It is dangerous to be right when the government is wrong.      – Voltaire

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Testosterone Replacement Therapy – why is it so controversial?
For reasons that are not readily apparent, there appears to be a conservative political movement that opposes the use of testosterone in older men. This was clearly demonstrated by the report of the Institute of Medicine, which felt that testosterone is not yet ready for prime time and that there is still a need for studies to prove its efficacy 1.  Along the same lines, the guidelines of the Endocrine Society on testosterone use in older men seem to be ultra-cautious 2 . But fortunately, there are also other, more liberal guidelines and recommendations  3-5.

Probably no other medical issue has been bombarded by the influx of “expert” views from all walks of life; from endocrinologists and psychiatrists to urological surgeons and gerontologists, from the lay press to the regulatory agencies and from the pharmaceutical to the entertainment industries. The dismal result of all this free-for all cacophony of opinions is a great deal of confusion, erroneous information and significant detriment to patients and physicians alike.

Let’s take an in-depth look at the reasons for the negative attitudes to male testosterone replacement therapy (I will cover post-menopausal testosterone replacement in an upcoming article), and the hard scientific data that refutes it…

Unsubstantiated Claim 1:

There Is Insufficient Evidence That Testosterone Is Beneficial in Older Men
Data:

Numerous placebo-controlled studies have demonstrated salutary effects testosterone therapy in older men 6-11. Testosterone therapy clearly improves sexual function (both libido, erectile and ejaculatory function) in older men 12. In addition, testosterone supplementation in borderline hypo-gonadal men increases muscle mass 13-17, decreases fat mass 14, 15, 17, and improves strength 8, 13, 16, 17. There are also data showing that testosterone replacement in older men increases bone mineral density 18, 19 (and thereby and counteracts osteoporosis), improves cognition (in both Alzheimer and non-demented elderly) 20-22  and mood 16, 20, 23, and also alleviates depression 24.

Recent studies have also shown that testosterone therapy significantly improves not only symptoms of androgen deficiency (including erectile dysfunction), but also metabolic and control (lowering of blood glucose and glycated hemoglobin (HbA1c) (from 10.4 to 8.6%) 25, while decreasing abdominal obesity 25. These beneficial effects were seen without any adverse effects on blood pressure or hematological, biochemical and lipid parameters 25. Testosterone gel also has been shown to reverse the metabolic syndrome and improve glycemic control in men with sub-normal plasma testosterone 26. The improvements in glycaemic control, insulin resistance, cholesterol and visceral adiposity seen is these studies show that testosterone therapy contributes to an overall reduction in cardiovascular risk.

It is strange that treatment of testosterone deficiency caused by classical diseases affecting the hypothalamus, pituitary, and/or testes has been accepted for decades although there were no large multicenter trials, but that that treatment of testosterone deficiency caused by aging is taboo despite overwhelming scientific data showing significant benefits. It appears that physicians and regulatory agencies are much more comfortable treating older men with questionable drugs that pose more harm than benefit in terms of both quality of life, cancer and mortality 27-47, than using testosterone, a drug that not only improves important symptoms and risk factors, but also can reverse sarcopenia and frailty 48-54 which has well-documented detrimental effects on well-being, physical independence, morbidity and mortality. This is a poster-child example of “eminence” based medicine trumping evidence-based medicine.

Unsubstantiated Claim 2:
Testosterone Increases Prostate Cancer
Data:

The most prominent concern regarding testosterone treatment is its effect on prostate health. For decades, the concept that testosterone is “bad for the prostate” has gone unchallenged. Even though prostate-specific antigen (PSA) levels increase in response to testosterone supplementation 55, 56, recent research shows that the longstanding fear of stimulating prostate cancer with testosterone supplementation is without scientific basis 57-59.
Mechanistic studies have shown that the development and growth of prostate cancer are much more complex than simply an excess of lack of androgens: nonsteroidal hormones (e.g., insulin, leptin, glucocorticoids and growth hormone), genetic susceptibility, inflammation and environmental factors appear to be significant contributors 60. Further, there are a number of puzzling situations. For instance, prostate cancer cell lines that requires initial stimulation by androgens to grow is eventually suppressed by them 60. More evidence for the not so clear-cut relation between testosterone and prostate cancer lies in the fact that prostate cancer occurs in older men at a time when testosterone levels have already declined to low levels 61. In addition, there is no prospective evidence that testosterone is correlated with the development of prostate cancer 62, and retrospective studies have failed to demonstrate an increase in prostate cancer in men treated with testosterone 63.

