Testosterone for Men

 

What is it and how is it made

Testosterone, the predominant male hormone, can convert into DHT (dihydrotestosterone) by the enzyme 5-alpha-reductase. DHT is the most potent male hormone, producing male characteristics of virile body, beard growth, voice, male hair pattern, penis and erections and so on.
Testosterone can also convert, by the enzyme aromatase, into estradiol, the female hormone which feminises; enlarging breasts, increasing female body fat pattern, reducing hair, voice, increases libido etc.
Neither DHT or Estradiol can be converted back once changed.
Men produce about 30mg a day, 20-30 times more than women. Levels are higher in the morning hence the morning erections men have. The majority og T is produced in the testes under control of pituitary LH hormone. Small amounts can be made from the adrenal gland and fat tissues from DHEA and other androgens.
Testosterone metabolites (breakdown products) mainly are: 

  • Androstenediol (blood tested)
  • Androsterone (urine tested)
  • Etiocholanolone (urine tested) 

What does T do 

  1. It is an androgen (male) group hormone, producing all the virilising characteristics of maleness and reproductivity
  2. T protects against heart disease and the vascular system. It is anti-atheroma, protecting blood vessels. Men with higher levels of T have less heart disease.
  3. It protects against developing diabetes and obesity by reducing fat mass and increasing muscle mass. It assists the transfer of glucose into muscles, brain and other tissues.
  4. T is good for the brain, increasing blood supply. It improves memory and cognitive brain function (better processor RAM !) 

What affects T production and levels 

  • Intense and prolonged physical activity, very frequent sex, can ‘burn’ more T and possibly deplete for a while.
  • Intense emotional stress can reduce T by blocking LH release hormone, happiness can increase it.
  • High sweet sugar diet and very high fibre diet can reduce T whereas high protein and good fats increase it.
  • Ageing reduces T gradually as testicle cells die off, and the symptoms of deficiency develop.
  • Studies show that men with higher levels of T have less prostate cancer. Testosterone DOES NOT cause prostate cancer – cancer cells may need T to grow but that’s quite a different story. Refer to the cancer page. 

Common symptoms of deficiency in men 

  1. Ageing appearance of face and body, increasing abdominal obesity
  2. Loss of muscles and strength – more prone to injury
  3. Tiredness, fatigue worse with activity
  4. Loss of mental drive, cant be bothered any more, loss of assertiveness
  5. Memory worsening, can’t concentrate
  6. Poor erections or none at all, loss of sensations, reduced sex drive
  7. Even hot flushes and upper body sweats
  8. Moodiness, depression, anxiety, worrying more, even crying spells
  9. Can become socially more withdrawn

Often symptoms come on gradually and fluctuate. Many men, their wives or family put these symptoms down to other reasons like “has   been under stress at work; hasn’t had a holiday; works too hard; doesn’t sleep properly; hasn’t been the same since such and such”.   Whilst these may be true, it may be quite the other way around; meaning low testosterone may set him up to not cope with all these   situations and he reacts far worse.

Assessment 

It is important that men too have an annual screening health review – also refer to Health Screening Tests 

  • Health Questionnaire
  • Physical examination including DRE (digital rectal examination)
  • ECG, Treadmill heart test, Cacium Scan heart test, Chest X-ray  –  where indicated only
  • Blood tests full range including hormones Testosterone, DHEA, Estradiol, SHBG
  • Further 24 hr urine tests can be done as an option for an in depth look at the total androgen hormone system – refer to DUTCH Comprehensive Hormone Test
  • Prostate screening – PSA, DRE, Ultrasound and Flow tests is indicated 

Treatment Options 

Many use Testosterone transdermal creams and gels applied daily to the skin. Skin route is best as the T bypasses the liver where it can be converted into other byproducts (metabolites). We never use oral T for this reason.
Injectable testosterone can be used when creams are not effective  – many men prefer this over creams.
For our patients on testosterone – The Testosterone Protocol 

Precautions

  • Don’t use if you have prostate cancer or possibly any other cancer – it needs to be excluded as far as modern testing can. Do regular checks
  • Caution with enlarged prostate causing obstruction to urination
  • Caution with prostate infection  

DHEA 

An excellent hormone! DHEA (Dehydro-epiandrosterone) is the most abundant steroid hormone. The term steroid refers to the biochemical structure of a whole class of hormones, of which there are dozens. In fact most of the hormones from the ovaries, adrenals, testes are very similar biochemically. Its amazing how a tiny difference in the structure of each can make a world of difference to resulting affects.
By 1996, many workers including Stephen Cherniske MS, had published over 3000 research articles on DHEA. Ever since, the role of DHEA as one of the most potent ‘anti-ageing’ hormones has been hotly argued and debated. 

In summary, DHEA – the facts:

  1. Is the most abundant hormone, influencing over 150 known repair functions in the body and brain.
  2. It declines gradually with age – when degenerative processes also accelerate.
  3. Long living people on average have higher DHEA levels.
  4. If low DHEA, there is more depression, obesity, diabetes, autoimmune disease, osteoporosis, cancer and cardiovascular disease.
  5. Low DHEA is associated with increased death rate from all causes.
  6. DHEA and its metabolites can easily be measured to give a valid ‘Ageing Biomarker’.
  7. Mainstream leading endocrinologists approach is to regard the levels found in ageing populations to be ‘normal’ levels. The opposing view by ‘anti-ageing’ doctors is that these levels are NOT OPTIMAL but ‘disease levels’ from DHEA deficiency! Optimal levels are those of a healthy adult of around 30 years of age. OPTIMAL versus NORMAL AVERAGE concept.
  8. DHEA is absorbed well from oral dosing of 10-50mg daily.
  9. There is no evidence – clinical or experimental – of any adverse effects by supplementing physiological doses other than the production in a few susceptible women of oily skin and acne.
  10. It is speculation to claim, as some critics do, that it is necessary to have lower levels of DHEA as part of the natural and normal ageing process.
  11. DHEA has been used with patients on cortisone or prednisone to reduce side-effects and enhance the depressed immune state caused by these other steroids.
  12. DHEA is an ANABOLIC hormone (builds and promotes tissues) rather than a CATABOLIC one (breaks down tissues). For example people on long term cortisol-like steroids (catabolic) will develop osteoporosis, the destruction of bones, but DHEA will protect bones.

DHEA use 

Start with low doses and build up according to blood tests.
In men, DHEA wont raise the T levels by anything significant. It acts on many areas of the body and brain itself or by converting into other hormones.
DHEA is like a ‘mother’ hormone. 

Who may benefit 

Anyone with sub-optimal DHEA levels 

In brief 

  • Fatigue
  • Depression even just mild unhappiness, low moods, anxiety, low resistance to stress, noise
  • Low sex drive and satisfaction
  • Autoimmune diseases e.g. lupus, rheumatoid arthritis
  • On cortisol or prednisone therapy 

Optimising treatment – Mediterranean diet, low sugar and refines carbs.

Caution 

As with most steroid hormones, it is prudent to to use in the presence of hormone sensitive cancer. Levels of other ‘conversion hormones’, like estradiol, must be monitored especially in males, and Testosterone in females.
For a comprehensive review of DHEA debate click here >>>
DHEA must be prescribed and monitored by doctors trained in Anti-ageing Medicine 

TESTOSTERONE HANDOUT >>