Category Archives: Testosterone Replacement Therapy

Testosterone Replacement Therapy is a life-changing treatment for men with low levels of testosterone. Optimale is the top-rated TRT clinic in the UK, using experienced doctors and advanced systems to ensure you get the best service and care available.

Established over 5 years ago, we have lots of experience helping men recover from low testosterone and realise their full potential in life. Our medical director, Dr Chris Airey, also used to suffer from low testosterone. Now he uses his personal experience and his degree in Endocrinology to ensure men get the best treatment possible.

Unlike other clinics, Optimale is flexible to your needs, providing protocols and medication options that are convenient and effective for your own personal circumstances. We provide a 5-star service which is why we are the top-rated clinic in the UK for Testosterone Replacement Therapy.

We only use experienced, GMC registered doctors in our clinics. We are CQC registered and regulated a legal requirement for any legitimate medical clinic in the UK.

If you are interested in learning more then visit our page on TRT in the UK, order a blood test, or complete our ADAM Questionnaire to find out if you are suffering from low testosterone.

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Testosterone Replacement Therapy (TRT) Experts | Optimale

Low T is short for low testosterone a condition that affects most men as they age. Testosterone levels typically decline after the age of 30 and become more prevalent and symptomatic in men 40 and over. Low T causes older men to lose muscle, energy and motivation. It can affect a persons mood, making them irritable and more prone to depression often call grumpy old man syndrome. Low T is also a leading cause of sexual dysfunction in aging men, including a drop in libido and ability to get and maintain erections. Men also lose HGH, Human Growth Hormone, as they age and this to can be treated if necessary with Testosterone Replacement Therapy (or TRT).

Testosterone Replacement Therapy for men is becoming more and more common as men are increasingly aware of the potential benefits. Testosterone Replacement Therapy can help men improve their mental clarity and focus. Additional benefits include increased muscle mass, libido, and motivation, while decreasing central body fat. Symptoms of low testosterone and/or low HGH levels are common among men over the age of 30. EHormonesMD will develop an individualized and comprehensive treatment protocol to help you achieve the maximum benefits of Testosterone Replacement Therapy.

For men with decreased libido or those who have problems with erectile dysfunction, also known as impotence, Testosterone Replacement Therapy can be significantly beneficial. While many men as young as 30 require Testosterone Replacement Therapy to restore Testosterone levels, HRT is particularly beneficial for men over the age of 40, when testosterone levels may have reached a significant decline. YourEHormonesMDdoctor will be able to determine whether Testosterone Replacement Therapy can help you fight the issues of waning libido and/or erectile dysfunction, and remove the need for ED medications.

Low levels of testosterone can lead to decrease in muscle mass, an increase in body fat and result in a decrease of bone mass over time. Several men experience the inability to achieve results from their work outs, which is usually a direct result of having low testosterone levels. Testosterone Replacement can help to counteract these physical changes and, in fact, clinical studies have shown that Men can see a 10% to 15% increase in muscle mass and protein synthesis in as little as 2 to 3 months. While many physical changes are normal for men as they age, testosterone treatment can offer significant benefits for men when combined with a healthy diet and regular exercise routine.

In fact, a recent study showed that testosterone treatment can decrease fat mass and increase muscle size and strength. Some men reported a change in lean body mass but no increase in strength. Its likely youll see the most benefits when you combine testosterone therapy with strength training and exercise.

While it might not sound obvious at first, Testosterone Replacement Therapy for men can actually help with some emotional problems that men experience as they age. Low Testosterone levels have shown to reduce self-confidence and motivation, which can have a negative impact on personal relationships and work results. Feelings of sadness and depression, as well as the inability to concentrate on important tasks or remember important pieces of information are also common with decreased testosterone levels.

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Testosterone Replacement Therapy Clinic - EHormones MD

In the last 100 years, life expectancy for men has increased by 65 percent, according to the Centers for Disease Control and Prevention (CDC).

In 1900, men lived until about age 46. By 2014, that age jumped to 76. Theres no question that men are redefining what it means to be 50, 60, and 70 years old or older.

Regular exercise, a healthy diet, and adequate rest all help maintain energy and vitality in men over 50. But men are also turning to one of the most advanced aging solutions available. Over the last decade, testosterone use among middle-aged and senior men has become popular.

Testosterone is the hormone responsible for the development of male external genitalia and secondary sexual characteristics. Its produced by the testicles. Testosterone is important for maintaining:

Testosterone also contributes to vitality and well-being.

As men age, their bodies gradually produce less testosterone. This natural decline starts around age 30 and continues throughout the rest of a mans life.

Some men have a testosterone deficiency called male hypogonadism. This is a condition in which the body doesnt produce enough testosterone. It may be caused by problems in the:

Men at risk for this condition include those who have had an injury to the testicles or have HIV/AIDS. If youve gone through chemotherapy or radiation therapy, or had undescended testicles as an infant you are also considered at risk for hypogonadism.

Symptoms of male hypogonadism in adulthood include:

Doctors can determine if you have male hypogonadism through physical exams and blood tests. If your doctor detects low testosterone they may perform additional tests to determine the cause.

Treatment typically includes testosterone replacement therapy (TRT) in the form of:

TRT reportedly helps to:

However, scientists caution there isnt enough information to determine the safety of regular testosterone supplementation.

Many men experience changes as they age similar to the symptoms of hypogonadism. But their symptoms may not be related to any disease or injury. Some are considered a normal part of aging, such as:

The Mayo Clinic reports that TRT can help men with hypogonadism. The results are not as clear with men who have normal levels of testosterone or older men with decreasing testosterone levels. More rigorous studies are needed, according to the Mayo Clinic.

Studies are mixed on whether TRT is beneficial for normal men as they age. Some research has brought up serious risks with the therapy, particularly when taken long term. This has led doctors to be cautious about recommending it.

