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Testosterone Deficiency

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Definition

Testosterone deficiency is a condition characterized by the production of too little testosterone by the testicles. Deficiency of this vital male hormone in an adult is manifested in the form of alteration in masculine physical characteristics and impairment of normal reproductive functions.

Testosterone is the key male hormone that maintains neurological functions, muscle mass and strength, fat distribution, bone mass, regulates cholesterol, dilates coronary arteries, sperm production, sex drive and potency. It is mainly produced by the testes. Starting around age 40, a man's body produces about 1 percent less testosterone each year. This aging associated natural decline of testosterone continues throughout life.

Testosterone production begins in the brain. The Luteinizing Hormone (LH) secreted by the pituitary gland in the brain prompts the Leydig cells in the testes to produce testosterone. In females, the ovaries and the adrenal gland produce testosterone. Testosterone is much more than a sex hormone. There are testosterone receptor sites in cells throughout the body, most notably in the brain and heart

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Causes

  • Natural Aging
  • Injury to or infection of the testicles
  • Chemotherapy or radiation treatment for cancer
  • Genetic abnormalities such as Klinefelter's Syndrome (extra X chromosome)
  • Hemochromatosis (too much iron in the body)
  • Dysfunction of the pituitary gland (a gland in the brain that produces many important hormones)
  • Inflammatory diseases such as sarcoidosis
  • Medications, especially hormones used to treat prostate cancer and corticosteroid drugs
  • Chronic kidney failure
  • Liver cirrhosis
  • Stress
  • Alcoholism

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Symptoms

  • Decreased energy.
  • Reduced muscle mass and strength.
  • Decreased cognitive function.
  • Less sexual interest
  • Erectile Dysfunction (Impotence).
  • Depressed mood.
  • Atrophied genitalia.
  • Bone Loss (osteoporosis).

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Effects of Testosterone on the Body

Estrogen
In men, estrogen is secreted by the adrenal gland and certain amounts of testosterone is also converted into estrogen within the body. With aging, a man's body converts larger amounts of testosterone into estrogen resulting in disorders resulting due to the combined effects of having too little testosterone and excess of estrogen. The most dangerous acute effect of excess estrogen and too little testosterone is an increased risk of heart attack or stroke. High levels of estrogen have been implicated as a cause of enlarged prostate gland. Estrogen can compete for testosterone receptor sites in the body and block the ability of testosterone to induce a healthy hormonal signal.
Heart

Weakening of the heart is one of the consequences of normal aging. Testosterone is a muscle-building hormone and there are many testosterone-receptor sites in the heart. The weakening of the heart muscle can sometimes be attributed to testosterone deficiency. Testosterone is not only responsible for maintaining heart muscle protein synthesis, it is also a promoter of coronary artery dilation and helps to maintain healthy cholesterol levels.

Prostate Gland

High testosterone levels contribute to enlarged prostate as this hormone stimulates prostate cell growth. This may be caused by the combined effect of testosterone and estrogen. The life enhancing effects of this hormone are underused by most men due to the fear of developing prostate cancer. Therefore, a serum PSA (Prostate specific antigen) test and a digital rectal exam is recommended to rule out existing prostate cancer before starting testosterone replacement therapy.

Depression
Low testosterone levels correlate with symptoms of depression and other psychological disorders. It has been consistently demonstrated that testosterone replacement therapy produces an increased feeling of well-being that is equivalent to that achieved with standard antidepressant drugs
Libido

Testosterone promotes sexual desire and then facilitates performance, sensation and the ultimate degree of fulfillment. Without adequate levels of this hormone, the quality of a man's sex life is adversely affected and the genitals atrophy. The genital-pelvic region is packed with testosterone receptors that are ultra-sensitive to testosterone-induced sexual stimulation.

Aging

Many of the symptoms in middle-aged men like depression, fatigue, abdominal weight gain, alterations in mood and cognition, decreased libido, erectile dysfunction, prostate disease and heart disease may be directly related to testosterone deficiency. In some men, the testes lose their functional ability to produce testosterone. A major problem that aging men face is dual effects of low testosterone production and excessive conversion of testosterone to estrogen. Many of the degenerative diseases associated with aging in men, such as Type-II diabetes, osteoporosis and cardiovascular disease are related to a testosterone deficiency.The common characteristics of middle age and older age, such as depression, abdominal fat deposition, muscle atrophy, low energy and cognitive decline are also associated with less than optimal levels of testosterone.

These findings have significant implications in the battle to maintain youthful hormone balance and embrace the normal aging process with optimism.

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What You Can Do

Testosterone Replacement Therapy (TRT)

Testosterone deficiency can be treated through Testosterone Replacement Therapy (TRT). Synthetic testosterone is chemically different from the natural testosterone your body makes, however it provides the same effect as natural testosterone. Testosterone replacement therapy must be done under the supervision of a licensed physician who can monitor your testosterone levels regularly.

