Description

Testosterone, important to both men and women,1 is a hormone secreted by the ovaries, adrenal glands, and testes.2 Women require less testosterone than men, but the hormone is needed to sustain a woman’s libido and enhance the functions of estrogen.3 In both males and females, it strengthens bones to help prevent bone loss.2

Testosterone is the primary male sex hormone, responsible for male sexual development and critical in maintaining erectile function, libido, energy levels, mood, and a wide range of other physical functions throughout the body.2 As with other hormones, testosterone declines with age. Testosterone levels begin declining when a man is in his thirties. Although the total testosterone does not drop dramatically, the free testosterone, which is the biologically active testosterone, declines dramatically with age.4 Because the drop in testosterone is gradual, andropause symptoms appear over a longer period of time as compared to female menopause.5 Symptoms appear as a gradual decrease in energy, thinning bones and muscles, increased visceral fat, depression, and impaired sexual function.1,5,6 Testosterone deficiency has also been linked to hypertension, obesity, and increased heart disease risks. Stress levels may also play a role in declining testosterone levels. Testosterone replacement therapy is available @ Preventative Medicine Clinic in Bend.

Benefits of Testosterone Therapy or Testosterone Optimization

The focus of testosterone therapy and reaching optimal levels result in:

• Increase in bone density, bone formation, and bone minerals2,7-10
• Increase in energy5,11-13
• Improvement in sexual function3,5,6,11,13-19
• Increase in sexual satisfaction16,18-20
• Decrease in body fat or improved body composition5,7-9,12,16,18,21
• Balance healthy cholesterol and/or improve lipid profiles21,22
• Decrease in cardiovascular ailments5,7,16,21,23-25
• Improved brain function, learning, concentration, and memory5,12,16,26
• Improved blood glucose levels5,7,21
• Balance healthy blood pressure5,21,22
• Increase in sexual desire16,20,22,27-29
• Increase in both muscle strength and in the diameter of muscle fibers8,30
• Enhancement of skin and hair texture5
• Improved mood6,10,11,13,14,18,22,29,31,32

Side Effects

Too much testosterone can increase aggressive behavior. Testosterone should not be prescribed if prostate cancer is present. Testosterone has not been shown to cause prostate cancer; however, it may accelerate the growth of a tumor. PSA levels should be monitored yearly or every 6 months.

Administration

Testosterone therapy includes administration of bio-identical or synthetic testosterone orally, by injection (hormone pellets), patches, pellet implants or application of a cream/gel form. The most common way to take testosterone is in the cream or gel form. It is quickly absorbed, short-acting, and less toxic for the liver. Dosing is usually done in the morning and evening, and the strength varies from 50–100 mg. Other testosterone therapy includes implantation of pellets and regular injections. Many patients find these delivery systems convenient and cost effective.

Frequently Asked Questions

Q. Will women taking testosterone have an increase in hair growth?
A. No. They would have to take a man’s dose to experience any hair growth. While men take 100–200 mg daily, women take only 4–8 mg.

Q. How often can I get my prescription refilled?
A. Testosterone is a controlled substance and cannot under any circumstances be refilled before your dose is due to run out. Take your medication exactly as prescribed by your doctor.

Q. Will taking testosterone cause my body’s own production to decrease?
A. Yes, it can in some cases and some men may experience a small decrease in testicle size, which may be unsettling but does not impact sexuality or well-being.

References

1. Horstman AM, et al. The role of androgens and estrogens on healthy aging and longevity. J Gerontol A Biol Sci Med Sci. 2012 Nov;67(11):1140-52.

2. De Oliveira DH, et al. Androgens and bone. Minerva Endocrinol. 2012 Dec;37(4):305-14.

3. van Anders SM, et al. Preliminary clinical experience with androgen administration for pre- and postmenopausal women with hypoactive sexual desire. J Sex Marital Ther. 2005
May-Jun;31(3):173-85.

4. Krasnoff JB, et al. Free testosterone levels are associated with mobility limitation and physical performance in community-dwelling men: the Framingham Offspring Study. J Clin Endocrinol Metab. 2010 Jun;95(6):2790-9.

5. Tsujimura A. The Relationship between Testosterone Deficiency and Men’s Health. World J Mens Health. 2013 Aug;31(2):126-135.

6. Hori Y, et al. Clinical study of 62 patients with symptoms of male climacterium. Hinyokika Kiyo. 2013 Aug;59(8):491-5.

7. Corona G, et al. Risks and Benefits of Late Onset Hypogonadism Treatment: An Expert Opinion. World J Mens Health. 2013 Aug;31(2):103-125.

8. Cunningham GR. Andropause or Male Menopause? Rationale for Testosterone Replacement Therapy in Older Men with Low Testosterone Levels. Endocr Pract. 2013 Sep 6:1-18. PubMed PMID: 24014001.