A large, 2010 meta-analysis of 51 studies looked at the safety of TRT. The report concluded that safety analysis of TRT is of low quality and fails to inform the public about potential long-term effects.

The Mayo Clinic cautions that TRT also may:

There are also risks involved in having low testosterone levels, such as:

Previously, there were concerns that TRT raised the risk of developing prostate cancer.

Most current data, including two reports in 2015, no longer supports a link between testosterone replacement and the development of 1) prostate cancer, 2) more aggressive prostate cancer, or 3) prostate cancer that returns after treatment.

If you have male hypogonadism or low testosterone, talk with your doctor about whether TRT may be a good option for you. Discuss the risks and benefits of TRT.

If you dont have hypogonadism, but youre interested in feeling more energetic and youthful. The following alternative methods may help increase your testosterone level without the use of hormone therapy.

One way to increase your testosterone levels is through TRT. Its especially effective if you have hypogonadism. Studies have not yet demonstrated the effectiveness of TRT in helping men with normal levels of testosterone or older men with decreasing testosterone levels due to aging.

Men who take TRT usually experience increased energy, a higher sex drive, and overall well-being. But its long-term safety hasnt been established.

There are a variety of lifestyle treatments involving exercise, diet, and sleep that have been shown to increase testosterone levels. Talk to your doctor about what may be best for you.

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Options to Increase Your Testosterone - Healthline

FtM transgender medical treatment

Masculinizing hormone therapy, also known as transmasculine hormone therapy, or female-to-male (or FTM) hormone therapy, is a form of hormone therapy and gender affirming therapy which is used to change the secondary sexual characteristics of transgender people from feminine or androgynous to masculine.[1][2][3] It is a common type of transgender hormone therapy (another being feminizing hormone therapy), and is predominantly used to treat transgender men and other transmasculine individuals. Some intersex people also receive this form of therapy, either starting in childhood to confirm the assigned sex or later if the assignment proves to be incorrect.

The purpose of this form of therapy is to cause the development of the secondary sex characteristics of the desired sex, such as voice deepening and a masculine pattern of hair, fat, and muscle distribution. It cannot undo many of the changes produced by naturally occurring puberty, which may necessitate surgery and other treatments to reverse. The medications used for FTM therapy include, mainly, androgens (namely testosterone) and GnRH analogues.

While the therapy cannot undo the effects of a person's first puberty, developing secondary sex characteristics associated with a different sex can relieve some or all of the distress and discomfort associated with gender dysphoria, and can help the person to "pass" or be seen as their gender identity. Introducing exogenous hormones into the body impacts it at every level and many patients report changes in energy levels, mood, appetite, etc. The goal of the therapy, and indeed all somatic treatments, is to provide patients with a more satisfying body that is more congruent with their gender identity.

Masculinizing hormone therapy has been shown to likely reduce the distress and discomfort associated with gender dysphoria.[4]

Several contraindications to androgen therapy exist.[5] An absolute medical contraindication is pregnancy.

Relative medical contraindications are:

Two recent studies indicate the potential for elevated risk of cardiovascular events. Nota, et al. (2019) found that transgender men taking testosterone had an increased risk of cardiovascular events compared to cisgender women, with 11 vs. 3 cardiovascular events per 100,000 person-years, though the risk was less than that of cisgender men. Researchers were not able to control for smoking status or stressors.[6]Another recent study (Alzahrani, 2019) found elevated risk of heart attacks among self-identified transgender menwhich persisted even after adjusting for age, diabetes mellitus, chronic kidney disease, smoking, hypertension, hypercholesterolemia, and exercisethough the study did not include data about whether the subjects were undergoing hormone therapy and did not control for stressors. The study found that transgender men have a >4-fold and 2-fold increased odds of having a myocardial infarction when compared with cisgender women and cisgender men, respectively.[7] Though it is not always the case,[8][9] testosterone for transmasculine people is often intended to be used long-term. Due to insufficient comprehensive research, there is no consensus on the full range of risks of lengthy testosterone administration.

Some transgender men may undergo DIY treatments and self-administer testosterone; however, without proper training, this can cause issues such as bruising, irritation, and needle breakages. Self-administration of testosterone for transmasculine people without training or a prescription is considered unsafe and is not recommended by public or private healthcare providers. It may also be illegal.[10]

Testosterone is metabolized by the cytochrome P450 enzyme system (specifically CYP3A isoforms) in the liver. There are certain drugs that increase or decrease the activity of cytochrome P450 enzymes and may cause increased or decreased levels of testosterone:

Testosterone can also alter the effects of other drugs:

Because of these interactions, it is advised that trans men make their healthcare providers aware of their hormone therapy when this is relevant to their treatment for other medical issues.

Medications used in hormone therapy for transgender men include androgens and anabolic steroids like testosterone (by injection and other routes) to produce masculinization, suppress estrogen and progesterone levels, and prevent/reverse feminization; GnRH agonists and antagonists to suppress estrogen and progesterone levels; progestins like medroxyprogesterone acetate to suppress menses; and 5-reductase inhibitors to prevent/reverse scalp hair loss.

The elimination half-life of testosterone in the blood is about 70 minutes, so it is necessary to have a continuous supply of the hormone for masculinization.

