Testosterone is a male’s dominant hormone. It floats in the bloodstream and disperses to all tissues of the body. It diffuses into cells then the nucleus naturally. There are millions of testosterone receptors throughout both men and women’s bodies, including the brain, eyes, blood vessels, heart, muscles, and more. Testosterone peaks higher than adults in baby boys at 3 months old and by adulthood remains at or around 550 (average). Testosterone is the reason men have higher blood counts, larger muscles and bones, and thicker facial hair.
What is low testosterone or Low T?
Low testosterone is diagnosed when a male’s testosterone levels are lower than expected. We expect total testosterone to be over 500. However, free testosterone must also be assessed in order to truly determine testosterone levels. Total testosterone is the grand total of all the testosterone floating in the blood stream, but the majority of testosterone in the bloodstream is bound to proteins like albumin and cleverly named Sex Hormone Binding Globulin (SHBG). Since testosterone that is bound to protein is inert, the amount that is freely floating in the blood stream is the most important. This freely floating testosterone not attached to proteins is called Free Testosterone. This level should be over 90 for optimal health (depending on the lab).
How is low testosterone diagnosed?
Low testosterone is diagnosed with a simple blood draw. Testosterone levels are highest in the morning. The younger and healthier the person, the more volatile the testosterone levels act. If you are over 50 and inactive, your testosterone level is likely to be very steady throughout the day. However, if you are 35 and fit, your testosterone can range from high to “deficient” within a 24-hour timeframe. This is normal and beneficial to the body!
It is important to assess both total testosterone and free testosterone in order to understand your testosterone balance.
Symptoms are important for the assessment of testosterone levels as some men experience deficiency symptoms at a total testosterone level of 400 while others feel normal at 350. This can usually be attributed to variable free testosterone levels.
What causes low testosterone or Andropause?
There are multiple causes of low testosterone. The leading cause of low testosterone is being overweight, sedentary, and eating poorly. Rarely, you can have a pituitary tumor that damages your sex hormone stimulating cells, which would cause low testosterone. Another cause of low testosterone would be removal of testicles, which is similar to surgical oophorectomy (ovaries removed) in women.
Since hormones are constantly communicating with each other, one hormonal imbalance can cause the other hormones to become depleted. Adrenal fatigue is a common cause of low testosterone since cortisol is considered the “master hormone.” Thyroid dysfunction can also contribute to low testosterone.
Another culprit of low testosterone that is more insidious and difficult to prove is the likelihood of environmental toxins (BPA, glycophosphates, phthalates, hormones in meats) that act as xenoestrogens. These xenoestrogens tell our brains to quit making testosterone.
These problems that cause low testosterone are lumped into a syndrome called Andropause.
How does estradiol (estrogen) cause low testosterone?
The brain determines a male’s testosterone level based on the amount of estrogen circulating in the bloodstream. Since a standard amount of testosterone is naturally converted to estradiol (estrogen) by an enzyme called aromatase present in all males, this works out perfectly. However, as false estrogens (xenoestrogens) enter our bodies, the brain stops stimulating testosterone production since it believes there are ample amounts already. This is the same phenomenon that happens as men gain weight. Fat cells naturally convert testosterone into estradiol through aromatase. This elevated level of estradiol shuts down the testicle’s testosterone stimulus called Leutenizing Hormone (LH).
There are currently two drugs that block the aromatase enzyme: Anastrozole (Arimidex) and Exemestane (Aromasin). Exemestane is considered a suicide inhibitor of the aromatase enzyme because when it binds to the enzyme, it permanently disables it. Overall, both are similar in nature: they reduce estradiol.
What are the symptoms of low testosterone?
