I recommend using a trans-mucosal DHEA cream. Applying it to the rectum or if you are a a woman, your vagina, will allow the mucous epithelial membranes that line your mucosa to perform effective absorption. These membranes regulate absorption and inhibit the production of unwanted metabolites of DHEA. I personally apply 50 milligrams of trans-rectal DHEA cream twice a day – this has improved my own testosterone levels significantly. However, please note that I do NOT recommend prolonged supplementation of hormones. Doing so can trick your body into halting its own DHEA production and may cause your adrenals to become seriously impaired down.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
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.
Avoid stressful situations – It is actually that simple. If you can avoid stressful situations, then you can significantly improve your overall testosterone production. Why is that? Well, you should know that stress makes our bodies to produce cortisol that is a notorious and well-known testosterone killer. So, what can you do about it? Well, you should definitely try deep breathing, meditating, exercising, and other lifestyle changes that can help you deal with the stressful situations the right way.
Tribulus terrestris is an ingredient commonly presented as improving testosterone levels, but has not been found to be more effective than a placebo or possess any testosterone increasing properties. WebMD cautions that it interferes with Lithium and diabetes medications, and in general, not enough is known about tribulus terrestris to recommend a dosage for anyone.
Testosterone functions within the brain. There are several lines of evidence for this: there are androgen receptors within the brain; testosterone is converted to both dihydrotestosterone (DHT) and estradiol by the actions of 5-α-reductase and aromatase respectively in the brain; steroid hormones promote neuronal cell growth and survival (Azad et al 2003). Testosterone enhances cerebral perfusion in hypogonadal men and that perfusion takes place specifically in Brodman areas 8 and 24, regions of the brain that are concerned with: strategic planning, higher motor action, cognitive behaviors, emotional behavior, generalized emotional reaction, wakefulness and memory (Greenlee 2000; Azad et al 2003). Studies of cognition demonstrate that older men with higher levels of free testosterone index (a surrogate measure of bioavailable testosterone) have better scores in tests of: visual memory, verbal memory, visuospatial functions and visuomotor scanning. Hypogonadal men have lower scores in tests of memory, visuospatial function, with a faster decline in visual memory (Moffat et al 2002). In a very small, short term placebo-controlled study hypogonadal men with Alzheimer’s Disease (AD) treated with testosterone demonstrated a modest improvement in a cognition assessment score in AD (Tan and Pu 2003).
"I'm 53 years old and my passion is surfing the oceans worldwide – big waves. Since taking Andro400, I'm now down to my ideal weight – from 185 to 175 now which is probably a net 15 pound loss, taking into account that the increased muscle I have now is heavier than the fat it replaced. My energy level is up. I feel strong and more physically fit in general. Also, from surfing I have been injured many times – for example I've broken my neck and pelvis among other things. Taking Andro400, I have much less pain overall – and I've been able to take less pain medication and anti-inflammatory drugs.”
The partial synthesis in the 1930s of abundant, potent testosterone esters permitted the characterization of the hormone's effects, so that Kochakian and Murlin (1936) were able to show that testosterone raised nitrogen retention (a mechanism central to anabolism) in the dog, after which Allan Kenyon's group[186] was able to demonstrate both anabolic and androgenic effects of testosterone propionate in eunuchoidal men, boys, and women. The period of the early 1930s to the 1950s has been called "The Golden Age of Steroid Chemistry",[187] and work during this period progressed quickly. Research in this golden age proved that this newly synthesized compound—testosterone—or rather family of compounds (for many derivatives were developed from 1940 to 1960), was a potent multiplier of muscle, strength, and well-being.[188]
To find the best testosterone booster, we collected every supplement available on BodyBuilding.com, and cross-checked our list against the top results on best of lists like MensFitness, BroScience, and BodyNutrition. We only looked at pills since some of the ingredients in testosterone boosters have a reputation for tasting bad, and powders just prolong the experience. There are a lot — 133 of them to be precise — and they all claim to boost testosterone levels. Testosterone (for men) is “thought to regulate sex drive (libido), bone mass, fat distribution, muscle mass and strength, and the production of red blood cells and sperm.” If a supplement can increase your natural testosterone levels, the rest should follow. As we mentioned above, it’s not that simple, and at best, you’ll experience only a short-lived boost.
Late onset hypogonadism reflects a particular pathophysiology and it may not be appropriate to extrapolate results from studies concerning the effects of testosterone in treating hypogonadism of other etiology to aging males. For this reason, the age of men treated in clinical trials is certainly relevant. Other important factors include patient comorbidities and the preparation and route of testosterone replacement used in the study, which can affect the production of estrogen and dihydrotestosterone, testosterone’s active metabolites
Pellets. Your doctor will place the testosterone pellets under the skin of your upper hip or buttocks. Your doctor will give a shot of local anesthesia to numb your skin, then make a small cut and place the pellets inside the fatty tissues underneath your skin. This medication dissolves slowly and is released over about 3-6 months, depending on the number of pellets. 
Low testosterone levels can cause mood disturbances, increased body fat, loss of muscle tone, inadequate erections and poor sexual performance, osteoporosis, difficulty with concentration, memory loss and sleep difficulties. Current research suggests that this effect occurs in only a minority (about 2%) of ageing men. However, there is a lot of research currently in progress to find out more about the effects of testosterone in older men and also whether the use of testosterone replacement therapy would have any benefits.