'Depot' drug formulations are created by mixing a substance with the drug that slows its release and prolongs the action of the drug. The two primarily used forms in the United States are the testosterone esters testosterone cypionate (Depo-Testosterone) and testosterone enanthate (Delatestryl or Xyosted) which are almost interchangeable. Testosterone enanthate is purported to be slightly better with respect to even testosterone release, but this is probably more of a concern for bodybuilders who use the drugs at higher doses (2501000mg/week) than the replacement doses used by transgender men (50100mg/week). These testosterone esters are mixed with different oils, so some individuals may tolerate one better than the other. Testosterone enanthate costs more than testosterone cypionate and is more typically the one prescribed for hypogonadal males in the US. Testosterone cypionate is more popular in the US than elsewhere (especially amongst bodybuilders). Other formulations exist but are more difficult to come by in the US. A formulation of injected testosterone available in Europe and the US, testosterone undecanoate (Nebido, Aveed)[20][21] provides significantly improved testosterone delivery with far less variation outside the eugonadal range than other formulations with injections required only four times yearly. However, each quarterly dose requires an injection of 4mL of oil which may require multiple simultaneous injections. Testosterone undecanoate is also much more expensive as it is still under patent protection. Testosterone propionate is another testosterone ester that is widely available, including in the US, Canada, and Europe, but it is very short-acting compared to the other testosterone esters and must be administered once every 2 or 3days, and for this reason, is rarely used.

The adverse side effects of injected testosterone esters are generally associated with high peak levels in the first few days after an injection. Some side effects may be ameliorated by using a shorter dosing interval (weekly or every ten days instead of twice monthly with testosterone enanthate or testosterone cypionate). 100mg weekly gives a much lower peak level of testosterone than does 200mg every two weeks, while still maintaining the same total dose of androgen. This benefit must be weighed against the discomfort and inconvenience of doubling the number of injections.

Injectable forms of testosterone can cause a lung problem called pulmonary oil microembolism (POME). Symptoms of POME include cough, shortness of breath, tightening of the throat, chest pain, sweating, dizziness, and fainting.[22][23] A postmarketing analysis by the manufacturer of Aveed (testosterone undeconate injection) found that POME occurred at a rate of less than 1% per injection per year for Aveed.[24]

Injected testosterone esters should be started at a low dose and titrated upwards based on trough levels (blood levels drawn just before your next shot). A trough level of 500ng/dL is sought. (Normal range for a cisgender man is 290 to 900ng/dL).

Both testosterone patches, creams and gels are available. Both approximate normal physiological levels of testosterone better than the higher peaks associated with injection. Both can cause local skin irritation (more so with the patches).

Patches slowly diffuse testosterone through the skin and are replaced daily. The cost varies, as with all medication, from country to country, it is about $150/month in the US, and about 60 in Germany.

Transdermal testosterone is available throughout the world under the brand names Andromen Forte, Androgel, Testogel and Testim. They are absorbed quickly when applied and produce a temporary drug depot in the skin which diffuses into the circulation, peaking at 4 hours and decreasing slowly over the rest of the day. The cost varies, as with all medication, from country to country, from as little as $50/month to about $280/month.

Transdermal testosterone poses a risk of inadvertent exposure to others who come in contact with the patient's skin. This is most important for patients whose intimate partners are pregnant or those who are parents of young children as both of these groups are more vulnerable to the masculinizing effects of androgens. Case reports of significant virilization of young children after exposure to topical androgen preparations (both prescription and 'supplement' products) used by their caregivers demonstrates this very real risk.

Implants, as subcutaneous pellets, can be used to deliver testosterone (brand name Testopel). 6 to 12 pellets are inserted under the skin every three months. This must be done in a physician's office, but is a relatively minor procedure done under local anesthetic. Pellets cost about $60 each, so the cost is greater than injected testosterone when the cost of the physician visit and procedure are included. The primary advantages of Testopel are that it gives a much more constant blood level of testosterone yet requires attention only four times yearly.

Oral testosterone is provided exclusively as testosterone undecanoate. It is available in Europe and Canada, but not in the US. Once absorbed from the gastrointestinal tract, testosterone is shunted (at very high blood levels) to the liver where it can cause liver damage (albeit very rarely) and worsens some of the adverse effects of testosterone, like lower HDL cholesterol. In addition, the first-pass metabolism of the liver also may result in testosterone levels too low to provide satisfactory masculinization and suppress menses. Because of the short terminal half-life of testosterone, oral testosterone undecanoate must be administered two to four times per day, preferably with food (which improves its absorption).

In 2003, the FDA approved a buccal form of testosterone (Striant). Sublingual testosterone can also be made by some compounding pharmacies. Cost for Striant is greater than other formulations (US$180210/month). Testosterone is absorbed through the oral mucosa and avoids the first-pass metabolism in the liver which is the cause of many of the adverse effects of oral testosterone undecanoate. The lozenges can cause gum irritation, taste changes, and headache but most side effects diminish after two weeks. The lozenge is 'mucoadhesive' and must be applied twice daily.

Synthetic androgens/anabolic steroids (AAS), like nandrolone (as an ester like nandrolone decanoate or nandrolone phenylpropionate), are agonists of the androgen receptor (AR) similarly to testosterone but are not usually used in HRT for transgender men or for androgen replacement therapy (ART) in cisgender men. However, they can be used in place of testosterone with similar effects, and can have certain advantages like less or no local potentiation in so-called androgenic tissues that express 5-reductase like the skin and hair follicles (which results in a reduced rate of skin and hair-related side effects like excessive body hair growth and scalp hair loss), although this can also be disadvantageous in certain aspects of masculinization like facial hair growth and normal body hair growth). Although many AAS are not potentiated in androgenic tissues, they have similar effects to testosterone in other tissues like bone, muscle, fat, and the voice box. Also, many AAS, like nandrolone esters, are aromatized into estrogens to a greatly reduced extent relative to testosterone or not at all, and for this reason, are associated with reduced or no estrogenic effects (e.g., gynecomastia). AAS that are 17-alkylated like methyltestosterone, oxandrolone, and stanozolol are orally active but carry a high risk of liver damage, whereas AAS that are not 17-alkylated, like nandrolone esters, must be administered by intramuscular injection (via which they act as long-lasting depots similarly to testosterone esters) but have no more risk of liver damage than does testosterone.

