A: If a health insurance company is providing coverage for a medication, including testosterone replacement therapy, they determine the final cost of the product. Costs will vary from one health insurance plan to another. To determine the costs of the testosterone replacement options, the health insurance plan should be contacted. There are various options for testosterone replacement therapy including gels, injections, patches, and tablets that dissolve under the lip. All of the formulations can be effective and each has advantages and disadvantages. The most appropriate testosterone replacement therapy depends on a variety of factors, including cost, patient preference, and tolerability. Testosterone replacement gels, such as AndroGel and Testim, are very effective and easy to administer. AndroGel and Testim can be easily applied to the skin once daily. However, the gels can be irritating to the skin and AndroGel and Testim are typically quite expensive. Testosterone replacement injections, such as Depo-Testosterone (testosterone cypionate) and Delatestryl (testosterone enanthate), are usually inexpensive. The injections are given only once every one to two weeks. The major disadvantage with injectable testosterone is that testosterone levels may be difficult to control. Levels may be too high after an injection and too low before the following injection. A testosterone replacement patch, such as Androderm, is applied every night and left on for 24 hours. Androderm can be applied to the arm, back or stomach, in an area without too much hair. Androderm can cause irritation of the skin. A testosterone tablet, Striant, is placed under the upper lip against the gums and replaced every 12 hours. Striant molds to the upper gum so that eating and drinking can occur normally. The testosterone tablet can irritate the gums and cause a bitter taste and toothache. People with low testosterone should work with their doctor or healthcare provider to find a safe, effective, and affordable testosterone replacement option for them. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Derek Dore, PharmD
Magnesium comes with a strict upper cap. Excess magnesium is hard on your kidneys, and can lead to kidney failure. The NIH recommends that men consume 400-420 mg of magnesium daily, but that they should not exceed 350 mg of supplemental magnesium per day. Because while it’s rare for people to chronically overdose on magnesium through diet (you’d have to eat a lot of almonds and spinach, for example), overdose by supplement is far more common.
Smith and colleagues (2005) undertook a prospective study on the contribution of stress to coronary heart disease. Their study, which involved 2512 men aged 45 to 59 years, looked at a number of metabolic parameters. They found that an increased cortisol to testosterone ratio was associated with a high risk of coronary artery disease and that this risk was mediated by components of the insulin resistance syndrome. They reported that high cortisol and low testosterone levels are associated with a worsening of insulin resistance and that there is evidence to support the possibility of improving this pattern by treatment with testosterone.
A previous meta-analysis has confirmed that treatment of hypogonadal patients with testosterone improves erections compared to placebo (Jain et al 2000). A number of studies have investigated the effect of testosterone levels on erectile dysfunction in normal young men by inducing a hypogonadal state, for example by using a GnRH analogue, and then replacing testosterone at varying doses to produce levels ranging from low-normal to high (Buena et al 1993; Hirshkowitz et al 1997). These studies have shown no significant effects of testosterone on erectile function. These findings contrast with a similar study conducted in healthy men aged 60–75, showing that free testosterone levels achieved with treatment during the study correlate with overall sexual function, including morning erections, spontaneous erections and libido (Gray et al 2005). This suggests that the men in this older age group are particularly likely to suffer sexual symptoms if their testosterone is low. Furthermore, the severity of erectile dysfunction positively correlates with lower testosterone levels in men with type 2 diabetes (Kapoor, Clarke et al 2007).
The production of the stress hormone cortisol blocks the production and effects of testosterone. From a biological perspective, cortisol increases your “fight or flight” response, thereby lowering testosterone-associated functions such as mating, competing, and aggression. Chronic stress can take a toll on testosterone production, as well as your overall health. Therefore, stress management is equally important to a healthy diet and regular exercise. Tools you can use to stay stress-free include prayer, meditation, laughter, and yoga. Relaxation skills, such as deep breathing and visualization, can also promote your emotional health.
