterone levels.
Testosterone is required to maintain the smooth muscle of the veins the penis that fill with blood during an erection and correlates with their ability to produce nitric oxide, the chemical signal in the vein that says, “hey, let’s fill with blood now.”12 Research also shows that low testosterone leads to penile atrophy and changes in the nerves in the penis as well.
Testosterone supports the same mechanisms that drugs like Viagra© effect. This is because hormones like testosterone exert their effects by acting directly on DNA synthesis that alter enzyme production. This includes the enzyme nitric oxide synthase. By increasing the production of these enzymes testosterone can help Viagra© work better.
We have treated thousands of patients with erectile dysfunction and often the ones that don’t get results with Viagra© alone get better results with a combined approach.13 Viagra© can be useful at helping to rehabilitate the penis when it is not working very well any more.
In terms of revascularization of the penis, research shows that it can take 18 to 30 weeks for some patients to see benefits but some patients may notice improvement immediately.14 In addition, it may be essential to reduce your estrogen levels as increased estrogen levels can contribute to venous insufficiency.15
Does testosterone therapy cause prostate cancer?
NO! There is no evidence testosterone therapy causes prostate cancer.16 In fact, low testosterone is more highly associated with prostate cancer and severe forms of prostate cancer.17