For the sake of clarification, the term "anabolicandrogenic steroid" is essentially synonymous with "androgen" (or with "anabolic steroid"), and that natural androgens like testosterone are also AAS. These drugs all share the same core mechanism of action of acting as agonists of the AR and have similar effects, although their potency, pharmacokinetics, oral activity, ratio of anabolic to androgenic effects (due to differing capacities to be locally metabolized and potentiated by 5-reductase), capacity for aromatization (i.e., conversion into an estrogen), and potential for liver damage may all differ.

Dihydrotestosterone (DHT) (referred to as androstanolone or stanolone when used medically) can also be used in place of testosterone as an androgen. The availability of DHT is limited; it is not available in the United States or Canada, for instance, but it is available in certain European countries, including the United Kingdom, France, Spain, Belgium, Italy, and Luxembourg.[26] DHT is available in formulations including topical gel, buccal or sublingual tablets, and as esters in oil for intramuscular injection.[27] Relative to testosterone, and similarly to many synthetic AAS, DHT has the potential advantages of not being locally potentiated in so-called androgenic tissues that express 5-reductase (as DHT is already 5-reduced) and of not being aromatized into an estrogen (it is not a substrate for aromatase).

In all people, the hypothalamus releases gonadotropin-releasing hormone (GnRH) to stimulate the pituitary to produce luteinizing hormone (LH) and follicle-stimulating hormone (FSH) which in turn cause the gonads to produce sex steroids. In adolescents of either sex with relevant indicators, GnRH analogues, such as leuprorelin can be used to suspend the advance of sex steroid induced, inappropriate pubertal changes for a period without inducing any changes in the gender-appropriate direction. GnRH analogues work by initially overstimulating the pituitary gland then rapidly desensitizing it to the effects of GnRH. Over a period of weeks, gonadal androgen production is greatly reduced. There is considerable controversy over the earliest age, and for how long it is clinically, morally and legally safe to do this. The Harry Benjamin International Gender Dysphoria Association Standards of Care permits treatment from Tanner stage 2, but do not allow the addition of gender-appropriate hormones until 16, which could be five or more years. The sex steroids do have important other functions. The high cost of GnRH analogues is often a significant factor.

Antiestrogens (or so-called "estrogen blockers") like aromatase inhibitors (AIs) (e.g., anastrozole) or selective estrogen receptor modulators (SERMs) (e.g., tamoxifen) can be used to reduce the effects of high levels of endogenous estrogen (e.g., breast development, feminine fat distribution) in transgender men. In addition, in those who have not yet undergone or completed epiphyseal closure (which occurs during adolescence and is mediated by estrogen), antiestrogens can prevent hip widening as well as increase final height (estrogen limits height by causing the epiphyses to fuse).

5-Reductase inhibitors like finasteride and dutasteride can be used to slow or prevent scalp hair loss and excessive body hair growth in transgender men taking testosterone.[28] However, they may also slow or reduce certain aspects of masculinization, such as facial hair growth, normal male-pattern body hair growth, and possibly clitoral enlargement.[28][29] A potential solution is to start taking a 5-reductase inhibitor after these desired aspects of masculinization have been well-established.[28]

Progestogens can be used to control menstruation in transgender men. Depot medroxyprogesterone acetate (DMPA) may be injected every three months just as it is used for contraception. Generally after the first cycle, menses are greatly reduced or eliminated. This may be useful for transgender men prior to initiation of testosterone therapy.

In those who have not yet started or completed epiphyseal closure, growth hormone can be administered, potentially in conjunction with an aromatase inhibitor or a GnRH analogue, to increase final height.

The main effects of HRT of the FTM type are as follows:[30]

Many transgender men are unable to pass as cisgender men without hormones. The most commonly cited reason for this is that their voice may reveal them.

Facial changes develop gradually over time, and sexual dimorphism (physical difference between the sexes) tends to increase with age. Within a population of similar body size and ethnicity:

Frequently the first sign of endometrial cancer is bleeding in post-menopausal women. Transgender men who have any bleeding after the cessation of menses with androgen therapy should be evaluated for age appropriate causes of abnormal uterine bleeding as per cisgender female guidelines.[31]

A number of skeletal and cartilaginous changes take place after the onset of puberty at various rates and times. Sometime in the late teen years epiphyseal closure (in other words, the ends of bones are fused closed) takes place and the length of bones is fixed for life. Consequently, total height and the length of arms, legs, hands, and feet are not affected by HRT. However, details of bone shape change throughout life, bones becoming heavier and more deeply sculptured under the influence of testosterone. Many of these differences are described in the Desmond Morris book Manwatching.

The psychological changes are harder to define, since HRT is usually the first physical action that takes place when transitioning. This fact alone has a significant psychological impact, which is hard to distinguish from hormonally induced changes. Most trans men report an increase of energy and an increased sex drive. Many also report feeling more confident.

While a high level of testosterone is often associated[how?] with an increase in aggression, this is not a noticeable effect in most trans men. HRT doses of testosterone are much lower than the typical doses taken by steroid-using athletes, and create testosterone levels comparable to those of most cisgender men. These levels of testosterone have not been proven to cause more aggression than comparable levels of estrogen.

Some transgender men report mood swings, increased anger, and increased aggressiveness after starting androgen therapy. Studies are limited and small scale, however, based on self reporting over a short period of time (7 months). In a study by Motta et al., trans men also reported better anger control.[34]

During HRT, especially in the early stages of treatment, blood tests should be consistently done to assess hormone levels and liver function.

