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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I am worried if my DHT is excessively high.
Testosterone = 1007 (range: 348-1197)
DHT = 127 (high) (range: 30-85)
E2 = 30 (standard 4515)
SHBG = 28.6
thanks
It does look a little high. Some guys are just genetically predisposed to produce more DHT. I’m more concerned with it’s effect on your prostate. Get another test to verify the number and discuss it with your doctor. You may need to monitor your prostate more frequently than other guys.
Hi, im a trans woman (mtf) and i want to permanently remove testostrone from my body. And just have estrogen pumped through my body. Is this possible?
This isn’t my area of expertise, but I’d say it is not possible or desirable to remove all the testosterone from your body. You need testosterone regardless.
Hello Dr
I am 26 years old. I have been training for 6 years. Am well constructed. I want to inject 8 weeks long, testosterone every week 250ml. Would like to ready for Model picutre for big fashion labels.
Many consider it a low dose (Bodybuilding forum and so on). I think that Is a good dose and i will have successes because it is low I will have no major side effects.
My question: it will stop my own testosterone production, I needed a post cyle therapy?
Thanks and regards Form swiss
At that dose for just 8 weeks, I don’t think it will change your normal testosterone production very much. It may take a short time for your body to recover to normal levels but there shouldn’t be any long term adverse effects at 250mg a week for 8 weeks.
SWIY is 44 and has low testosterone with every text book symptom. The pathetic doctor wouldn’t reveal numbers but said if 11 – 34 was considered average he is at 12 (so on the lower end of the spectrum). Obviously it could be better or worse on different days. Either way they refused to treat him and he is done with their bullshit.. SWIY wants to take things into his own hands and begin dosing via injection once a week at 80mgs of testosterone enanthate. Is this too high a dose (swiy is willing to start on what ever dose would be most advised)? will swiy experience testicular shrinkage? is there a risk of aromatization taking place? what dose would you experts advise swiy begins on? can swiy take it permanently without issues or does he need to cycle using pct? also Swim (swiys good friend) is 27 and a good healthy natural bodybuilder. He wants to begin on a cycle of 500mg of testosterone enanthate also depo. Is swim likely to experience aromatization? Swim intended on either doing one single cycle and that’s it, or potentially doing repeated cycles for how ever long it can be sustained for (Swim will decide at the end of his first cycle). Would you experts advise swim to take Aromatase inhibitors in conjunction to prevent gyno? Swim would also do pct (regardless of whether its a one off cycle or a constant cycling). All advice and opinions is greatly appreciated.
Regards Swim and Swiy
Whichever form of T Your Doc gives You the goal is to reach a good level of DHT and E2. With gel and cream You can easily reach this. Which inj You often need to take an AI to get enough DHT without excessive E2.
Dr. West,
Need quick advice if you can provide it. 29 yo male wrongly given androgel for symptoms of fatigue and low sex drive. T level was 474 at the time. Did it for month doc did not tell me of side effects like shrinkage. I stopped it about 4 months ago. Month after stopping got sick with a chest cold that lasted almost 6 weeks. During this time I was getting terrible sleep. Anyway I am still feeling a little run down, i feel much better than i did than wjen i first stopped the testosterone. But i think my levels could still be low cause im still not 100% and my ejaculate volume is kinda low. Testicles still feel a little smaller than normal too
I may go in and get blood work again, but will I recover soon without meds? Or would you suggest I ask my doc a course of hcg or clomiphene. I switched doctors.
I don’t recommend testosterone creams for men for several reasons. Taking it only a month shouldn’t have given you those effects. The lengthy cold was most likely a coincidence. If you find a doctor, get testosterone injection.
Also a general comment to help those posting here, dont be fooled into taking painful injections with needles the size of a pencil, that are as long as your pinky finger. as long as you know your entering the muscle, you’re fine with the length, and as far as thickness goes, that’s largely (entirely?) a matter of how much patience you have with waiting for it to draw up the meds and inject in your body.
I often see people using 18g, 20g needles of 1.5″ and such. i have a bodyfat of about 18% or so, but as there is no fat at all on my thighs or deltoids i use an insulin syringe (30g/31g with a less than .5″ tip) or a “better” more “standard” syringe that is 28g with a 5/8″ tip.