Testosterone Replacement Therapy is used to Treat the Following Conditions in Men:

Diseases of Aging Men
Depression
Cardiovascular diseases
Decreased libido
Erectile Dysfunction
Infertility
Decreased Production of Testosterone
Hypopituitrism
Testicular failure
Chronic illness
Prolactinoma

Though potentially beneficial for some men, testosterone therapy is not risk-free. The table below highlights some of the risks and benefits of testosterone replacement therapy.

Benefits of TRT

  • Improves muscle mass, strength & energy.
  • Increases bone density.
  • Thickens hair and skin.
  • Improves sex drive.
  • Decreases irritability and depression.
  • Improves cognitive functions.
  • Improves feeling of wellness.

Risks of TRT

  • Causes or aggravates sleep apnea.
  • Stimulates non-cancerous growth of the prostate gland
  • Causes or worsens urinary symptoms due to prostate problems.
  • Stimulates the growth of already present prostate cancer.
  • Enlarges the breasts.
  • Limits sperm production.
  • Stimulates excess blood production.
  • Causes acne.

Talk with your doctor to find out whether testosterone replacement therapy - and in which form - is right for you! Men with prostrate cancer, breast cancer or allergies to testosterone or any ingredient in the dosage form should avoid testosterone replacement therapies.

Commercially testosterone is available in the following forms.

Pills
Andriol (testosterone undecanoate)
Orally administered testosterone in the form of pills is not absorbed well and may increase your risk of cardiovascular diseases, increase cholesterol levels and cause liver damage.
Injections
Depo-Testosterone® (brand of testosterone cypionate)
Intra muscular testosterone injections are painful but safe and effective. Testosterone injections are generally administered every two to four weeks and can be given either by your doctor or can be self administered.
Delatestryl® (testosterone enanthate)
Skin Patches
Testoderm® (Scrotal Patch)
Skin patches effectively and consistently deliver testosterone into the body and they can be applied to various parts of the body (non-scrotal patch) or directly on to the scrotum (scrotal patch).
Androderm® (testosterone transdermal system)
Gel
AndroGel® 1% (testosterone gel)
The gel can be rubbed on the skin on various parts of the body. As the gel dries, testosterone is absorbed through the skin. A potential side effect of the gel is the possibility of transferring the medication to your partner. This can be avoided by waiting approximately 5 hours after an application or covering the area before having skin-to-skin contact.
Testim®
Buccal Gel
Striant® (testosterone buccal system gel)
This preparation delivers tetosterone through the mucous memebrane of the mouth from where it is rapidly absorbed directly into your blood stream. This mode of administration of testosterone is easy and extremely effective.
  • To maintain an optimum level of Testosterone in the body, the following steps can prove to be very helpful.
Physical Exercise
A routine of regular high-intensity exercises contributes to maintaining testosterone at optimal levels in the body.
High-Protein Diet
A diet high in protein can contribute to maintain normal testosterone levels in the body.
Soy
Consumption of soy-based-food products lower levels of estrogen.
Fish Oil
Essential fatty acids found in fish oil make more testosterone available to perform their normal functions.
Nutritional Supplements
Zinc
Zinc is essential for maintaining a man’s sexual functioning and is involved in almost every aspect of male reproduction, including testosterone metabolism, sperm formation and sperm motility.
Indole-3-carbinol
Getting an adequate intake of indole-3-carbinol either through vegetables like broccoli, brussels sprouts and cabbage or via supplements, may prove helpful in keeping estrogen levels in check and decreasing the risk of prostate cancer
Natural Extracts
Chrysin

Chrysin may offer libido-enhancing effects in the aging male by increasing free testosterone, decreasing excess estrogen, producing anti-anxiety effects.

Nettle
This highly concentrated extract from the nettle root provides a unique mechanism for increasing levels of testosterone by blocking the binding of testosterone leaving more in its sexually activating form.
Muira Puama

Muira puama comes from the stems and roots of a plant and is widely used in some parts of the world as an aphrodisiac, tonic and cure for rheumatism and muscle paralysis. It is possible that this herb induces these positive changes by favorably altering the hormone balance in aging men, i.e. increases free testosterone and/or suppresses excess estrogen

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For More Information

LifeMD

Men's Health Canada

C Health

Andropause Canada

MEDLINEplus

MayoClinic

Healthfinder

Cleveland Clinic Glickman Urological Institute

American Society for Reproductive Medicine

American Association of Clinical Endocrinologists (AACE)

Health Canada

Aging and Seniors

Sympatico Health

Canada Food Guide

Health Reserve.com

Healthnet Canada

Centre For Medical Consumers

The 2nd World Congress On The Aging Male

ClinicalTrials.gov

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Testosterone Deficiency