Gianna Israel and colleagues have suggested that for pre-oophorectomy trans men, therapeutic testosterone levels should optimally fall within the normal male range, whereas estrogen levels should optimally fall within the normal female range. Before oophorectomy, it is difficult and frequently impractical to fully suppress estrogen levels into the normal male range, especially with exogenous testosterone aromatizing into estrogen, hence why the female ranges are referenced instead. In post-oophorectomy trans men, Israel and colleagues recommend that both testosterone and estrogen levels fall exactly within the normal male ranges. See the table below for all of the precise values they suggest.[39]

The optimal ranges listed for testosterone only apply to individuals taking bioidentical hormones in the form of testosterone (including esters) and do not apply to those taking synthetic AAS (e.g., nandrolone) or dihydrotestosterone.

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Masculinizing hormone therapy - Wikipedia

Testosterone is a hormone found in humans, as well as in other animals. In men, the testicles primarily make testosterone. Womens ovaries also make testosterone, though in much smaller amounts.

The production of testosterone starts to increase significantly during puberty and begins to dip after age 30 or so.

Testosterone is most often associated with sex drive and plays a vital role in sperm production. It also affects bone and muscle mass, the way men store fat in the body, and even red blood cell production.

A mans testosterone levels can also affect his mood.

Low levels of testosterone, also called low T levels, can produce a variety of symptoms in men, including:

While testosterone production naturally tapers off as a man ages, other factors can cause hormone levels to drop.

Injury to the testicles and cancer treatments such as chemotherapy or radiation can negatively affect testosterone production.

Chronic health conditions and stress can also reduce testosterone production. Some of these include:

Testosterone levels decline steadily in adult women, however, low T levels can also produce a variety of symptoms, including:

Low T levels in women can be caused by removal of the ovaries as well as diseases of the pituitary, hypothalamus, or adrenal glands.

Testosterone therapy may be prescribed for women with low T levels, however, the treatments effectiveness on improving sexual function or cognitive function among postmenopausal women is unclear.

A simple blood test can determine testosterone levels. Theres a wide range of normal or healthy levels of testosterone circulating in the bloodstream.

Normal male testosterone levels range between 280 and 1,100 nanograms per deciliter (ng/dL) for adult males, and between 15 and 70 ng/dL for adult females, according to the University of Rochester Medical Center.

Ranges can vary among different labs, so its important to speak with your doctor about your results.

If an adult males testosterone levels are below 300 ng/dL, a doctor may do a workup to determine the cause of low testosterone, according to the American Urological Association.

Low testosterone levels could be a sign of pituitary gland problems. The pituitary gland sends a signaling hormone to the testicles to produce more testosterone.

A low T test result in an adult man could mean the pituitary gland isnt working properly. But a young teen with low testosterone levels might be experiencing delayed puberty.

Moderately elevated testosterone levels in men may produce few noticeable symptoms. Boys with higher levels of testosterone may begin puberty earlier. Women with high testosterone may develop masculine features.

Abnormally high levels of testosterone could be the result of an adrenal gland disorder, or even cancer of the testes.

High testosterone levels may also occur in less serious conditions. For example, congenital adrenal hyperplasia, which can affect males and females, is a rare but natural cause for elevated testosterone production.

If your testosterone levels are extremely high, your doctor may order other tests to find out the cause.

Reduced testosterone production, a condition known as hypogonadism, doesnt always require treatment.

You may be a candidate for testosterone replacement therapy if low T is interfering with your health and quality of life. Artificial testosterone can be administered orally, through injections, or with gels or skin patches.

Replacement therapy may produce desired results, such as greater muscle mass and a stronger sex drive. But the treatment does carry some side effects. These include:

Some studies have found no greater risk of prostate cancer with testosterone replacement therapy, but it continues to be a topic of ongoing research.

One study suggests that theres a lower risk of aggressive prostate cancers for those on testosterone replacement therapy, but more research is needed.

Testosterone is most commonly associated with sex drive in men. It also affects mental health, bone and muscle mass, fat storage, and red blood cell production.

Abnormally low or high levels can affect a mans mental and physical health.

Your doctor can check your testosterone levels with a simple blood test. Testosterone therapy is available to treat men with low levels of testosterone.

If you have low T, ask your doctor if this type of therapy might benefit you.

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Testosterone: What It Is and How It Affects Your Health

When you think of testosterone, what comes to mind? Macho men? Aggressive, impatient, type A behavior? Road rage? Violence?

Testosterone's role in bad behavior is largely a myth. What's more, testosterone plays other important roles in health and disease that may surprise you. For example, did you know that testosterone is a key player in prostate cancer? Or, that women need testosterone, too? There's more to testosterone than guys behaving badly.

Testosterone is the major sex hormone in males and plays a number of important roles, such as:

Adolescent boys with too little testosterone may not experience normal masculinization. For example, the genitals may not enlarge, facial and body hair may be scant and the voice may not deepen normally.

Testosterone may also help maintain normal mood. There may be other important functions of this hormone that have not yet been discovered.

Signals sent from the brain to the pituitary gland at the base of the brain control the production of testosterone in men. The pituitary gland then relays signals to the testes to produce testosterone. A "feedback loop" closely regulates the amount of hormone in the blood. When testosterone levels rise too high, the brain sends signals to the pituitary to reduce production.

If you thought testosterone was only important in men, you'd be mistaken. Testosterone is produced in the ovaries and adrenal gland. It's one of several androgens (male sex hormones) in females. These hormones are thought to have important effects on:

The proper balance between testosterone (along with other androgens) and estrogen is important for the ovaries to work normally. While the specifics are uncertain, it's possible that androgens also play an important role in normal brain function (including mood, sex drive and cognitive function).

Testosterone is synthesized in the body from cholesterol. But having high cholesterol doesn't mean your testosterone will be high. Testosterone levels are too carefully controlled by the pituitary gland in the brain for that to occur.

Having too much naturally-occurring testosterone is not a common problem among men. That may surprise you given what people might consider obvious evidence of testosterone excess: road rage, fighting among fathers at Little League games and sexual promiscuity.