As far as injection site, i find the deltoids and outer thigh (vastus lateralis) are the easiest for myself as i have great vision (clear view) and control (opposite of awkward positioning or angle) with those. in fact i have never and likely never will do the typical injection sight of “the butt” like many seem to do. I don’t like the idea of hitting a nerve, bone, or major vessel, and don’t run those risks where I inject as far as I know.
ive actually read recent documentation from multiple major medical bodies actually recommend NOT aspirating the syringe when injecting at such sites as it is not necessary as there is no risk of hitting an artery, etc and therefore can only cause other issues.
last tip, you can change the… tip of your syringes when using small ones to inject so you don’t need to wait forever to draw up your medication. you cannot do this with “all in one” designs like insulin varieties, but with regular syringes used popularly for intramuscular use, you can easily draw with a large gauge needle, then replace it with a higher, smaller gauge needle to inject with, so you get the best of both worlds.
IN SOME OF MY PATIENTS THAT I GIVE TESTOSTERONE TO TRANSDERMALLY FOR INSTANCE RX OF TESTOSTERONE 50MG+CHRYSIN10MG THEY GET HIGH DHT LEVELS. BESIDES SAW PALMETTO, LYSINE AND GREEN TEA ANY OTHER SUGGESTIONS TO LOWER DHT WITHOUT USING AVODART. DO YOU SUGGEST HCG INJECTIONS?
whoa woa whoa, your patients? you are a doctor? you shouldnt need random people telling you not to go lowering peoples dht levels if they are “high” without telling them they will get a limp dick first so they are aware and can make an educated decision as to whether or not they want to do that. if they aren’t suffering from bph or something else and dht isnt too high it shouldnt be a problem. i took the time to respond to you because , im guessing from your writing style and ability you are no doctor and just wanted some answers for yourself, so i figured id help. no real doctor would post for medical assistance HERE. best of luck.
Sorry in addition to what I’ve just posted I meant to ask is it safe for me to take 5mg dhea per day?
thats a tremendously conservative dose. i didnt say underdosed, but safe. start with that and get bloodwork done, then analyze and adjust accordingly. rinse and repeat.
Some great information on here. I suffer with chronic back pain, depression, IBS, constipation, fibromyalgia, chronic fatigue, erectile dysfunction, no sensitivity in penis, unable to climax. I find it impossible to lose weight and I have man boobs. However since taking just 5mg per day of douglas laboratories micronized dhea my back pain has almost vanished. My libido has improved a bit and my mood has slightly lifted. I do have morning wood and feel more sensitivity in my penis but afternoon and evening my libido is weak. I’m worried about taking more than 5mg per day as don’t want to increase my estrogen. Is there anything else I can take with the dhea to improve my libido and to help with my other issues. Yes already had several doctors look at my bloods, hormones, thyroid but they can’t find nothing wrong. They even performed an MRI scan on my brain but couldn’t find anything wrong. Yes when they first checked my testosterone and vitamin D levels were low but since supplementation I’ve been told they have now normalized. Really desperate for help, almost suicidal. I don’t care about how much it costs, I just want the best supplement. Any help greatly appreciated.
“I’m worried about taking more than 5mg per day as don’t want to increase my estrogen.”
Bloodwork is the only way to tell. that said there are many studies showing the use of 200mg daily without adverse results, just as there are studies showing increased estrogen from 50mg a day. it is all about the gender, age, condition of health, level of other hormones, etc of the user and bloodwork is your friend here. 25 should be safe for a starting dose for a man over 35, it is what dr. crisler believes and he is a nationally known hormone doctor who’s many views i respect.
“Is there anything else I can take with the dhea to improve my libido and to help with my other issues.” certainly. things that increase dopamine, testosterone, even things that affect histamine levels all effect the intricate network that operates your sexual desire and function. be careful, study long and hard, and consult a doctor for a proper plan. see a specialist who focuses on such things.
“Yes already had several doctors look at my bloods, hormones, thyroid but they can’t find nothing wrong.”
you say that, and my first though it is, you have low testosterone, you have low thyroid, and so on. just because they said you are ok does not mean you are ok. you could have been at the very end of the range of being ok. is that really ok? maybe if you came in the next day, you would have been a few points lower or higher on some scale for some hormone and they would have maybe said something differently. i would definitely get my hands on those numbers and take charge of my life.
Hi Tony,
Did you take finasteride?
I read a lot of symptoms that matches with the use of finasteride.
Even if you stop with finasteride, the symptoms get worse after months and years.
Many regards,
Olivier