Unsubstantiated Claim 3:
Testosterone increases cardiovascular disease risk

Another debate centers on the putative increased cardiovascular risk of testosterone therapy. While it is true that supra-physiological doses of testosterone, such as those administered by athletes, doe increase several risk factors for cardiovascular disease and cardiac events 64-66, this is not the case when testosterone therapy is used to restore low age-related testosterone levels to the normal range 59. To counter this, the anti-testosterone maffia often points to a study that was stopped before completion because much more adverse cardiovascular events were measured in the treatment group 67. However, the adverse cardiovascular events in this study could be explained by the pre-study high prevalence of cardiovascular risk factors within the study participants.
The adverse effects of testosterone therapy include an increase in hemoglobin and hematocrit (volume percentage (%) of red blood cells in blood) 59, 68, and a small decrease in HDL (the “good” cholesterol) 59, 69. However, elderly men with low testosterone tend to have a low hematocrit and also frequently present with anemia (hemoglobin deficiency) 70, so this side-effect can actually be a good thing. And the hematocrit-induced increase in blood viscosity can be alleviated with fish oil 71, while the decrease in HDL can be counteracted by carbohydrate restriction 72 and/or niacin (vitamin B3, the most effective way for increasing HDL) 73, 74, and a moderately increased physical activity 75-78. It should be noted that the small HDL reduction is primarily observed with intramuscular testosterone injections 69, and not with transdermal gel preparations 79.

To the contrary, it is well documented that low testosterone levels actually increase cardiovascular disease risk 80, 81. Following the recent reevaluation of the estrogen-protection orthodoxy, empirical research has flourished into the role of androgens in cardiovascular health. Observational studies show that blood testosterone levels are consistently lower among men with cardiovascular disease 80, 81, suggesting a preventive role for testosterone therapy.

In middle-aged and older men, lower testosterone levels are associated with insulin resistance, metabolic syndrome and diabetes, and related conditions that predispose to cardiovascular disease 82. Lower testosterone levels predict cardiovascular events, such as stroke and transient ischaemic attack, in older men and are associated with higher cardiovascular and overall mortality 82. Randomized trials have even shown that testosterone supplementation in men with existing coronary artery disease can be protective against heart attack (myocardial ischaemia) 82.

Unsubstantiated Claim 4:
Andropause doesn’t exist
Data:

While andropause, the progressive decline in testosterone production in aging men, unquestionably does exist and warrants treatment, whether the term “andropause” per see is a good descriptor for this phenomenon has been debated.

The terms “andropause” or “male menopause” are not completely accurate because androgen secretion does not cease altogether, as the term “pause” indicates 83, 84. The term menopause is correct in that in women the reproductive cycle invariably ends with ovarian failure and an abrupt cessation of estrogen production and onset of symptoms. In men however, the reduction in testosterone levels is a gradual process and the appearance of its clinical manifestations is more subtle and develop over time. This has unfortunately led to a tendency among many suffering older men to ignore the symptoms and accept it as an unavoidable and untreatable result of aging. In a survey of health care professionals, half reported that their patients rarely or never asked about low testosterone 85. Several prominent scientists have strongly recommended that awareness of andropause and its consequences be increased 83, 86, 87.

The term “male climacteric” is more appropriate as it suggests a decline and not a precipitous drop in hormones levels 88. The term “male climacteric” refers to the syndrome of endocrine, somatic, and psychic changes that occur in normal men with aging. This term is good in that it emphasizes the multidimensional nature of age-related changes, including age-related decreases in other important hormones such as growth hormone (GH), insulin-like growth factor-1 (IGF-1), dehydroepiandrosterone (DHEA), and melatonin 89-91, and not only relates aspects of the male aging syndrome specifically with testosterone levels.