Testosterone retains nitrogen and is an essential ingredient in the development and maintenance of muscle mass (Sinha-Hikim et al 2006). With a diminution in testosterone, muscle mass diminishes as does strength. Weakness and fatigue result. A number of studies have demonstrated the ability of testosterone to restore lean body mass (muscle) in hypogonadal men, while at the same time causing a reduction in fat mass (Wang et al 2004). Treatment of hypogonadal men with testosterone results in improvement in overall physical performance as well as strength as assessed by, eg, hand grip power (Page 2005). Because of decreased muscle strength and impaired balance, older hypogonadal men are susceptible to falling and since they may already be osteopenic or osteoporotic as a consequence of hypogonadism, they are at increased risk for fracture as a result of the fall (Szulc et al 2003). Men with low levels of testosterone as in androgen deprivation therapy for prostate cancer, have a significant decrease in lean body mass and hemoglobin, while at the same time they experience an increase in weight, body fat and body mass index (Smith et al 2002). Treatment of frail hypogonadal men with testosterone, therefore, can result in changes in muscle gene expression, increased muscle mass, improvements in strength, power and endurance and improved physical function.
Magnesium deficiency is another widespread problem in our country. While this makes you prone to stress and muscle cramps, it also starves your body’s endocrine system of a vital mineral it needs for testosterone production. We wrote another article on how magnesium alone can send your testosterone levels through the roof. You have to check it out.
As you can see, the entire workout is only 20 minutes. Twenty minutes! That really is a beautiful thing. And within those 20 minutes, 75 percent of that time is warming up, recovering or cooling down. You're really only working out intensely for four minutes. It's hard to believe if you have never done this that you can actually get that much benefit from four minutes of exercise. That's all it is.
Transdermal preparations of testosterone utilize the fact that the skin readily absorbs steroid hormones. Initial transdermal preparations took the form of scrotal patches with testosterone loaded on to a membranous patch. Absorption from the scrotal skin was particularly good and physiological levels of testosterone with diurnal variation were reliably attained. The scrotal patches are now rarely used because they require regular shaving or clipping of scrotal hair and because they produce rather high levels of dihydrotestosterone compared to testosterone (Behre et al 1999). Subsequently, non-scrotal patches were developed but the absorptive capacity of non-scrotal skin is much lower, so these patches contain additional chemicals which enhance absorption. The non-scrotal skin patches produce physiological testosterone levels without supraphysiological dihydrotestosterone levels. Unfortunately, the patches produce a high rate of local skin reactions often leading to discontinuation (Parker and Armitage 1999). In the last few years, transdermal testosterone gel preparations have become available. These require daily application by patients and produce steady state physiological testosterone levels within a few days in most patients (Swerdloff et al 2000; Steidle et al 2003). The advantages compared with testosterone patches include invisibility, reduced skin irritation and the ability to adjust dosage, but concerns about transfer to women and children on close skin contact necessitate showering after application or coverage with clothes.
Topical testosterone, specifically gels, creams and liquids, may transfer to others. Women and children are most at risk of harmful effects from contact with them. You should take care to cover the area and wash your hands well after putting on the medication. Be careful not to let the site with the topical TT touch others because that could transfer the drug.
Osteoporosis refers to pathological loss of bone density and strength. It is an important condition due to its prevalence and association with bone fractures; most commonly of the hip, vertebra and forearm. Men are relatively protected from the development of osteoporosis by a higher peak bone mass compared with women (Campion and Maricic 2003). Furthermore, women lose bone at an accelerated rate immediately following the menopause. Nevertheless, men start to lose bone mass during early adult life and experience an increase in the rate of bone loss with age (Scopacasa et al 2002). Women of a given age have a higher prevalence of osteoporosis in comparison to men but the prevalence increases with age in both sexes. As a result, men have a lower incidence of osteoporotic fractures than women of a given age but the gap between the sexes narrows with advancing age (Chang et al 2004) and there is evidence that hip fractures in men are associated with greater mortality than in women (Campion and Maricic 2003).