The University of Connecticut recently published findings stating that those who supplemented with whey protein produced less cortisol, a stress hormone, than those who did not supplement. Cortisol lowers production of sex hormones and is also responsible for belly fat formation. Ricotta is an excellent source of natural whey protein and amino acids, both of which are essential to muscle growth and avoiding the spare tire.


VI-PEX or Vasodilator Ingredients with Penile Expansion is a highly-potent combination of blood flow-boosting ingredients which prolong and intensify the vasodilation properties of Male UltraCore, resulting in an undeniable improvement in size and hardness during penile erection. VI-PEX technology works hand-in-hand with STEM technology to leverage sexual arousal as a size-boosting factor during penile erection.
A notable study out of Wayne State University in Indiana found that older men who had a mild zinc deficiency significantly increased their testosterone from 8.3 to 16.0 nmol/L—a 93 percent increase—following six months of zinc supplementation. Researchers of the study concluded that zinc may play an important role in modulating serum testosterone levels in normal healthy men.6

To reduce excess estrogens and weight gain (since fat stores estrogen), I suggest increasing fiber to assist with detox, as well as bumping up nutrients known to be good estrogen detoxifiers like methylated B12, betaine, choline, and methylated folate. These types of nutrients are referred to as methyl donors and help with estrogen metabolism and detoxification.

With the decline of ovarian function in menopause, not only do estrogen levels decline, but so does testosterone availability, since the ovaries contribute, either by direct secretion or through precursor production, about 50 percent of circulating testosterone. The other 50 percent is supplied by the adrenal glands. Many post-menopausal or oophorectomized women are symptomatic as a consequence of reduced testosterone, the leading symptom being loss of libido (Sherwin and Gelfand 1987; Simon et al 2005). There is an increasing trend toward testosterone supplementation in these women. Such supplementation may also lead, not only to increased libido, but to increased bone mineral density and an improvement in general overall sense of well-being including energy, strength, motivation and mood (Davis et al 1995; Davis et al 2000).
In males, the testosterone test can help find the reason for sexual problems, like reduced sex drive or erectile dysfunction. If you’re having a hard time getting your partner pregnant, the test can tell if your blood testosterone level is low. It can also screen for problems with the hypothalamus or pituitary gland. This controls how much testosterone your body makes.

Testosterone is an important hormone for both men and women. Even though it’s often associated with a man’s libido, testosterone occurs in both sexes from birth. In females, it plays a part in sexual drive, energy, and physical strength. In males, it stimulates the beginning of sexual development and helps maintain a man’s health throughout his life.