Andropause has also been referred to by some medical professionals as “androgen deficiency in the aging male (ADAM),” “partial androgen deficiency in the aging male (PADAM),” or “aging-associated androgen deficiency (AAAD)” 84. However, andropause is the term that is used commonly by experts in the field and by lay persons alike because it retains some analogy to the term menopause in women 83. After all, what’s in a name?

Unsubstantiated Claim 5:
Estrogen replacement in post-menopausal women turned out to be bad, and therefore testosterone replacement in men must also be bad.

Reality:

This claim is screams irrational logic and an unwarranted extrapolation.
Unsubstantiated Claim 6:

Bad Kharma: It’s All about Sex

Reality:

Testosterone therapy is a touchy topic because it improves sexual capacity and enjoyment. Even in the times of Viagra, attitudes to sex remain embarrassingly silly “imagine if you give an older man testosterone, he may want to have sex!!”  The use of testosterone in women is facing a similar issue 92-95.

Unsubstantiated Claim 7:
If testosterone becomes mainstream treatment in elderly it will become abused by younger adults

Reality:

Abuse of testosterone will occur whether or not it is available for older men.

Conclusion

Testosterone deficiency in older men (hypogonadism) is very common 52, 96, 97 (up to 50% of men over the age of 50 are deficient in free testosterone when compared with peak morning concentrations in young men 91), and yet only a small proportion of hypogonadal men are receiving testosteone replacement therapy 98. In the end, a particular political viewpoint is in the eye of the beholder. Nevertheless, it is obvious that the political climate is working against testosterone replacement therapy in older men despite overwhelming scientific data supporting this appropriate pursuit as a strategy to prolong healthy longevity.
 
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71 Comments
  1. David Moore 8 years ago

    Great article, I have been on TRT for the past 4 years. I’ve been working with my doctor hand in hand durning that time. I’ve done a ton of research a long the way and you hit the nail on the head. The biggest key for guys out there is to find a doctor that will #1 work with you and #2 listen. The best way to describe the difference before and after is balance. I’ve come a long way in 4 years, will be 50 next month and Im in the best shape of my life. It’s not just the TRT but the workouts and diet combined. It’s not the magic pill just a part of the of the equation. You still have to do the work to get there. Again thank you for a great article.

    • Monica 8 years ago

      I’m glad you enjoyed the article.
      Yes, TRT is not a magic bullet, but it does enhance the results you get from training and dieting by helping you to train with a higher intensity/duration and recuperate faster.

  2. Randall L. Nord 8 years ago

    I am a Cardiothoracic Surgery Physician Assistant of 29 yrs. I am also an avid bb along with my wife
    and two sons. We live a fitness lifestyle.
    We met in 2009 at the Arnold. I have always admired your physique. You are a gifted medical writer.
    I completely agree with your paper. There is an extreme bias/prejudice in the conventional medical
    community against male hormones. I can tell you some seriously ironic stories about trying to use testosterone in critical settings.
    Thank you for this superiorly written paper.
    Randall

    • Monica 8 years ago

      Randall, thank you so much for the compliments. Hopefully in the near future we will see more medical professionals open up to out-of-the-box thinking. In the meantime I encourage every middle-age man, and post-menopausal woman, to take the initiative to ask their docs for a comprehensive hormone lab, and if indicated, a TRT prescription.

      • Enrique Delgado Watanabe 7 years ago

        Dear Monica, thank you for this article. It gave me confidence in accepting testosterone treatment that my doctor has recommended. I was reluctant since looking in Internet I only found bad comments against the use of testosterone, prostate cancer, heart and brain diseases, etc.
        And now looking for more articles I found yours and it gives me hope to improve my life style since I am 66 and ectomorph.
        Thank you so much again. Now I feel more confidence to use testosterone supplementation. God bless you. Enrique

    • Will Brink 7 years ago

      Well said Randall!

  3. Kevin 8 years ago

    What many people don’t realize is that their doctor will only offer what the insurance companies will cover. My testosterone had been at the low end of ‘normal’ for many years. I had asked my doctor about it several times. He insisted that I was in the ‘normal’ range. What he wouldn’t tell me is that at 40 my testosterone level was ‘normal’ for an 80 year old. He was ok with writing scripts for prevastatin and metformin, but not ok with prescribing testosterone. He told me my health insurance wouldn’t cover it anyway. At 45, I was already dreading turning 50 and felt my life was over. I didn’t have the energy or ambition to do much. I started looking for answers on the internet. I found a doctor who specializes in trt and I pay cash. Best money I ever spent. I have never felt better than I do now!

