Testosterone makes a contribution to nitric oxide formation. Nitric oxide, released from penile nerves stimulates guanylate cyclase which catalyzes the transformation of guanosine-5-triphosphate into 3′,5′-cyclic, guanosine monophosphate (cyclic GMP). Gyclic GMP causes vasodilatation and hence erection formation (Morelli et al 2005). The breakdown of cyclic GMP to GMP is mediated by the enzyme, phosphodiesterase type-5, the inhibitors of which (eg, sildenafil citrate) enhance erection formation and maintanence (Carson and Lue 2005).


We know stress generates too much cortisol and shuts down sexual hormones since our bodies go into a "fight or flight" mode. Supplements that nourish our adrenals are key to correcting those imbalances. A few recommendations that I have include adrenal adaptogens such as maca, ashwagandha, Siberian ginseng, and rhodiola. Adaptogens are a great way to restore adrenal glands, balance hormones, and detoxify. Supplementing with 25 to 50 mg of DHEA, and a high-quality multivitamin with bioavailable B vitamins and high dose vitamin C can also be helpful. It's important to eat a diet high in quality omega-3s like salmon, oysters, and sardines. I suggest 2,000 to 6,000 mg per day of carnitine to improve energy production and mitochondrial function.
Like other supplements and medication, testosterone therapy comes with risks and possible side effects. This is particularly true if you try to take it for normal aging rather than for treatment of a condition. Also, the Cleveland Clinic points out that the effects that these supplements may have on your heart and prostate can lead to a number of potential issues. Complications include:

A blood test may not be enough to determine your levels, because testosterone levels can fluctuate during the day. Once you determine that you do have low levels, there are a number of options to take. There are synthetic and bioidentical testosterone products out on the market, but I advise using bioidentical hormones like DHEA. DHEA is a hormone secreted by your adrenal glands. This substance is the most abundant precursor hormone in the human body. It is crucial for the creation of vital hormones, including testosterone and other sex hormones.
A diagnosis of low testosterone is typically made if a man’s free testosterone hormone level is below 300 ng/dL. But as a doctor specializing in sexual health, I typically consider optimized male testosterone levels somewhere between 600 to 800 ng/dL—rarely above or below those numbers. The tests that I routinely recommend to my male clients can be found in this test panel and include biomarkers associated with testosterone, free and total (this includes sex-hormone binding globulin [SHBG]), estradiol, estrogen (total and serum), cortisol, DHEAs, thyroid-stimulating hormone (TSH), hemoglobin A1C, and vitamin D.
When your testosterone levels go up, so does your libido. Unfortunately, the inverse is not true — your libido levels can go up without your testosterone levels also going up. And that’s how most supposed T-boosters “work”: they make you feel ornery, leading you to think that your T levels are appreciably higher, when they actually aren’t. In rare cases, supplementation will result in a 20% testosterone increase. This kind of improvement may sound impressive, but is irrelevant for practical purposes.
^ David KG, Dingemanse E, Freud JL (May 1935). "Über krystallinisches mannliches Hormon aus Hoden (Testosteron) wirksamer als aus harn oder aus Cholesterin bereitetes Androsteron" [On crystalline male hormone from testicles (testosterone) effective as from urine or from cholesterol]. Hoppe-Seyler's Z Physiol Chem (in German). 233 (5–6): 281–83. doi:10.1515/bchm2.1935.233.5-6.281.
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.
I am also suspect of the fact that men 100 years ago had testosterone levels of 800-2000 ng/dL. The truth is that there are men today that are stronger and more muscular than the men from 100 years ago. Sure the “average man” of today is less than the “average man” of prior generations, but this is because we sit around in offices all day, and then come home to sit on the couch and watch tv…little to no activity.

The aim of treatment for hypogonadism is to normalize serum testosterone levels and abolish symptoms or pathological states that are due to low testosterone levels. The exact target testosterone level is a matter of debate, but current recommendations advocate levels in the mid-lower normal adult range (Nieschlag et al 2005). Truly physiological testosterone replacement would require replication of the diurnal rhythm of serum testosterone levels, but there is no current evidence that this is beneficial (Nieschlag et al 2005).


A: A troche is a small lozenge designed to dissolve in the mouth. Testosterone is available in troche or buccal form. If you are referring to testosterone troche, this product is generally used to treat conditions in men that result from a lack of natural testosterone. Testosterone is vital to maintaining an active and healthy male sex drive. Testosterone deficiency can cause erectile dysfunction. Studies suggest that if erectile dysfunction is associated with a low testosterone level, it can often be treated with prescription testosterone pills. Based on your complete medical history and blood levels of testosterone, your doctor can determine the best treatment option to meet your needs. For more information, please consult with your health care provider and visit //www.everydayhealth.com/drugs/testosterone. Michelle McDermott, PharmD
Ghlissi, Z., Atheymen, R., Boujbiha, M. A., Sahnoun, Z., Makni Ayedi, F., Zeghal, K., ... Hakim, A. (2013, December). Antioxidant and androgenic effects of dietary ginger on reproductive function of male diabetic rats [Abstract]. International Journal of Food Sciences and Nutrition, 64 (8), 974–978. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23862759
A loophole in FDA regulations allows pharmaceutical marketers to urge men to talk to their doctors if they have certain "possible signs" of testosterone deficiency. "Virtually everybody asks about this now because the direct-to-consumer marketing is so aggressive," says Dr. Michael O'Leary, a urologist at Harvard-affiliated Brigham and Women's Hospital. "Tons of men who would never have asked me about it before started to do so when they saw ads that say 'Do you feel tired?'"
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