Effects of low testosterone
Men and women: Decreased energy (fatigue), muscle strength and mass, sexual desire/function; slower exercise recovery; decreased exercise tolerance, sense of well-being, quality of life; irritability and depression.
Women: Decreased vaginal lubrication, sexual arousal and sexual orgasmic ability.
Benefits of Testosterone replacement
Men and Women:
Increased HEALING, lean muscle mass, strength, aerobic endurance, exercise tolerance, desire for exercise, energy, memory, concentration, cognition (thus may protect against Alzheimer’s through aromatization of estrogen), bone density, insulin sensitivity, sexual desire/function, mood/affect, quality of life, skin quality (increased collagen & thickness, improved texture, decreased wrinkles and fat deposition) and length of life.
Decreased fat, fasting glucose, cholesterol, triglycerides, diastolic blood pressure, cardiovascular risk (decreased total cholesterol and increased good HDL with natural testosterone) and pro-inflammatory cytokines (TNF alpha, IL-6, C-Reactive Protein).
Protects against tendon degeneration, joint degeneration (osteoarthritis), osteoporosis, diabetes, cardiovascular disease, dementia, Alzheimer’s and depressed mood.
Testosterone for Women
In addition to the above-mentioned benefits, women should take special note of the following. Estrogen helps protect against bone loss (osteoporosis) but testosterone is much better. Testosterone is the best hormone for the skin to prevent thinning and wrinkles (increased collagen and elastin). Testosterone helps alleviate the symptoms of menopause and increases sexual desire and responsiveness.
Potential side effects of Testosterone
Lowering the dose, stopping for a while, or adding other medications can treat these side effects. Weight gain (muscle weighs more than fat) or weight loss (due to decreased fat), increased PSA in men (by 0.5, but without increased size of prostate, and without symptoms), hair loss (men), hair growth (women) where the topical medication is applied, increased libido (sexual desire), decreased testicular size (men), acne, fluid retention and edema, sleep apnea (rare) and elevated estrogen.
NO prostate cancer! Testosterone does NOT increase the risk of prostate cancer. If you have prostate cancer, testosterone will be not be initiated and may be discontinued if you get prostate cancer. If you happen to develop prostate cancer while on testosterone, tumor growth may be accelerated. Therefore, PSA levels will be monitored on a regular basis in men.
NO prostate enlargement! Testosterone does NOT cause Benign Prostatic Hypertrophy (BPH).
Side effects are typically seen with injectable forms, but less likely with others: acne, aggression, decreased sperm production (possibly leading to infertility), gynecomastia (increase in breast size in men) and vocal cord swelling (women). SYNTHETIC injectable testosterone (but not natural compounded testosterone cream) and oral testosterone can cause liver problems and increased cholesterol. The natural compounded cream has a good effect on cholesterol.
Special notes re: testosterone:
- Physiologic erythrocytosis occurs with testosterone use. It is more prominent with injections and rare in women. This is an increased number of red blood cells and is not dangerous. It may be confused with, but is NOT polycythemia vera, a problem of increased red blood cells, white blood cells and platelets, which causes “thick blood” and possibly clotting. Those not familiar with this effect of testosterone will be mistakenly concerned about clotting.
- Transfer to others will occur if the topical forms are used improperly. With topical application, testosterone can be transferred to others by skin-to-skin contact (such as hugging/playing with children) and by “off-gassing” under the covers when sleeping if applied within 3-4 hours of bedtime.
Who should NOT use Testosterone?
Pregnant women or women who plan to become pregnant (as it will cause birth defects), men with active prostate cancer, men with fertility issues, men under 40 years old, women with hormone responsive cancer (such as breast cancer) and body builders.
Who might consider Testosterone use?
Anyone who would like the benefits noted above and anyone with low or suboptimal levels of testosterone.
How is Testosterone supplied?
Topical, sublingual (under the tongue), implanted pellets, injection and for women, vaginal suppositories. Oral pills are toxic to the liver in men, but not women, due to the lower doses in women. The commercially prepared gels are not typically prescribed, as the testosterone levels do not reach high enough levels with these products. In addition, they’re much more expensive. Topical preparations are usually a good place to start.