However, testosterone is only one of many factors that aid in adequate erections. Research is inconclusive regarding the role of testosterone replacement in the treatment of erectile dysfunction. In a review of studies that looked at the benefit of testosterone in men with erection difficulties, showed no improvement with testosterone treatment. Many times, other health problems play a role in erectile difficulties. These can include:
Epidemiological studies have also assessed links between serum testosterone and non-coronary atherosclerosis. A study of over 1000 people aged 55 years and over found an inverse correlation between serum total and bioavailable testosterone and the amount of aortic atherosclerosis in men, as assessed by radiological methods (Hak et al 2002). Increased intima-media thickness (IMT) is an early sign of atherosclerosis and has also been shown to predict cardiovascular mortality (Murakami et al 2005). Cross-sectional studies have found that testosterone levels are negatively correlated with carotid IMT in independently living men aged 74–93 years (van den Beld et al 2003), diabetic men (Fukui et al 2003) and young obese men (De Pergola et al 2003). A 4-year follow up study of the latter population showed that free testosterone was also inversely correlated with the rate of increase of IMT (Muller et al 2004).
Mood disturbance and dysthymia are part of the clinical syndrome of hypogonadism. Epidemiological studies have found a positive association between testosterone levels and mood, and depressed aging males have lower testosterone levels than controls (Barrett-Connor, Von Muhlen et al 1999). Furthermore, induction of a hypogonadal state during treatment of men for prostate cancer leads to an increase in depression scores (Almeida et al 2004). Trials of testosterone treatment effects on mood have varied in outcome. Data on the effects on men with depression are conflicting (Seidman et al 2001; Pope et al 2003) but there is evidence that testosterone treatment of older hypogonadal men does result in improvements in mood (Wang et al 1996) and that this may occur through changes in regional brain perfusion (Azad et al 2003).
With the decline of ovarian function in menopause, not only do estrogen levels decline, but so does testosterone availability, since the ovaries contribute, either by direct secretion or through precursor production, about 50 percent of circulating testosterone. The other 50 percent is supplied by the adrenal glands. Many post-menopausal or oophorectomized women are symptomatic as a consequence of reduced testosterone, the leading symptom being loss of libido (Sherwin and Gelfand 1987; Simon et al 2005). There is an increasing trend toward testosterone supplementation in these women. Such supplementation may also lead, not only to increased libido, but to increased bone mineral density and an improvement in general overall sense of well-being including energy, strength, motivation and mood (Davis et al 1995; Davis et al 2000).
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
Epimedium is also known as horny goat weed which is used as an aphrodisiac and testosterone booster. A recent study on rats showed that horny goat weed increased testosterone levels. At low doses, it is shown to improve bone strength in females. It also has an active ingredient Icariin which is responsible for the aphrodisiac effect of horny goat weed.
It goes without saying that what you eat significantly influences your hormone balance and body composition. This is nothing new. There are countless athletes and bodybuilders who are paying a close attention to what they eat for a reason. For example, if you consume a lot of so-called junk food, then you inevitably end up with a poor nutritional profile. In plain English, you can forget about a six-pack and the high testosterone.

It is important to note that you can certainly boost testosterone naturally without supplementation. Supplements are expensive now a days and a lot of people do not like taking tons of pills. Plus, a lot of these vitamins and minerals are only needed if deficient, so I recommend getting routine blood work done to see where you are short. I can almost guarantee you will come out vitamin D deficient, so while you don’t have to take these, they will certainly help.
Why do we need magnesium? Magnesium is an essential nutrient in the body that can help decrease the risk of developing osteoporosis, improve insulin sensitivity, and lower the risk of hypertension. This article looks at other health benefits of magnesium, what happens if a person has a deficiency, supplements, and how to include it in the diet. Read now

Mínguez-Alarcón, L., Chavarro, J. E., Mendiola, J., Roca, M., Tanrikut, C., Vioque, J., ... Torres-Cantero, A. M. (2017, March–April). Fatty acid intake in relation to reproductive hormones and testicular volume among young healthy men [Abstract]. Asian Journal of Andrology, 19(2), 184–190. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27834316


In general, the normal range in males is about 270 to 1070 ng/dL with an average level of 679 ng/dL. A normal male testosterone level peaks at about age 20, and then it slowly declines. Testosterone levels above or below the normal range are considered by many to be out of balance. Moreover, some researchers suggest that the healthiest men have testosterone levels between 400 - 600 ng/dL.
Over the years I have successfully treated many men with low T. My treatment of choice often includes a combination of bioidentical hormones. Bioidentical hormones are made from natural compounds and are identical to our body’s own natural hormones, which mean they are more easily metabolized and utilized by the body without the negative side effects often associated with synthetic hormones. There are prescription-based bioidentical hormones that are FDA approved. Testosterone hormone replacement therapy can consist of creams, gels, pellets (inserted under the skin), injections, and oral tablets. Men need to be cautious with creams and gels as contact with children or partners can result in them absorbing the testosterone.
Examine.com does not assume liability for any actions undertaken after visiting these pages, and does not assume liability if one misuses supplements. Examine.com and its Editors do not ensure that unforeseen side effects will not occur even at the proper dosages, and thereby does not assume liability for any side effects from supplements or practices hosted under the domain of Examine.com.
Recent reports have revealed that there may be an unaired episode of the hit series Shark Tank in which a new testosterone supplement landed the biggest deal in the show's history! Supposedly, two sisters from Korea, Angela and Yoojin Kim, had created an innovative supplement that promotes muscle growth and resolves erectile dysfunction! Inside sources say that when they presented their product to the Sharks, it got an overwhelming response!
An added testosterone benefit of my high fat and balanced protein and carb diet was that it probably helped me lose some body fat (I went from 18% to 12% body fat). Studies show that high fat diets actually contribute to increased body fat loss. And as we discussed earlier, as you lose body fat, your T production ramps up. Virtuous cycle for the win!
If you are concerned, your doctor can take a blood test to determine if your testosterone is abnormally low. Most doctors are willing to take your preference for natural treatments into consideration when designing a treatment plan, but your doctor will also let you know if medical treatments (i.e. prescription testosterone therapy) would be better for your circumstances.
The definition of the metabolic syndrome continues to be a work in progress. Within the last decade a number of definitions have emerged each with its own set of criteria although there is considerable overlap among them. The most recent definition seems to enjoy considerable consensus. It requires central adiposity (>94 cm waist circumference) plus two of, increased triglycerides, decreased HDL cholesterol, hypertension, insulin resistance as evidenced by impaired glucose tolerance, or frank diabetes (Alberti 2005). Almost immediately on the heels of this consensus, came a number of specific chemical markers which have been proposed to complement the basic definition of the metabolic syndrome (Eckel et al 2005).
I know the experiment didn’t simply bring me back to my pre-August levels because of the fact that when I learned that the original test I took can sometimes overestimate your T levels, I took a more accurate test around four months after the start of the experiment (I’ve continued the lifestyle changes made during the experiment) and my total T had gone up again to 826.9 ng/dL.

