The goal of testosterone replacement therapy is to replace the lowered testosterone at physiologic doses. At this proper dosing, the body’s reaction to testosterone is a restored youthful response in all body tissues. What we are trying to do is replicate the previous testosterone levels by restoring them throughout the body. Too much, and the body responds by increasing estrogen and the protein, sex hormone binding globulin (SHBG). Too little, and you will still suffer from low testosterone symptoms.
It should be noted that testosterone therapy will not prolong life expectancy. It will, however, increase the quality of life. Testosterone deficiency is the most common hormonal disorder in males. Low testosterone is related to several preventable diseases and still remains significantly underdiagnosed. Restoring testosterone levels quickly corrects most symptoms of deficiency as levels fall approximately 1-2% per year beginning around age 35.
When levels are restored, men report improvement in energy, well-being, psychosocial drive, initiative, assertiveness, increased libido, more frequent sexual encounters, increased muscular strength and endurance.
In men, testosterone is produced and secreted mainly by the testicles. Starting with cholesterol, testosterone is synthesized within the 500 million Leydig cells inside the testis. These specialized cells make up about 5% of the testis volume. A small amount of testosterone is made from DHEA in specialized areas of the body. This conversion accounts for a very small amount of your total testosterone.
Interestingly, giving a man DHEA at 50mg a day, will not increase his testosterone to acceptable replacement levels, but it will increase his estrogen level. However, a woman taking this dose, will see her testosterone increase.
The pituitary secretes luteinizing hormone (LH) in short bursts to signal the production and release of testosterone. The bursts occur every 60-90 minutes. Releasing LH in this manner maintains the Leydig cell’s sensitivity to LH and maintains the pattern of secretion. Constant stimulation and the Leydig cells will become resistant to the signal.
Men produce between 3mg and 10mg of testosterone per day with 4% being converted to dihydrotesterone (DHT) and about 0.2% being converted to estradiol, an estrogen.
DHT is 3 to 10 times as androgenic (male characteristics) as testosterone. The enzyme 5-alpha-reductase is responsible for this conversion of testosterone to DHT. In the prostate, 95% of testosterone is converted to DHT by 5-alpha-reductase. Specific medications can block this enzyme in the prostate. DHT, along with estrogen, is the contributing factor to an enlarged prostate. Testosterone has a protective benefit to the prostate.
A small percentage, just 0.2%, of testosterone is converted to estradiol by the enzyme aromatase. This may seem insignificant but estradiol is 100 times more potent at the cell receptor site than testosterone. This means that a male needs 100 times more testosterone than estradiol just to have an equal affinity for the receptor. Approximately 80% of estradiol in males is produced via this conversion from testosterone.
The major determining factor in the removal of testosterone from the body are SHBG levels, the individual’s circadian rhythm, amount of blood flow to the liver, genetics, and environmental factors. The clearance of testosterone from the body is reduced with lower SHBG levels and reduced blood flow to the liver.
Beginning around age 35, there is a gradual decrease in testosterone and increases in estrogen and SHBG. The decrease is accelerated and begins earlier with poor health or chronic illness.
Testosterone is transported by binding to SHBG. SHBG is made and secreted by the liver. SHBG binds 70% to 99% of the testosterone in a man’s body. The remaining 1% to 30% is either bound to other proteins or free to move into tissues resulting in an effect on the cell. The higher the SHBG concentration, the lower the amount of free testosterone available to the body. SHBG concentration is affected by testosterone levels, estrogen levels, liver disease, obesity, and genetics. Once bound to these proteins, the testosterone is rendered “inactive” and is taken to the liver for removal from the body.
Testosterone peaks for men in the early morning and slowly declines throughout the day with a low in mid-afternoon only to rise slightly again in the evening.
Many physicians use blood to measure testosterone levels. This is accurate for testing the total testosterone level but inaccurate for testing the free and active form. Additional blood tests are rarely performed to determine SHBG and the “free testosterone” measurement is given as an estimate. This estimate can vary by several fold and is generally considered useless in a clinical setting. Without additional blood testing, the only true and accurate way to measure free and active hormone levels is through saliva.
Certain diseases and medications will increase the SHBG levels. A hyperthyroid (fast thyroid) condition will increase the body’s SHBG by stimulating release from the liver. This will cause low testosterone symptoms while total testosterone levels remain unchanged.