Part of this may be due to the difficulty defining "normal" testosterone levels and "normal" behavior. Blood levels of testosterone vary dramatically over time and even during the course of a day. In addition, what may seem like a symptom of testosterone excess (see below) may actually be unrelated to this hormone.

In fact, most of what we know about abnormally high testosterone levels in men comes from athletes who use anabolic steroids, testosterone or related hormones to increase muscle mass and athletic performance.

Problems associated with abnormally high testosterone levels in men include:

Among women, perhaps the most common cause of a high testosterone level is polycystic ovary syndrome (PCOS). This disease is common. It affects 6% to 10% of premenopausal women.

The ovaries of women with PCOS contain multiple cysts. Symptoms include irregular periods, reduced fertility, excess or coarse hair on the face, extremities, trunk and pubic area, male-pattern baldness, darkened, thick skin, weight gain, depression and anxiety. One treatment available for many of these problems is spironolactone, a diuretic (water pill) that blocks the action of male sex hormones.

Women with high testosterone levels, due to either disease or drug use, may experience a decrease in breast size and deepening of the voice, in addition to many of the problems men may have.

In recent years, researchers (and pharmaceutical companies) have focused on the effects of testosterone deficiency, especially among men. In fact, as men age, testosterone levels drop very gradually, about 1% to 2% each year unlike the relatively rapid drop in estrogen that causes menopause. The testes produces less testosterone, there are fewer signals from the pituitary telling the testes to make testosterone, and a protein (called sex hormone binding globulin (SHBG) increases with age. All of this reduces the active (free) form of testosterone in the body. More than a third of men over age 45 may have reduced levels of testosterone than might be considered normal (though, as mentioned, defining optimal levels of testosterone is tricky and somewhat controversial).

Symptoms of testosterone deficiency in adult men include:

Some men who have a testosterone deficiency have symptoms or conditions related to their low testosterone that will improve when they take testosterone replacement. For example, a man with osteoporosis and low testosterone can increase bone strength and reduce his fracture risk with testosterone replacement.

As surprising as it may be, women can also be bothered by symptoms of testosterone deficiency. For example, disease in the pituitary gland may lead to reduced testosterone production from the adrenal glands disease. They may experience low libido, reduced bone strength, poor concentration or depression.

There are times when low testosterone is not such a bad thing. The most common example is probably prostate cancer. Testosterone may stimulate the prostate gland and prostate cancer to grow. That's why medications that lower testosterone levels (for example, leuprolide) and castration are common treatments for men with prostate cancer. Men taking testosterone replacement must be carefully monitored for prostate cancer. Although testosterone may make prostate cancer grow, it is not clear that testosterone treatment actually causes cancer.

Men can experience a drop in testosterone due to conditions or diseases affecting the:

Genetic diseases, such as Klinefelter syndrome (in which a man has an extra x-chromosome) and hemochromatosis (in which an abnormal gene causes excessive iron to accumulate throughout the body, including the pituitary gland) can also affect testosterone.

Women may have a testosterone deficiency due to diseases of the pituitary, hypothalamus or adrenal glands, in addition to removal of the ovaries. Estrogen therapy increases sex hormone binding globulin and, like aging men, this reduces the amount of free, active testosterone in the body.

Currently, testosterone therapy is approved primarily for the treatment of delayed male puberty, low production of testosterone (whether due to failure of the testes, pituitary or hypothalamus function) and certain inoperable female breast cancers.

However, it is quite possible that testosterone treatment can improve symptoms in men with significantly low levels of active (free) testosterone, such as:

However, many men with normal testosterone levels have similar symptoms so a direct connection between testosterone levels and symptoms is not always clear. As a result, there is some controversy about which men should be treated with supplemental testosterone.

Testosterone therapy may make sense for women who have low testosterone levelsand symptoms that might be due to testosterone deficiency. (It's not clear if low levelswithout symptoms are meaningful; treatment risks may outweigh benefits.) However, the wisdom and effectiveness of testosterone treatment to improve sexual function or cognitive function among postmenopausal women is unclear.

People with normal testosterone levels are sometimes treated with testosterone at the recommendation of their doctors or they obtain the medication on their own. Some have recommended it as a "remedy" for aging. For example, a study from Harvard Medical School in 2003 found that even among men who started out with normal testosterone results noted loss of fat, increased muscle mass, better mood, and less anxiety when receiving testosterone therapy. Similar observations have been noted among women. However, the risks and side effects of taking testosterone when the body is already making enough still discourages widespread use.

Testosterone is so much more than its reputation would suggest. Men and women need the proper amount of testosterone to develop and function normally. However, the optimal amount of testosterone is far from clear.

Checking testosterone levels is as easy as having a blood test. The difficult part is interpreting the result. Levels vary over the course of the day. A single low level may be meaningless in the absence of symptoms, especially if it was normal at another time. We need more research to know when to measure testosterone, how best to respond to the results and when it's worthwhile to accept the risks of treatment.

Image: Zerbor/Dreamstime

Read more:
Testosterone What It Does And Doesn't Do - Harvard Health

Cork woman Jess N Mhaolin was just 27 years old when she went into menopause.

Jess had always had trouble with her periods as a teenager, she would miss days of school because of the debilitating pain.

The first time I remember being in hospital because of my periods, I was about 15, she told RSVP.

The doctors thought it was my appendix. Then they found ovarian cysts on the ultrasound. There was very much the attitude that Id grow out of it.

Read more: Limerick mum says hormone replacement therapy has changed her life after menopause

In her 20s, Jesss symptoms got worse, but she still felt like she wasnt taken seriously by doctors.