Each male is different, so you may experience different symptoms than listed here. The common symptoms are:
- Decreased mental sharpness
- Low energy / Fatigue
- Worsening or Difficult to Maintain Strength
- Slow Recovery at the Gym
- Increased Body Fat
- Poor Libido / Sex Drive
- Decreased Sensitivity to Stimulation
- Low Quality or Difficult Orgasms
- Erectile Dysfunction
- Low Mood, Depression
- Loss of Eagerness and Enthusiasm
- Irritability or “Grumpy Old Men“
- Increased risk of cancer (low testosterone levels increase cancer risk)
How will I feel when I increase my testosterone levels?
This is a frequently misused question as patients are sometimes expecting to become Superman with testosterone replacement. The true answer is that you should expect to feel more youthful and healthy. It should help restore energy, elevate mood, trim body fat, increase muscle tone, balance mood, and enhance sexual function back to its normal set point. If you take more testosterone than normal, you can certainly expect further improvements in symptoms, but this is not recommended. High dose testosterone has not been studied scientifically despite it being used in the anabolic steroid bodybuilding days.
Restoring natural testosterone levels can reverse the physical decline that robs men of their energy, strength, and libido. Testosterone can restore muscle tone and improve stamina. Testosterone can restore healthy sexual excitement and desire, which in turn, results in an improvement in mood and overall wellbeing.
How do I increase my testosterone levels?
There are multiple forms of testosterone replacement. It is important to choose the testosterone replacement therapy that fits you and your lifestyle. You will find the different options of testosterone replacement therapy below. Your physician can help you decide which therapy is best for you. You will find the most common methods listed below with their advantages and disadvantages.
Testosterone Pellet Implants
Testosterone pellet implants (also called Testopel) are the preferred testosterone replacement at Oubre Medical. It creates a sustained, steady testosterone level that is dependable without risk of transference to others. We can also place estrogen-blocking pellets (anastrozole) at the time of the procedure to prevent elevated estradiol if this occurs.
Testosterone pellets are inserted underneath the skin of your hip every 4-6 months. The pellets are slowly dissolved by your body thus creating a very constant and steady level of testosterone. This method has no risk of transferring testosterone to loved ones. Refer to our Pricing Page for cost.
Testosterone Injections (Depo-Testosterone, Testosterone Cypionate)
Testosterone injections are the oldest method of testosterone replacement. It involves injecting the testosterone oil into a muscle 1-3 times per week. The injections work immediately with a rise in testosterone level seen within an hour. Unfortunately, it falls as quickly as it rises which creates volatile testosterone levels. Many men experience the “slump” of low testosterone before their next injection. We usually encourage patients to inject a smaller amount two or three times per week in order to maintain steady, optimal levels. There is no risk of transference to loved ones.
Rapidly Dissolving Testosterone Tablets (RDT, Trochi)
Rapidly dissolving tablets, or RDTs, are quickly becoming a preferred testosterone replacement method. The RDTs are simple and easy. They usually taste great, depending on the compounding pharmacy. There is minimal risk of transference unless oral contact with others occurs within minutes of administration. There is a potential risk of increased blood clotting if you swallow the tablets. They must be dissolved, not chewed or chased with water. Assessing testosterone levels on RDTs is complicated as immediately after administration, the levels are excessively high. Then, they drift downwards to a steady state 3-6 hours after dissolving. When getting labs drawn using RDTs, it is imperative to get blood work drawn 3-6 hours after dissolving your RDT. The tablets must be compounded by a compounding pharmacist.
Clomiphene Tablets (Clomid) with Anastrozole / Exemestane
Clomiphene has a unique way of raising testosterone levels. It is not a testosterone replacement. Instead, it blocks your brain’s ability to detect estrogen. This is explained in more detail in the segment above labeled “How does estradiol cause low testosterone?” When the brain cannot detect estrogen in the blood, it ramps up its Leutenizing Hormone (LH) and Follicle Stimulating Hormone (FSH). It tells the testicles to produce more testosterone. Unfortunately, it also increases the body’s production of estrogen, so estrogen always needs to be blocked with Clomiphene. This combination can be purchased separately or combined at a compounding pharmacy into a daily capsule. Clomiphene is one of the only testosterone therapies that maintains and restores fertility. It does not have any risk of transference to loved ones. It is the preferred treatment for younger men with low testosterone.
