Here’s Everything You Wanted to Know About Testosterone Optimization

Estimated Reading Time: 12 Minutes

The Low Down on Low T

During the teenage years, testosterone begins to rise in males. Testosterone (T) is a naturally occurring hormone in the body. As men get older, testosterone begins to decline. T lowers an average of 1 to 2% per year. The decrease in T may start to occur as early as age 30 to 40.22

Low T (low testosterone) is a condition where testosterone levels are lower than expected. Low T may occur due to several different health issues. It is essential to rule out any underlying conditions that may be causing low T as a precaution before initiating therapy. Many times, low testosterone is an isolated finding without a known reason or cause.

Producing Testosterone

Let’s start with the basics of the body. Testosterone is a hormone primarily produced in the testis of males. The hypothalamus-pituitary-gonadal (HPG) axis (also referred to as the hypothalamus-pituitary-testicular axis) is a complex pathway in the body. The HPG axis works to keep testosterone and other hormones stable.

It sounds scary, but it is not when you break it down. The hypothalamus is a small region of the brain responsible for the release of hormones. The hypothalamus also controls the ‘master gland’ called the pituitary. The pituitary produces hormones on-demand and releases them directly into the bloodstream.

Among the hormones released by the pituitary are the luteinizing hormone (LH) and follicle-stimulating hormone (FSH). LH stimulates Leydig cells inside the testis to produce testosterone. When FSH pairs with high levels of testosterone inside the testis, it makes sperm.

What does Testosterone have to do with it? Impact on the Male Body

Testosterone acts as a hormone in three ways:

  1. Testosterone binds to hormone receptors ‘as is.’
  2. Testosterone converts to dihydrotestosterone (DHT). Hormone receptors like DHT and grab on to it better compared to regular testosterone.
  3. Testosterone converts to a form of estrogen and bind to estrogen receptors. That’s right – Men have estrogen too!

When testosterone binds to a hormone receptor, it triggers a signal. The signal launches several coordinated responses within the body. These responses impact sex drive, the ability to conceive children, muscle mass, fat distribution, bone mass, growth of body hair, and sexual function. For the human body to develop and function normally, proper levels of testosterone must be present.

Risks of Testosterone Deficiency

When testosterone levels are below average, men may display symptoms, such as:

  • Decreased sex drive
  • Difficulty establishing an erection
  • Absence of morning erections
  • Depleted semen volume
  • Testicular shrinkage
  • Fatigue
  • Lack of motivation
  • Increased weight and fat
  • Inability to lose weight with diet and exercise
  • Reduced physical performance
  • Decreased muscle and bone mass
  • Loss of hair
  • Moodiness
  • Hot flashes
  • Depression
  • Sleep disturbance

Testosterone deficiency increases the risk of heart disease, stroke, and type 2 diabetes. It is also associated with increased insulin resistance, cholesterol, blood sugar, and hemoglobin A1c, a measure that indicates blood sugar control over three months. Over time these insults take their toll on the heart and body and impose silent, irreversible damage to vital organs.

Low levels of testosterone can slow brain function and make concentration difficult. Studies show that men suffering from low T levels perform lower on memory, self-regulation, and attention testing.10

The jury is still out on testosterone deficiency’s impact on lifespan. However, current research suggests low T may also shorten total life expectancy.

Low Testosterone is Expensive

Health effects aside, untreated low T may also impact your pocketbook. Individuals with untreated Low T display average higher healthcare costs per person per month. Specific areas displaying worse health outcomes in the low T group include heart health, pain, and mental health.14 Who can afford not to treat low T?

When to Treat Low Testosterone

It will not take long to see that there are many mixed recommendations around when to treat men with testosterone therapy if you are researching the topic. Reputable experts agree that the most significant benefits are in men with symptoms and low T levels. The same experts also note that testosterone values in the low end of normal might not be adequate. Individuals teetering the low T cusp may benefit from supplementation.3,11,23

The 2018 US Endocrine Society Guidelines state that differences in laboratory ranges and patient symptoms should play a role when making decisions to start therapy. Men who start testosterone therapy should receive a follow-up evaluation to review treatment response, adverse effects, and adherence to regimen.1, 2

Refer to our previous post, Why Your Blood Test May Be Misleading You, for additional discussion on typical testosterone values in men.