I had a consultant tell me to go away and have a baby and that would sort it out, she said. I changed consultants I dont know how many times. A few people said it might be IBS so I tried a low FODMAP diet. That didnt work. I tried natural remedies, I tried yoga, I tried different painkillers. None of it worked.

Around 2017, Jess was finally diagnosed with endometriosis, a condition that causes cells similar to the lining of the uterus to grow outside the uterus. She was put on a treatment that put her system to sleep.

In theory, that sounded great, because I wasnt getting periods anymore so I wasnt in pain, admitted Jess.

In reality, it was shutting down my hormone centre. I couldnt regulate my temperature. I was nauseous all the time. I was severely bloated. I was having terrible mood swings.

The next step for Jess was to go through surgical treatment and during this stage, doctors discovered problems with her ovaries. She had to have emergency surgery to have her right ovary removed because there was a growth on it, and her left ovary had stopped working because it was covered in adhesions.

She went to a specialist surgeon in the UK to have treatment on the left ovary but when she was there, she was given some devastating news.

During my scan, the consultant basically stopped what he was doing, sat me down and explained that my left ovary had practically shut down, Jess added.

He asked me if I had suffered menopausal symptoms. I had been experiencing them but Id been through so many operations that I thought it was part of the recovery process.

An hour later, Jesss surgeon gave her her options: but the most practical one was a full hysterectomy.

He gave me some time to think and I remember standing in the middle of Harley Street in London, just crying, she recalled. I had this whole future mapped out in front of me in my head. I thought Id be settled at 30, be buying a house and probably having a baby with someone.

All of a sudden Im 27, in a country that isnt home, being given this devastating news. It was like someone had taken a piece out of my heart that I was never going to get back.

Jess went through with the hysterectomy, but her road hasnt been easy.

Most of my friends are at the age now where they are having their first or second child, or theyre pregnant, she continued.

Im not in a relationship. Part of that is by choice, because I'm married to my job. But part of it is: How do you approach the subject of not being able to have kids with someone? Do you tell them straight away? Do you tell them a few dates in?

Now 30 years old, Jess struggles with the side effects of menopause, but hormone replacement therapy has really helped.

Im on oestrogen and testosterone gel, and it makes such a difference. If I forget to use it or I dont use enough, I would feel towards the end of the day that I would start to get anxious, the brain fog would begin and I would get hot flushes.

My mum is actually going through menopause at the same time as me, so I can talk to her about it which is comforting but also sad.

The Government policy advisor said she is happy to share her story because she wants to help other women.

I thought menopause was something that happened to you when you were maybe 55, when youd had your kids, she said. If I had known that I was having menopausal symptoms before that last scan, maybe I would have had enough time to freeze my eggs. Its hard to know, and I could drive myself mad thinking about it.

Women can get menopause in their 30s for various reasons, so its important to know the symptoms and always advocate for yourself.

Visit The Menopause Hub's website here for more information.

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Cork woman felt like she lost part of herself after going into menopause aged 27 - RSVP Live

New York, Sept. 13, 2022 (GLOBE NEWSWIRE) -- Reportlinker.com announces the release of the report "Global Testosterone Replacement Therapy Market 2022-2026" - https://www.reportlinker.com/p04046949/?utm_source=GNW 1% during the forecast period. Our report on the testosterone replacement therapy market provides a holistic analysis, market size and forecast, trends, growth drivers, and challenges, as well as vendor analysis covering around 25 vendors.The report offers an up-to-date analysis of the current global market scenario, the latest trends and drivers, and the overall market environment. The market is driven by initiatives to increase awareness about hypogonadism among population, rise in chronic diseases, and untapped potential in developing countries.The testosterone replacement therapy market analysis includes the product segment and geographic landscape.

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This study identifies the rise in novel therapeutic approaches as one of the prime reasons driving the testosterone replacement therapy market growth during the next few years. Also, patient assistance programs and the development of new therapies will lead to sizable demand in the market.

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The analyst presents a detailed picture of the market by the way of study, synthesis, and summation of data from multiple sources by an analysis of key parameters such as profit, pricing, competition, and promotions. It presents various market facets by identifying the key industry influencers. The data presented is comprehensive, reliable, and a result of extensive research - both primary and secondary. Technavios market research reports provide a complete competitive landscape and an in-depth vendor selection methodology and analysis using qualitative and quantitative research to forecast accurate market growth.Read the full report: https://www.reportlinker.com/p04046949/?utm_source=GNW

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The Global Testosterone Replacement Therapy Market is

Hypogonadism is a common condition in the male population, with a higher prevalence in older men, obese men, and men with type 2 diabetes. It is estimated that approximately 35% of men older than 45 years of age and 30-50% of men with obesity or type 2 diabetes have hypogonadism.

Testosterone is an important sex hormone in men. It is secreted by the testes and is responsible for the typical male characteristics, such as facial, pubic, and body hair as well as muscle. This hormone also helps maintain sex drive, sperm production, and bone health. The brain and pituitary gland (a small gland at the base of the brain) control the production of testosterone by the testes.

Be open with your doctor about your medical history, all prescription and nonprescription drugs you are now taking, sexual problems, and any major changes in your life. Your doctor will take a thorough history of your symptoms and then complete a physical exam, including your body hair, breast tissue, and the size and consistency of the testes and scrotum.

Your doctor will also use blood tests to see if your total testosterone level is low. The normal range depends on the lab that conducts the test. To get a diagnosis of hypogonadism, you need at least two early morning (710 AM) blood tests that reveal low testosterone in addition to signs and symptoms typical of low testosterone. The cause of hypogonadism can be investigated further by your doctor. This might include additional blood tests, and sometimes imaging such as a pituitary MRI.

Male hypogonadism is a combination of low testosterone levels and the presence of any of these symptoms:

Over time, low testosterone may cause a man to lose body hair, muscle bulk, cause weak bones (osteoporosis), low red blood cells and smaller testes. Signs and symptoms (what you see and feel) vary from person to person.