9. Miller KK, et al. Effects of risedronate and low-dose transdermal testosterone on bone mineral density in women with anorexia nervosa: a randomized, placebo-controlled study. J Clin Endocrinol Metab. 2011 Jul;96(7):2081-8.

10. Dolan Looby SE, et al. Effects of long-term testosterone administration in HIV-infected women: a randomized, placebo-controlled trial. AIDS. 2009 May 15;23(8):951-9.

11. Amano T. Role of Androgen in the Elderly. Clinical androgen replacement therapy for late-onset hypogonadism. Clin Calcium. 2013 Aug;23(8):1179-84.

12. Blick G. Optimal diagnostic measures and thresholds for hypogonadism in men with HIV/AIDS: comparison between 2 transdermal testosterone replacement therapy gels. Postgrad Med. 2013 Mar;125(2):30-9.

13. Studd J. Ten reasons to be happy about hormone replacement therapy: a guide for patients. Menopause Int. 2010 Mar;16(1):44-6.

14. Miner MM, et al. Twelve-month observation of testosterone replacement effectiveness in a general population of men. Postgrad Med. 2013 Mar;125(2):8-18.

15. Panay N, et al. Testosterone treatment of HSDD in naturally menopausal women: the ADORE study. Climacteric. 2010 Apr;13(2):121-31.

16. Davis SR. Androgen therapy in women, beyond libido. Climacteric. 2013 Aug;16 Suppl 1:18-24.

17. Abdallah RT, Simon JA. Testosterone therapy in women: its role in the management of hypoactive sexual desire disorder. Int J Impot Res. 2007 Sep-Oct;19(5):458-63.

18. Blick G, et al. Testosterone replacement therapy in men with hypogonadism and HIV/AIDS: results from the TRiUS registry. Postgrad Med. 2013 Mar;125(2):19-29.

19. Kingsberg S, et al. Evaluation of the clinical relevance of benefits associated with transdermal testosterone treatment in postmenopausal women with hypoactive sexual desire disorder. J Sex Med. 2007 Jul;4(4 Pt 1):1001-8.

20. Davis S, et al. Safety and efficacy of a testosterone metered-dose transdermal spray for treating decreased sexual satisfaction in premenopausal women: a randomized trial. Ann Intern Med. 2008 Apr 15;148(8):569-77.

21. Saad F. Androgen therapy in men with testosterone deficiency: Can testosterone reduce the risk of cardiovascular disease? Diabetes Metab Res Rev. 2012 Dec;28 Suppl 2:52-9.

22. Stephenson K, Neuenschwander PF, Kurdowska AK. The effects of compounded bioidentical transdermal hormone therapy on hemostatic, inflammatory, immune factors; cardiovascular biomarkers; quality-of-life measures; and health outcomes in perimenopausal and postmenopausal women. Int J Pharm Compd. 2013 Jan-Feb;17(1):74-85.

23. Poliwczak AR, Tylińska M, Broncel M. Effect of short-term testosterone replacement therapy on heart rate variability in men with hypoandrogen-metabolic syndrome. Pol Arch Med Wewn. 2013 Aug 19. doi:pii: AOP_13_047. PubMed PMID: 23974276.

24. He H, et al. Sex hormone ratio changes in men and postmenopausal women with coronary artery disease. Menopause. 2007 May-Jun;14(3 Pt 1):385-90.

25. Worboys S, et al. Evidence that parenteral testosterone therapy may improve endothelium-dependent and -independent vasodilation in postmenopausal women already receiving estrogen. J Clin Endocrinol Metab. 2001 Jan;86(1):158-61.

26. Möller MC, et al. Effect of estrogen and testosterone replacement therapy on cognitive fatigue. Gynecol Endocrinol. 2013 Feb;29(2):173-6.

27. Gettler LT, et al. Do testosterone declines during the transition to marriage and fatherhood relate to men’s sexual behavior? Evidence from the Philippines. Horm Behav. 2013 Sep 7.PubMed PMID: 24018138.

28. Lejeune H, Huyghe É, Droupy S. Hypoactive sexual desire and testosterone deficiency in men. Prog Urol. 2013 Jul;23(9):621-8.

29. Vigesaa KA Pharmd, et al. Efficacy and Tolerability of Compounded Bioidentical Hormone Replacement Therapy. Int J Pharm Compd. 2004 July-Aug;8(4):313-319.

30. Sinha-Hikim I, et al. Testosterone-induced muscle hypertrophy is associated with an increase in satellite cell number in healthy, young men. Am J Physiol Endocrinol Metab. 2003 Jul;285(1):E197-205.

31. Miller KK, et al. Low-dose transdermal testosterone augmentation therapy improves depression severity in women. CNS Spectr. 2009 Dec;14(12):688-94.

32. Goldstat R, et al. Transdermal testosterone therapy improves well-being, mood, and sexual function in premenopausal women. Menopause. 2003 Sep-Oct;10(5):390-8.