Benefits of Testosterone Level Optimization & Testosterone Replacement Therapy

The body thrives when testosterone levels are optimal. Sufficient T levels offer well-known perks like bigger muscles and body physique. Less advertised and overlooked benefits include overall well-being and mental clarity.

Body fat and lean muscle mass are reliable indicators for health outcomes. Testosterone replacement therapy increases lean muscle and decreases fat. Also, weight loss, waist slimming, body mass index (BMI) improvement, and lowered blood pressure are favorable outcomes seen with treatment.

Low T levels are associated with an abnormal amount of cholesterol and fat in the blood. Optimal testosterone in the body maximizes the ‘good’ cholesterol that protects against ‘bad’ cholesterol build-up by transporting it to the liver for removal.8

Testosterone decreases pressure in blood vessels through its fast-acting dilating effects on the heart and lung blood vessels. By blocking the entry of calcium into the muscle cells of the heart and the arteries, testosterone decreases the work on the heart and increases exercise capacity.13

In addition to its improvements in cardiac function, when T levels are within a healthy range, insulin sensitivity increases, and blood sugar reduces. When used appropriately, testosterone therapy curtails the adverse effects of low T levels on heart health, diabetes, and other complicated conditions.

In a well-known study known as TIMES2, testosterone replacement in men diagnosed with diabetes and metabolic syndrome showed benefits to the pre-existing conditions through improved blood sugar, cholesterol control, and sex drive. The same study displayed that improvements occurred without increases in unwanted side effects.9,12 Should testosterone be part of treatment in certain conditions? More reviews to come!

Testosterone is a well-established protector of bone health. Through a chemical reaction, testosterone converts to a form of estrogen. Testosterone binds to hormone receptors, which suppresses bone reabsorption and maintains bone integrity leading to strong and sturdy bones. Through the interaction described, testosterone protects from fragile and weak bones.7,16

Last but not least, T supplementation boosts the brain! In men with low T levels, testosterone replacement therapy improves brainpower. T levels affect the ability to think and remember clearly. Studies also discuss T supplementation may support brain function in individuals with average T levels though additional research is in the works.10

Fact or Fiction: Debunking Testosterone Therapy Myths

Hormone replacement research has come a long way since starting in the 1940s. Despite rising information supporting that testosterone replacement therapy is safe, low T treatment still catches a lousy wrap in the media. But should it? Let’s explore the facts.

The Risk for Heart Disease

If you consult good ole’ google on heart risks associated with treatment, results will show a variety of opinions. You may see references to an analysis published in 2013 that included unapproved formulations and questionable practices. This study drew major media attention.

As a result of the publication, the United States Food and Drug Administration (FDA) issued an alert in March 2015. The warning stated that there might be elevated risks to the heart with initiating or continuing TRT.

Did the FDA react too quickly? Today, experts in the field insist that there is no credible evidence supporting an increase in cardiovascular events. Those same experts have published the flaws and misrepresentation stating that when the study data is interpreted appropriately, male recipients of TRT showed a lower occurrence of cardiovascular events.2,4

The best available information supports the use of testosterone when testosterone levels in the blood are monitored intermittently. When initiated in patients with low levels, testosterone replacement can improve or prevent the following cardiovascular-related conditions:

  • Obesity
  • Heart disease
  • Stroke
  • High cholesterol
  • High blood pressure
  • Pre-diabetes
  • Diabetes

Additional research comparing risks in untreated low testosterone versus long-term replacement is needed to put the remaining naysayers to rest.2 The FDA has yet to reverse their statement despite the mounting support to do so.

The Risk for Prostate Conditions

Another common myth is around testosterone and its relationship to prostate conditions. Over the past twenty years, accumulating evidence shows that there is not a measurable risk that would suggest testosterone accelerates prostate cancer growth or increases the risk of developing prostate cancer.15 

It is reasonable to routinely measure prostate-specific antigen (PSA) levels in the blood to screen for prostate health as a preventive measure. But it is not always required before starting testosterone therapy.

Historical studies claim that testosterone replacement therapy is linked to increased risk for prostate enlargement, and lower urinary tract symptoms, such as urinary retention. Emerging studies within the past ten years suggest otherwise.