Zinc is little more of a nice-to-have ingredient than a must-have. It’s on our radar as an ingredient that possibly boosts testosterone levels, and while we couldn’t find enough supporting evidence that taking zinc would increase natural testosterone, low zinc levels have been connected to infertility. A low zinc level is also possibly a sign of hypogonadism. The closest support we found is in a study which found that people recovered from nutritional deficiency-related problems more quickly if they took a zinc supplement than those who did not. Zinc is available in many foods, such as oysters, fortified breakfast cereals, and red meat.


Consume vegetable carbohydrates and healthy fats. Your body requires the carbohydrates from fresh vegetables rather than grains and sugars. In addition to mono- or polyunsaturated fats found in avocados and raw nuts, saturated fats are also essential to building your testosterone production. According to research, there was a decrease in testosterone stores in people who consumed a diet low in animal-based fat.11 Aside from avocados and raw nuts, ideal sources of healthy fat that can boost your testosterone levels include:

What are the health benefits of kale? Kale is a leafy green vegetable featured in a variety of meals. With more nutritional value than spinach, kale may help to improve blood glucose, lower the risk of cancer, reduce blood pressure, and prevent asthma. Here, learn about the benefits and risks of consuming kale. We also feature tasty serving suggestions. Read now


It's an old secret of the adolescents of Kerala (Land of Coconuts), India, that if you want to grow mustache and beard faster, then you have to consume more coconuts. They didn't know however that it was due to the ability of coconuts to increase testosterone. Coconut is mainly saturated fats which are considered to be the best type of fat for increased testosterone production.
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.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 1997-2019, A.D.A.M., Inc. Duplication for commercial use must be authorized in writing by ADAM Health Solutions.