Human Chorionic Gonadotropin, or HCG, is a hormone that is produced by the developing fetus inside the mother’s womb. The fetus maintains its own survival in the womb by overriding the mother’s female hormone cascade with HCG. The HCG hormone mimics Leutenizing Hormone (LH), which stimulates progesterone production in women; hence, the name progesterone (pro = for, gest = pregnant, one = steroid). When HCG is used in men, it also mimics the LH hormone, but LH in men stimulates testosterone production. HCG is not frequently used as a testosterone booster. It is mainly used to maintain fertility and testicular size when using testosterone replacement. There are theories that HCG has more benefits aside from testosterone replacement, but the data is lacking at this time. It does not have any risk of transference. The HCG hormone is a subcutaneous injection similar to insulin. It causes minimal discomfort and uses a much smaller needle than testosterone injections.
This method of testosterone replacement is the easiest to use. The topical testosterone is applied to the skin daily. However, topical testosterone is the most difficult to maintain adequate levels. Because every patient’s skin has different thickness, absorption, sweat, and oils, it can take months to achieve optimal levels. It also has the highest risk of transference to loved ones (spouse, children, parents).
There are multiple types of topical testosterone. The compounded creams are affordable without insurance, and your physician can customize the prescription to fit your daily needs. The pharmaceutical testosterone gels are expensive (unless covered and you use coupons). Each pharmaceutical gel comes with a different delivery, which has its own advantages and disadvantages. A unique pharmaceutical topical testosterone is a nasal testosterone called Natesto. The ointment is applied to both nostrils three times per day. This is the only topical testosterone with a low risk of transference unless someone else is picking your nose.
10-Week Testosterone Injection (Aveed, Testosterone Undecanoate)
This method of testosterone delivery is the longest acting injection on the market. It is currently branded under the name Aveed. It is expensive without insurance (around $1,200 per injection). The injections cannot be self-administered. They must be performed in an office that has been registered with Aveed. You must be monitored for 30 minutes after the injection as there is a small risk of the oil causing a small pulmonary embolism. There is no risk of transference with this method. The long-acting testosterone injections are more uncomfortable than testosterone cypionate as it is a thicker substance.
What are the risks or side effects of testosterone therapy?
As with any therapy, there are risks associated with testosterone replacement. A common side effect is acne, including cystic acne. This is usually resolved after discontinuing treatment. Since testosterone stimulates red blood cell production, some patients may notice increasing blood counts called Polycythemia, which is treated by lowering the testosterone dosage or routinely donating blood. If you are performing injections, there is always the risk of a localized infection at the site of injection.
Men with the genes for Male Pattern Baldness will most likely notice faster hair loss. This is due to the conversion of testosterone to Dihydrotestosterone (DHT). Male Pattern Baldness can usually be slowed by lowering the testosterone dosage, using DHT blockers like finasteride, and application of topical minoxidil.
There are several controversial risks associated with testosterone replacement.
There has been a great deal of TV advertisement about the heart attack risk associated with testosterone therapy, and this has never been proven true. In fact, data regarding the reduction of heart attacks is beginning to surface. If testosterone restores energy and muscle growth, then you are more likely to exercise, which reduces the risk of heart attacks.
There is a suggested increased risk of blood clotting with testosterone therapy. However, the risk of blood clotting is only associated with oral administration of hormones which we do not offer.
There is controversy regarding the dangers of testosterone replacement causing or enhancing prostate cancer growth. Currently, we are lacking adequate scientific data to direct patients on this topic. One study linked low testosterone to increased risk of prostate cancer.
Where do I get my compounded testosterone prescriptions?
You can get your compounded testosterone prescriptions at any compounding pharmacy that you choose. Most compounding pharmacies do good work, so you should choose one based on cost and customer service.