Risk of Infertility

Matured male testis produce testosterone and sperm. Naturally produced testosterone stimulates the development of sperm. Testosterone from outside the body has the opposite effect. Testosterone supplementation is known to slow sperm production. In short, testosterone supplementation tells the hypothalamus to slow down the pituitary release of LH (Luteinizing hormone, also known as lutropin and sometimes lutrophin) and FSH (Follicle-stimulating hormone). Low LH and FSH turn down the dial for testosterone and sperm production inside the testis.

There are ways to prevent and reignite sperm production if having children in the future is important to you. For example, safe, injectable medications can help. Drugs that stimulate sperm production may be taken with testosterone therapy as maintenance or started before attempting to conceive.18 Most experts may advise temporarily stopping testosterone therapy before starting to try to have a baby.

There is a low risk for absent sperm movement with testosterone replacement, though most cases are reversible. Discuss benefits and risks with an expert before starting therapy. However, you do not need to turn to other solutions completely if kids are in the cards someday down the road.

Risks to Breathing During Sleep

Natural testosterone produced in the body helps establish and maintain healthy sleep patterns. In contrast, research shows that supplemental testosterone may worsen sleep apnea symptoms. Sleep apnea is a condition in which individuals temporary stops breathing while asleep. As a result, testosterone replacement therapy is a contraindication in persons with severe and untreated sleep apnea.17

Have you been diagnosed with sleep apnea? No worries – testosterone therapy is still an option! Experts state that this effect may be last only for a short period, and symptoms may actually improve with long-term testosterone replacement therapy. Most folks are still viable candidates and would benefit from treatment.17 If you are on or seeking testosterone therapy and have sleep apnea, let your hormone replacement expert know.

Illegal Drug Use

Despite mixed media messaging, testosterone replacement therapy is not the same as illegal steroid use. The goal of testosterone supplementation is to achieve physiologic or normal levels of testosterone.

Illegal steroids are typically driven by bodybuilders, or other athletes, with a desire to ‘get stacked.’ Unauthorized steroid use is unsafe. Replacement or optimization of testosterone should be done under the guidance of experts to ensure overuse, improper dosing, use of hazardous medications, and undetected health risk do not occur.

Consult with a Hormone Replacement Expert

Most routine healthcare professions do not provide testosterone therapy routinely. It is best to consult a hormone replacement expert who is familiar with up and coming research and practices medicine in the specialty.

Dose adjustment is vital during therapy. Proper dosing required to maintain lean mass, fat mass, and sexual function varies by person.6 Trust a seasoned hormone replacement expert to optimize your wellness.

Do you have symptoms of testosterone? Are you ready to take the next steps to be well? Our experts are here to get you started on your journey today. Are you interested in beginning Testosterone Replacement Therapy?

Contact BodyRX today for an appointment.

References

1Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010;95(6):2536–2559. doi:10.1210/jc.2009-2354

 

2Borst SE, Yarrow JF, Conover CF, et al. Musculoskeletal and prostate effects of combined testosterone and finasteride administration in older hypogonadal men: a randomized, controlled trial. Am J Physiol Endocrinol Metab. 2014;306(4):E433–E442. doi:10.1152/ajpendo.00592.2013

 

3Buvat J, Maggi M, Gooren L, et al. Endocrine aspects of male sexual dysfunctions. J Sex Med. 2010;7(4 Pt 2):1627–1656. doi:10.1111/j.1743-6109.2010.01780.x

 

4Carter D. Controversy over Cardiovascular Risks of Testosterone Therapy. Am J Nurs. 2015;115(5):17. doi:10.1097/01.NAJ.0000465018.88189.53

 

5Corona, G., Giagulli, V. A., Maseroli, E., Vignozzi, L., Aversa, A., Zitzmann, M., … Maggi, M. (2016). Testosterone supplementation and body composition: results from a meta-analysis of observational studies. Journal of endocrinological investigation, 39(9), 967–981. doi:10.1007/s40618-016-0480-2

 

6Finkelstein JS, Lee H, Burnett-Bowie SA, et al. Gonadal steroids and body composition, strength, and sexual function in men. N Engl J Med. 2013;369(11):1011–1022. doi:10.1056/NEJMoa1206168

 

7Golds, G., Houdek, D., & Arnason, T. (2017). Male Hypogonadism and Osteoporosis: The Effects, Clinical Consequences, and Treatment of Testosterone Deficiency in Bone Health. International journal of endocrinology, 2017, 4602129. doi:10.1155/2017/4602129

 

8Goodale, T., Sadhu, A., Petak, S. & Robbins, R. (2017). Testosterone and the Heart. Methodist Debate Cardiovascular Journal 13(2), 68-72. Apr-June 2017.