Decreased testosterone production in men with rheumatoid arthritis is a common finding (Stafford et al 2000), and it is now generally recognized that androgens have the capacity to suppress both the hormonal and cellular immune response and so act as one of the body’s natural anti-inflammatory agents (Cutolo et al 2002). This known anti-inflammatory action of testosterone has led to studying the effect of testosterone therapy in men with rheumatoid disease. Although not all studies have reported positive effects of testosterone treatment (Hall et al 1996), some studies do demonstrate an improvement in both clinical and chemical markers of the immune response (Cutolo et al 1991; Cutolo 2000). This observation would go along with more recent evidence that testosterone or its metabolites protects immunity by preserving the number of regulatory T cells and the activation of CD8+ T cells (Page et al 2006).
If in a 46 XY individual testosterone is either not produced in adequate concentrations as in gonadal dysgenesis (MacLaughlin and Donahue 2004), or in the absence of the enzyme 17 alpha-hydroxylase so that testosterone is not produced (Ergun-Longmire et al 2006), or testosterone androgen receptors are absent as in the androgen insensitivity syndrome (Hughes and Deeb 2006), phenotypic females will result.
Bhatia et al (2006) studied 70 male patients with type2 diabetes mellitus (age range 24–78 years). Thirty-seven subjects were found to have hypogonadism based on a calculated free testosterone level of less than 6.5 μg/dl. The hypogonadal group had a statistically significant lower hematocrit. Anemia was observed in 23% of the patients (16 out of 70). In 14 of 15 anemic patients calculated free testosterone was low.
A team led by Dr. Joel Finkelstein at Massachusetts General Hospital investigated testosterone and estradiol levels in 400 healthy men, 20 to 50 years of age. To control hormone levels, the researchers first gave the participants injections of a drug that suppressed their normal testosterone and estradiol production. The men were randomly assigned to 5 groups that received different amounts (from 0 to 10 grams) of a topical 1% testosterone gel daily for 16 weeks. Half of the participants were also given a drug to block testosterone from being converted to estradiol.
Vitamin D supplementation may potentially boost testosterone levels, but further research is needed to determine if it really has an effect on the testosterone levels of young people and athletes. The truth is likely similar to zinc and magnesium — being in a deficient state causes your testosterone levels to drop below baseline, and supplementing it just takes you right back to baseline (but not any higher).
A testicular action was linked to circulating blood fractions – now understood to be a family of androgenic hormones – in the early work on castration and testicular transplantation in fowl by Arnold Adolph Berthold (1803–1861). Research on the action of testosterone received a brief boost in 1889, when the Harvard professor Charles-Édouard Brown-Séquard (1817–1894), then in Paris, self-injected subcutaneously a "rejuvenating elixir" consisting of an extract of dog and guinea pig testicle. He reported in The Lancet that his vigor and feeling of well-being were markedly restored but the effects were transient, and Brown-Séquard's hopes for the compound were dashed. Suffering the ridicule of his colleagues, he abandoned his work on the mechanisms and effects of androgens in human beings.
Individuals with metabolic syndrome are at increased risk for developing coronary artery disease and diabetes mellitus. Predicting who might develop the metabolic syndrome would allow preventive measures to be taken in addition to weight control and other lifestyle modifications such as cessation of smoking and increased exercise. It is known that with decreasing testosterone availability in aging males there is an increase in fat mass and decrease in lean body mass (van den Beld et al 2000), there are disorders of insulin and glucose metabolism (Haffner et al 1996) and dyslipidemia (Tsai et al 2004). Kupelian and colleagues (2006) in analyzing data from the Massachusetts Male Aging Study demonstrated that men with low levels of testosterone, sex hormone-binding globulin, or clinical androgen deficiency, especially men with a BMI of greater than 25, were at increased risk of developing the metabolic syndrome and hence, diabetes mellitus and/or coronary artery disease.
Testosterone is considered to be the "male hormone" that's produced in men by the testes. Although women's ovaries produce some testosterone, the hormone is produced in much higher concentrations in men and it is responsible for many of the secondary sex characteristics seen in men such as a deeper voice and hair on the chest, in addition to contributing to a healthy libido, building muscle mass, and maintaining energy levels.