There are many causes of hypogonadism. They may involve a problem with the testes or with the signal from the brain that controls testosterone secretion. Low testosterone can result from:

Improvement of testosterone levels can improve sexual concerns, bone health, muscle and anemia (low red cells in the blood). Hypogonadism can be treated with the use of doctor-prescribed testosterone replacement therapy. This treatment is safe and can be effective for men who are diagnosed with consistently abnormal low testosterone production and symptoms that are associated with this type of androgen (hormone) deficiency.

Although testosterone replacement therapy is the primary treatment option, some conditions that cause hypogonadism, such as obesity, can be reversible without testosterone therapy. These should be addressed before testosterone therapy is contemplated. If testosterone therapy is needed, goals of treatment are to improve symptoms associated with testosterone deficiency and maintain sex characteristics.

There are many different types of testosterone therapy. Method of treatment depends on the cause of low testosterone, the patients preferences, cost, tolerance, and concern about fertility. You should discuss the different options with your physician "your partner in care" to find out which therapy is right for you.

Injections: Self or doctor administered in a muscle every 12 weeks; administered at a clinic every 10 weeks for longer-acting. Side effects: uncomfortable, fluctuating symptoms.

Gels/Solutions: Applied to upper arm, shoulder, inner thigh, armpit. Side effects: may transfer to others via skin contact must wait to absorb completely into skin.

Patches: Adhere to skin every day to back, abdomen, upper arm, thigh; rotate locations to lessen skin reaction. Side effects: skin redness and rashes.

Buccal Tablets: Sticky pill applied to gums twice a day, absorbs quickly into bloodstream through gums. Side effects: gum irritation.

Pellets: Implanted under skin surgically every 36 months for consistent and long-term dosages. Side effects: pellet coming out through skin, site infection/ bleeding (rare), dose decreasing over time and hypogonadism symptoms possibly returning towards the end of dose period.

Nasal Gel: Applied by pump into each nostril 3x a day. Side effects: nasal irritation or congestion.

Sometimes a medication called clomiphene citrate is used to treat hypogonadism, but this is not FDA approved for this indication. A thorough discussion is needed with your doctor.

You should discuss with your physician how to monitor for prostate cancer and other risks to your prostate. Men with known or suspected prostate or breast cancer should not receive testosterone therapy. You should also talk to your doctor about the risks of testosterone therapy if you have, or are at risk for, heart disease or stroke. In addition, if you are planning fertility, you should not use testosterone therapy.

You should not receive testosterone therapy if you have:

Possible risks of testosterone treatment include:

If you are treated with testosterone, your doctor will need to see you regularly, along with blood tests.Testosterone therapy is only recommended for hypogonadism patients. Boosting testosterone is NOT approved by the US Food and Drug Administration (FDA) to help improve your strength, athletic performance, physical appearance, or to treat or prevent problems associated with aging. Using testosterone for these purposes may be harmful to your health.

There is no firm scientific evidence that long-term testosterone replacement is associated with either prostate cancer or cardiovascular events. The FDA requires that you are made aware that the possibility of cardiovascular events may exist during treatment. Prostate cells are stimulated by testosterone, so be extra vigilant about cancer screenings. African American men over age 45 especially those with family history of cancer are already at risk for prostate cancer.

See the rest here:
Hypogonadism in Men | Endocrine Society

Dear Dr. Roach: My 75-year-old husband was frustrated with not being able to retain an erection. He talked to his doctor about it, and she prescribed 200 mg of testosterone cypionate, which he would inject into his bottom once a week. He did this for four months, and then had a severe bilateral stroke (as in, he does not know where he is, what happened to him, cannot read or write, cannot walk, etc.).

After spending two weeks in the ICU, he went to a rehabilitation hospital for three weeks. The hematologist there told me his hemoglobin level was up to 20, and there was no reason a 75-year-old should have been prescribed testosterone when it can elevate his hemoglobin so much.

What are the normal protocols for testosterone with older men? Could his testosterone injections have led to his stroke?

D.H.

Dear D.H.: Testosterone replacement therapy is commonly prescribed to men in their 70s and 80s. Elevations of the hemoglobin levels are certainly well-described, but levels above normal only happen about 1% of the time. Experts recommend checking a blood count to look for these elevations three to six months after starting treatment. Testosterone should be stopped if the hemoglobin level is above normal.

Sometimes, there are other causes for the hemoglobin to go up, but a rise that high, when he had never had it before, makes it seem very likely to me that the testosterone was the cause. A hemoglobin level that high, from any cause, is a risk for stroke and heart attack. It is very possible the testosterone prescription led directly to the stroke.

I am publishing this in the column so that men who are taking testosterone know they should be periodically tested for this unusual complication.

Dear Dr. Roach: I had carpal tunnel surgery two years ago. I now have trigger fingers in my index and ring fingers. I had cortisone injections but that didnt cure it. I, at one point, was not able to open my fingers. Now, my fingers are really stiff, and I cant bend them. Surgery was suggested. Im hesitant, because Im wondering if this will get better on its own with exercises.

J.T.

Dear J.T.: Trigger finger is caused by the tendon getting stuck inside one of the pulleys of the hand. To the best of my knowledge, carpal tunnel surgery doesnt predispose to trigger finger, but there are some conditions that put people at risk for both conditions. Initial treatment of trigger finger is conservative, with splinting and anti-inflammatory drugs.

If that doesnt work, injection of cortisone by a hand surgeon is usually successful.

Most of the hand surgeons I know will try injection three times before recommending surgery. Unfortunately, postponing surgery too long can lead to the finger getting a contracture, where it will not straighten at all.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.

Go here to read the rest:
Dr. Roach: Testosterone injections most likely led to severe stroke - Detroit News