 

9Grober E. D. (2014). Testosterone deficiency and replacement: Myths and realities. Canadian Urological Association journal = Journal de l’Association des urologues du Canada8(7-8 Suppl 5), S145–S147. doi:10.5489/cuaj.2309

 

10Hua, J. T., Hildreth, K. L., & Pelak, V. S. (2016). Effects of Testosterone Therapy on Cognitive Function in Aging: A Systematic Review. Cognitive and behavioral neurology : official journal of the Society for Behavioral and Cognitive Neurology, 29(3), 122–138. doi:10.1097/WNN.0000000000000104

 

11Isidori AM, Balercia G, Calogero AE, et al. Outcomes of androgen replacement therapy in adult male hypogonadism: recommendations from the Italian society of endocrinology. J Endocrinol Invest. 2015;38(1):103–112. doi:10.1007/s40618-014-0155-9

 

12Jones, T. H., Arver, S., Behre, H. M., Buvat, J., Meuleman, E., Moncada, I., … TIMES2 Investigators (2011). Testosterone replacement in hypogonadal men with type 2 diabetes and/or metabolic syndrome (the TIMES2 study). Diabetes care, 34(4), 828–837. doi:10.2337/dc10-1233

 

13Jones, T. H., & Kelly, D. M. (2018). Randomized controlled trials – mechanistic studies of testosterone and the cardiovascular system. Asian journal of andrology, 20(2), 120–130. doi:10.4103/aja.aja_6_18

 

14Kaltenboeck A, Foster S, Ivanova J, et al. The direct and indirect costs among U.S. privately insured employees with hypogonadism. J Sex Med. 2012;9(9):2438–2447. doi:10.1111/j.1743-6109.2012.02810.x

 

15Kaplan AL, Hu JC, Morgentaler A, Mulhall JP, Schulman CC, Montorsi F. Testosterone Therapy in Men With Prostate Cancer. Eur Urol. 2016;69(5):894–903. doi:10.1016/j.eururo.2015.12.005

 

16Kathrins M, Doersch K, Nimeh T, Canto A, Niederberger C, Seftel A. The Relationship Between Testosterone-Replacement Therapy and Lower Urinary Tract Symptoms: A Systematic Review. Urology. 2016;88:22–32. doi:10.1016/j.urology.2015.11.006

 

17Kim, S. D., & Cho, K. S. (2019). Obstructive Sleep Apnea and Testosterone Deficiency. The world journal of men’s health37(1), 12–18. doi:10.5534/wjmh.180017

18McBride, J. A., & Coward, R. M. (2016). Recovery of spermatogenesis following testosterone replacement therapy or anabolic-androgenic steroid use. Asian journal of andrology18(3), 373–380. doi:10.4103/1008-682X.173938O – Monroe AK, Dobs AS. The effect of androgens on lipids. Curr Opin Endocrinol Diabetes Obes. 2013;20(2):132–139. doi:10.1097/MED.0b013e32835edb71

 

19Mohamad, N. V., Soelaiman, I. N., & Chin, K. Y. (2016). A concise review of testosterone and bone health. Clinical interventions in aging, 11, 1317–1324. doi:10.2147/CIA.S115472

 

20Morgentaler A. (2015). Testosterone deficiency and cardiovascular mortality. Asian journal of andrology, 17(1), 26–31. doi:10.4103/1008-682X.143248

 

21Spitzer M, Huang G, Basaria S, Travison TG, Bhasin S. Risks and benefits of testosterone therapy in older men. Nat Rev Endocrinol. 2013;9(7):414–424. doi:10.1038/nrendo.2013.73

 

22Tsametis CP, Isidori AM. Testosterone replacement therapy: For whom, when and how?. Metabolism. 2018;86:69–78. doi:10.1016/j.metabol.2018.03.007

23Wang C, Nieschlag E, Swerdloff R, et al. Investigation, treatment and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA and ASA recommendations. Eur J Endocrinol. 2008;159(5):507–514. doi:10.1530/EJE-08-0601

 



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