Clinically, testosterone is used to treat anemia, osteoporosis, chronic obstructive pulmonary disease, angioedemia, immune system disorders, lung deficiencies, and muscular diseases. Chronic heart failure is associated with low testosterone levels. These conditions are usually treated with newer, more expensive therapies that show only a slight benefit over the much less expensive testosterone. There are also no side effects to testosterone therapy with correct dosing. At conventional doses for replacement therapy, there is no need to monitor the liver, kidneys, or electrolytes.
When taken orally, testosterone is quickly broken down by the liver into inactive metabolites. Because of this, testosterone is best given by intramuscular injection, transdermal cream, or sublingually.
Testosterone production can be completely shut down in men using synthetic progestins.
Abuse of testosterone and it’s anabolic/androgenic derivatives by athletes has produced a stigma surrounding the therapy. These hormones allow the body to produce larger and stronger muscles in a shorter period of time. They also significantly decrease recovery time between strenuous activity. Taking high levels of testosterone also temporarily shuts down sperm production and is associated with male infertility while on supra-physiologic doses.
Limited studies show that short-term, high dosing of testosterone has little medical danger, is not physically addictive, and most abusers eventually stop. After long-tern use, recovery of normal bodily testosterone production may take up to two years.
Testosterone replacement therapy, when done properly, is an inexpensive treatment to significantly improve the quality of life for males. The therapy has been used successfully for decades but has recently been associated with abuse among athletes and recreational users. Because of this, many doctors are reluctant to educate themselves of the risks, benefits, and protocols of testosterone therapy.
Also, since the hormones cannot be patented, pharmaceutical manufacturers cannot make a profit and therefore will not advertise this from of therapy. The prescription form of testosterone that my patients use costs them about $5.00 a week.
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HI, I had testicular cancer three years ago and have been in remission for two years. The BEP chemotherapy has affected my hormones negatively. My blood tests revealed levels as follows:
total testosterone is very high
LH is also high
Estradiol is high
SHBG is also high (3 times what it should be)
Free Testosterone is low.
I have virtually no energy and have stopped going to the gym. What approach would be best to decrease SHBG and estradiol? Which in turn will increase free t?
Regards
Jaron
i have been taking dhea for about 6 months now i am 54 years old, i initially started with one brand and i was taking 50 mg. a day, i initially and currently have seen a leaner me, however the first brand or manufacturer did not really have a mood change or libido change on me.
i have since switched over to dhea from general nutrition center and the change has been remarkable my libido has increased and i am able to achieve a stronger longer lasting erection.
i am thinking that perhaps 50mg. might be a little much so i will be cutting it down to approximately 37mg. as i tried 25mg. and that was insufficient.
i have also been doing some research on dhea and evidently taking dhea in a micronized powdered capsule form seems to be the way to go and perhaps 25mg taken in that form might be sufficient as absorption increases tremendously.
i think that taking the correct dose is optimal in order to truly experience the full benefits of dhea with minimal side effects if any at all.
i have tried testosterone before in the form of 250 mg injected once weekly intramuscularly the results were completely different there was much more muscle gain and greater strength however as far as libido and and erection issues the dhea is much better.
i only took the testosterone injections for 10 weeks and i would only take it again for muscle gains, however in all fairness to dhea users the dhea seems to be close to taking anabolic steroids but the results aren’t as obvious as quickly, but stamina, muscle gain and weight loss are all present with dhea therapy, i would also assume that dhea is not as bad on our bodies as anabolic steroids, not to mention much cheaper and available over the counter at walmart or any health food store.
just to be clear i was taking enathate as the anabolic steroid which is the mildest of all injectable steroids (as i have been told)
i hope this helps.
marc
“i am thinking that perhaps 50mg. might be a little much so i will be cutting it down to approximately 37mg. as i tried 25mg. and that was insufficient.
i think that taking the correct dose is optimal in order to truly experience the full benefits of dhea with minimal side effects if any at all.”
Correct. Simply don’t guess, and test your levels. Adjust dosage accordingly.
“i have tried testosterone before in the form of 250 mg injected once weekly intramuscularly the results were completely different there was much more muscle gain and greater strength however as far as libido and and erection issues the dhea is much better.”
were you using the dhea after, before, during the testosterone? Do you know if your testosterone levels on the testosterone injections were providing too low of a level to see proper results? Were you getting more than you needed and it was converting into other hormones, worsening your libido? Without proper bloodwork you cannot say one is better or worse than the other, and the truth is, the human body will perform best libido-wise when both DHEA and testosterone are optimal , whether that comes to you naturally or via supplementation is an individual matter.