Prolactin is suppressed by dopamine activity. Since supplementing L-DOPA suppresses prolactin (by increasing dopamine activity), supplementing L-DOPA would increase testosterone if prolactin was abnormally high. The average, healthy male does not have elevated prolactin (unless he’s on steroids), so supplementing with L-DOPA will not increase your testosterone levels.
Mental status changes including excess aggression are a well known phenomenon in the context of anabolic steroid abuse (Perry et al 1990). An increase in self-reported aggressive behaviors have also been reported in one double blind placebo controlled trial of testosterone in young hypogonadal men (Finkelstein et al 1997), but this has not been confirmed in other studies (Skakkebaek et al 1981; O’Connor et al 2002). Aggression should therefore be monitored but in our experience is rarely a significant problem during testosterone replacement producing physiological levels.
A recent study compared total and bioavailable testosterone levels with inflammatory cytokines in men aged 65 and over. There was an inverse correlation with the pro-inflammatory soluble interleukin-6 receptor, but no association with interleukin-6 (IL-6), highly sensitive CRP (hsCRP), tumor necrosis factor-α (TNF-α) or interleukin-1β (IL-1β (Maggio et al 2006). Another trial found that young men with idiopathic hypogonadotrophic hypogonadism had higher levels of proinflammatory factors interleukin-2 (IL-2), interleukin-4 (IL-4), complement C3c and total immunoglobulin in comparison to controls (Yesilova et al 2000). Testosterone treatment in a group of hypogonadal men, mostly with known coronary artery disease, induced anti-inflammatory changes in the cytokine profile of reduced IL-1β and TNF-α and increased IL-10 (Malkin, Pugh, Jones et al 2004).
Testosterone is a steroid from the androstane class containing a keto and hydroxyl groups at the three and seventeen positions respectively. It is biosynthesized in several steps from cholesterol and is converted in the liver to inactive metabolites. It exerts its action through binding to and activation of the androgen receptor. In humans and most other vertebrates, testosterone is secreted primarily by the testicles of males and, to a lesser extent, the ovaries of females. On average, in adult males, levels of testosterone are about 7 to 8 times as great as in adult females. As the metabolism of testosterone in males is more pronounced, the daily production is about 20 times greater in men. Females are also more sensitive to the hormone.
We required all of our testosterone boosters to have magnesium, but gave preference to magnesium aspartate, citrate, lactate, and chloride. These forms have been found to be more easily absorbed than magnesium oxide and sulfate. (On the other hand, it didn’t count if the supplement had magnesium stearate, which is used to make pills not stick together.)
In contrast to steroids, testosterone boosters have a fully different mechanism of action. They are the products which contain the natural ingredients only. These ingredients act by stimulating the man’s body to synthesize own testosterone. So, testosterone levels grow naturally without negative health effects associated with the intake of steroids.
This over-the-counter supplement is intended to increase your body's level of testosterone to its highest. The manufacturer also advertises the positive effect that the drug can have on your sex life and achieving muscle growth. As a supplement, you are instructed to take four capsules each night before bed. On training days, recommended dosage is two capsules before you workout. Ingredients found in the product include tribulis terristris, long jack, maca root and epimedium.
Japanese Knotweed (a.k.a Hu Zhang or Polygonum cuspidatum) is highlighted by WebMD as needing more evidence to rate its effectiveness in a number of different areas: like treating constipation and liver or heart disease. They also warn that it can interact poorly with medications that are changed and broken down by the liver, and those that slow blood clotting (anticoagulants and antiplatelets).
The use of anabolic steroids (manufactured androgenic hormones) shuts down the release of luteinising hormone and follicle stimulating hormone secretion from the pituitary gland, which in turn decreases the amount of testosterone and sperm produced within the testes. In men, prolonged exposure to anabolic steroids results in infertility, a decreased sex drive, shrinking of the testes and breast development. Liver damage may result from its prolonged attempts to detoxify the anabolic steroids. Behavioural changes (such as increased irritability) may also be observed. Undesirable reactions also occur in women who take anabolic steroids regularly, as a high concentration of testosterone, either natural or manufactured, can cause masculinisation (virilisation) of women.