Directions — SUGGESTED USE: As a dietary supplement take 3 capsules daily, preferably with a meal, or as directed by a healthcare professional. — Take two capsules with a meal twice a day. On days that you are not training, take two capsules in the morning and two capsules at night. On days that you train, take two capsules about an hour before workouts and take two capsules in the morning or at night depending on when you train.
Take 1 teaspoon. Incredibly dense in nutrients and feed by bees to the larvae who grows on to be the queen bee. I found one human study where a 4g daily serving led to an small increase in testosterone in older men (ref 78). There are also numerous animal studies (ref 79) showing positive effects. Personally I source NZ manuka royal jelly from Manuka Health.
A: According to the package insert, there are several longer-term side effects that have occurred with testosterone therapy. Testosterone can stimulate the growth of cancerous tissue. Prostate cancer or enlargement of the prostate can develop during prolonged therapy with testosterone, and these conditions are more likely to occur in elderly men. In patients receiving testosterone therapy, tests for prostate cancer should be performed as is current practice. Androgen therapy, such as testosterone, can cause a loss of blood sugar control in patients with diabetes. Close monitoring of blood glucose is recommended. Male patients can experience feminization during prolonged therapy with testosterone. The side effects of feminization include breast soreness and enlargement. These side effects are generally reversible when treatment is stopped. Hair loss resembling male pattern baldness has also occurred. Sexual side effects including decreased ejaculatory volume and low sperm counts have occurred in patients receiving long-term therapy or excessive doses. For more information, please consult with your health care provider and visit //www.everydayhealth.com/drugs/testosterone. Michelle McDermott, PharmD
A little goes a long way for men, but clinically many men do well with 5 to 10 mg of a topical progesterone cream at bedtime, again, only under your doctor’s supervision. Arginine is important for nitric oxide (NO) production and should be taken twice daily. I've also been recommending Testoplex™ for years. It's Xymogen’s formulation—featuring mungbean sprout powder—to address healthy testosterone levels and provide support for libido and overall vitality.
Cognitive abilities differ between males and females and these differences are present from childhood. In broad terms, girls have stronger verbal skills than boys who tend to have stronger skills related to spatial ability (Linn and Petersen 1985). It is thought that the actions of sex hormones have a role in these differences. Reviewing different cognitive strengths of male versus female humans is not within the scope of this article but the idea that cognition could be altered by testosterone deserves attention.
Workouts lasting longer than about an hour may begin to spike cortisol levels and subsequently decrease testosterone. Additionally, research has demonstrated that a shorter rest period between sets (1 minute versus 3 minutes) elicited higher acute hormonal responses following a bout of resistance training.11 To maximize your testosterone response, keep your rest periods short and total workout time to 60 minutes or fewer.
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
But when a premenopausal woman’s testosterone levels are too high, it can lead to polycystic ovary syndrome (PCOS), a condition that increases the risk of irregular or absent menstrual cycles, infertility, excess hair growth, skin problems, and miscarriage. High levels of testosterone in women, whether caused by PCOS or by another condition, can cause serious health conditions such as insulin resistance, diabetes, high cholesterol, high blood pressure, and heart disease. (12)

In addition to conjugation and the 17-ketosteroid pathway, testosterone can also be hydroxylated and oxidized in the liver by cytochrome P450 enzymes, including CYP3A4, CYP3A5, CYP2C9, CYP2C19, and CYP2D6.[155] 6β-Hydroxylation and to a lesser extent 16β-hydroxylation are the major transformations.[155] The 6β-hydroxylation of testosterone is catalyzed mainly by CYP3A4 and to a lesser extent CYP3A5 and is responsible for 75 to 80% of cytochrome P450-mediated testosterone metabolism.[155] In addition to 6β- and 16β-hydroxytestosterone, 1β-, 2α/β-, 11β-, and 15β-hydroxytestosterone are also formed as minor metabolites.[155][156] Certain cytochrome P450 enzymes such as CYP2C9 and CYP2C19 can also oxidize testosterone at the C17 position to form androstenedione.[155]
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.
Testosterone is a stimulant of hematopoiesis in the bone marrow and consequently, increases the hematocrit (Shahidi 1973). Men with unexplained anemia should have their testosterone measured and if reduced, these men should be treated with testosterone. Because of the erythropoietin stimulating effect of testosterone, one of the parameters to be monitored during testosterone treatment is hematocrit since a small percent of testosterone-treated men develop polycythemia.
Testosterone insufficiency has been associated with HIV infection in men (Dobs et al 1988). Early reports suggested that testosterone therapy may have an ameliorating effect on both depression and decreased energy in HIV infected men, even if testosterone levels were not reduced (Rabkin et al 1999; Grinspoon et al 2000; Rabkin et al 2000). Both depression and fatigue, however, are common features of HIV-positive men and may be associated with factors other than reduced levels of testosterone. The disease itself may induce depression and fatigue may be a consequence of the disease, per se, or of some of the medications used to control HIV.

Studies have demonstrated reduced testosterone levels in men with heart failure as well as other endocrine changes (Tappler and Katz 1979; Kontoleon et al 2003). Treatment of cardiac failure with chronic mechanical circulatory support normalizes many of these changes, including testosterone levels (Noirhomme et al 1999). More recently, two double-blind randomized controlled trials of testosterone treatment for men with low or low-normal serum testosterone levels and heart failure have shown improvements in exercise capacity and symptoms (Pugh et al 2004; Malkin et al 2006). The mechanism of these benefits is currently unclear, although a study of the acute effects of buccal testosterone given to men with chronic cardiac failure under invasive monitoring showed that testosterone increased cardiac index and reduced systemic vascular resistance (Pugh et al 2003). Testosterone may prove useful in the management of cardiac failure but further research is needed.
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 hormone also plays a role in sex drive, sperm production, fat distribution, red cell production, and maintenance of muscle strength and mass, according to the Mayo Clinic. For these reasons, testosterone is associated with overall health and well-being in men. One 2008 study published in the journal Frontiers of Hormone Research even linked testosterone to the prevention of osteoporosis in men.
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