“i only took the testosterone injections for 10 weeks and i would only take it again for muscle gains, however in all fairness to dhea users the dhea seems to be close to taking anabolic steroids but the results aren’t as obvious as quickly, but stamina, muscle gain and weight loss are all present with dhea therapy,”
this simply is not true, regardless of your perceived experience. testosterone at safe dosages blow dhea out of the water in terms of muscle building, and when you take testosterone in large amounts and dhea in large amounts, the testosteron’s effects increase linearly giving massive gains while dhea will give you nearly zero if not worse results. This is based on hundreds of scientific studies, generally acknowledged medical fact, and anecdotal evidence.
“i would also assume that dhea is not as bad on our bodies as anabolic steroids, not to mention much cheaper and available over the counter at walmart or any health food store.”
whether something is legal over the counter has nothing at all to do with it’s safety or efficacy. for example dhea requires a prescription in canada. neither will cause issues when used appropriately, and at the appropriate level plus more, oftentimes testosterone can increase its benefits in various catergories while dhea will not continue to increase results linearly as well.
“just to be clear i was taking enathate as the anabolic steroid which is the mildest of all injectable steroids (as i have been told)
i hope this helps.”
enanthate is no more ‘acceptable’ or ‘less frowned upon’, than any other form of testosterone. on the same note, it is not any less potent than any other form of testosterone. so it is in fact not milder in any sense whatsoever from other testosterone products such as cypionate or propionate.
I am a 68 y/o male, 6′ 5″ 220 lbs. Five years ago I was muscular, with good endurance but a minor accident resulted in a total-hip-replacement. The doctor totally botched the job, I am in constant pain, require narcotics to do anything. I have always been a little anemic, but now I am more anemic and have lost a tremendous amount of muscle mass. I am constantly fatigued and never want to do anything. I would like to try T-therapy, but don’t know where to start. Will a GP recommend testosterone for a situation such as this, does health insurance cover any of the costs. If my GP won’t recommend it, what’s the best way to get the treatment? I live in Ogden Utah and am not aware of any clinics in the area. I could use a total “quality of life transplant.” Thanks John
hi John, just wondering what you found out? I have been on Testosterone injections (I prescribe for myself and order off internet) for about a year. Usually high doses, but going to cut down soon. It has helped me immensely. I am 61 and have good muscle growth and have lost 120 lbs, although I did most of that before I ever started test…
Opiates can cause low testosterone. I would recommend trying another avenue for relief of your back pain, if possible.
“I have always been a little anemic, but now I am more anemic ”
” I am constantly fatigued and never want to do anything. ”
“I would like to try T-therapy, but don’t know where to start. ”
buddy, START with the anemia! get on some prescription iron if you are indeed iron deficient. if you aren’t, get on something safe and prove to increase your blood count… i dont know, say, TESTOSTERONE?! if you dont want to get on testosterone though and dont have a medical need for it, then of course don’t use testosterone, i was just saying it like that to get across the idea that it could be killing two birds with one stone. seriously get the anemia fixed. testosterone is not the first line of treatment to increase blood count, just making sure that im clear on that. it was just recommended for your particular situation, if medically applicable.
“I would like to try T-therapy, but don’t know where to start. Will a GP recommend testosterone for a situation such as this, does health insurance cover any of the costs. If my GP won’t recommend it, what’s the best way to get the treatment?”
Where to start?… go to the doctors office, get tested for testosterone and some other goodies, get results, walk out with prescription. its truly that simple. i speak from experience, and anecdotally for others. or go to antiaging clinic and pay possibly more, at least upfront and have someone more likely to prescribe you testosterone if you are having trouble getting your primary to prescribe it, or if you just want to start there because you know of a good place locally. always remember, if the doctor doesnt think you need it, but your results seem low, then go to another doctor, try again. do so until someone agrees. you just need to be tenacious. how much do you truly want to change your life? that is up to you friend. and yes, like most any other prescription it is covered by most any barebones insurance plan. maybe not the gels sometimes but at least the cheapo injections. cheapo does not mean not as good! just mean that without a script you can spend $100 on something that will last the “average guy on the average dosage” FIVE MONTHS!
Dr West Conner: I’m a 43 yr old male i’m considering using supplements 7keto- 7-ketodehydroepiandrosterone in safe levels what dosages can you recommend. Also can
you recommend a good aromatase inhibitor?
well good that your going to use them at safe dosages. which i assume means your getting bloodwork done.
i would stay away from 7keto. why bother? what are you trying to get from taking this? real dhea is where the benefits are.
a good aromatase inhibitor? theres plenty, and they’ve been working incredibly well, demolishing massive levels of estrogen in women, saving their lives from cancer for years and years.
just use any of them, preferably a weaker one so its easier to titrate the dosage as you will need far less than a woman would. anastrozole, letrozole, and aromasin are some. there are also drugs like tamoxifen citrate and others that block estrogen at the receptors, like at the boobies for example, which are different from things like the ones i mentioned earlier, as those stunt the production of estrogen rather than blocking it from binding with estrogen receptors. thats the kind you want as a maintenence drug during trt therapy. that said, i dont know WHY YOU want to use an AI, so you may indeed actually not what an AI but something like nolvadex (tamoxifen citrate) after all. speak with your doctor.
Androgel pushed my E2 over 200 pmol/L, which is 2x the upper desirable limit. I was confirmed low-T before starting the gel. Serum free-T (not a reliable test, I understand) responded as expected, rising into the upper third of the reference range.
I am roughly 6 feet, 200lbs, with some evenly distributed trunk fat but no pot belly. I have started on Adex to reduce E2 levels but I find it flattens mood, even at .25mg EOD.
Would using a little transdermal progesterone to modulate E2 [and 5a-reductase] be worth trying instead?
do not throw progesterone into the mix yourself. your playing with fire and further complicating things. you need to hold dosages for weeks and let things stabilize, check blood levels, and then asses your situation. you probably feel blunted moodwise becasue you drove your estrogen too low. .25mg EOD is a ton for not even having testosterone at 1000. your probably going to suffer from your wee wee not working pretty soon, if not already. keep e2 at 20-30 pg/ml. that is also recommended by LEF which is a seriously awesome foundation and i trust there word, even more so when it just backs up what i have prescribed to myself for years 🙂
I am a 43 year old male. Started therapy Feb 13 2012. Test level 243. One month of androderm level increased only to 246. One month of 200mg/ml testosterone cypionate bi weekly injections test level only increased to 257. Dr. recommended that I increase frequency of injection to every week. How long until test levels are normal?
you say 246 for androderm, and i believe it. who knows how well you absorb it, where you spread it on your body, if you showered, etc.
you say you had levels of 257 on 200mg biweekly injections… the injections pretty much work across the board and dont have the person to person variability the gels can have with blood results, so here i do believe your results as well, but with the caveat that i dont believe this is your effective result. you need to realize if you tested your levels at the day before an injection or so, your levels are going to be a small percentage of where they were earlier. lets say your levels on day 14 should be half of what they were at the end of day 7, and the levels on day 7 are half of what they were when you peaked a day or two after your injection.. so you could have been at 1000, then end of the week 500 then the end of the next week 250. see what i mean?
anyway….try every week, and then restest, you will probably be much happier both with the result as well as the effects.
What do i take now?
Last three weeks i took. .5 testosterone 100 follwed by 1 ml then1ml again if want to finsh cycle what do i do or take?
How long does it take for testosterone to convert to estradiol? I took three shots of testosterone cypionate (250/150/100mgs E3D) and then my doc checked my estra level which is 191 pmol/L.It wasn’t checked prior to starting.
43 yrs old, 15.1 nmol/L testosterone start nothing else checked – not measured since. Just wondering if 3 shots could have put my estradiol that high that quickly or if there is a possibility that I was estrogen dominant prior to starting treatment?
JP,
Everyone converts at a different rate. You should be taking an aromatase inhibitor along with your testosterone therapy. Did you get 250mg, 150mg, then 100mg three days apart? If so, get a new doc.
So is there a side effect of taking DHEA since it produces more estrogen than Testosterone?
Pat,
For men, too much DHEA will convert over to estrogens. We need the right amount, about 25mg. At that dose, there usually isn’t any conversion and no side effects. Unless you count feeling better and having more energy side effects.