    • Kent Ingram 8 years ago

      Kevin, I admire you! You did the due diligence and took the bull by the horns. That’s inspiring to someone like me, who’s over 60 years old and had some issues with low-T.

    • Monica 8 years ago

      A good doctor will prescribe what his patient needs regardless whether it is covered by the patient’s insurance. I’m glad you did your homework and found a doctor who was willing to help you. Thanks for sharing your experience.

    • Travis Neel 7 years ago

      Perfectly said! This mirrors my own experience except I am 53. My physician is so against this it is laughable to even try to have a conversation about it.

      • Will Brink 7 years ago

        Then I’d recommend you find a new doctor, one willing to work with you and is up to 2013 on the topic. Remember, end of the day, he/she works for you, not the other way around. Should be a partnership, not an authoritarian relationship that went out circa 1950s.
        Good luck.

  4. Kent Ingram 8 years ago

    Monica, how nice it is to separate the wheat from the chaff! Thank you for shedding necessary light on this subject! As an over-60 man, I’ve experienced some of the symptoms of low-T. But, I’d like to ask a question, please: is low-T therapy the only effective way to deal with this situation, such as in clinics like Cenegenics, or can I deal with it on a much less expensive method, like going to Vitamin Cottage (or similar store) and purchasing Horny Goat Weed and other supplements? Thanks, again, for shedding light on this subject.
    PS- I’ve never understood why there’s such a stigma over older people enjoying sex. Young people sometimes act disgusted at the thought of it. I never thought that way at a younger age, so I don’t get it.

    • Wade Vinson 8 years ago

      Speaking of supplementation. Can either Monica or Will recommend any other supplementation that will increase testosterone levels without having to go to a Dr.? What about D-aspartic acid?

    • Monica 8 years ago

      Yes, T therapy is the only way to restore your T level. The OTC supplements, known as T-booster, available on the market today, don’t have a significant effect. Don’t waste your money.
      Neither have I; everybody has right, and should, enjoy sex.

      • Wade Vinson 8 years ago

        Thanx Monica. As always, your articles are well prepared and practical.

        • Monica 8 years ago

          It’s my job as a medical writer to present scientific data in a way that is relevant and understandable; I hope everybody finds it useful and actionable.

  5. ralph roberts 8 years ago

    excellent article,, thanks for this

  6. Dr G 8 years ago

    Im a clinical physician in New Zealand with a major interest in Mens Health and work for a charitable trust to educate men about their health. Enjoyed this article and some new references I had not seen but will be reading in full.
    My only request is that you include on the site a “printer friendly” button so I can extract your paper and send it so a number of my colleagues ? as a pdf. These are important issues that doctors are often confused about but fortunately our patients are becoming more informed and are helpping to bring us up to date!
    Best wishes – keep the research coming.
    Dr G

    • Monica 8 years ago

      I just uploaded and linked to the pdf. Thanks for sharing 🙂

  7. Jim 8 years ago

    Hi Monica,
    There are at least treatment 2 criteria that are emerging from the empirical data associated with male hormone replacement therapy:
    1. The benefits you note (decreased risk of heart disease, stroke and diabetes) are only seen when total testosterone is greater than 550 ng/dl. So, bringing it up to 549 doesn’t provide the protective effects of supplementation; and
    2. Estradiol must be managed as well (typically with an aromatase inhibitor). Levels lower than 21.8 pg/mL or higher than 30.11 pg/mL result in a dramatically higher risk of mortality.
    More physicians are starting to recognize the need for supplementation. Unfortunately, very few docs understand the need to manage estradiol.

    • Monica 8 years ago

      Yes, too little or too much of any hormone will have deleterious effects.
      While you are right that benefits accrue at higher levels; however, like in every biological system, levels have to be seen as a continuum. Therefore it is wrong to say that you get benefits if you’re level is 550, but no benefits if it’s 549. Statistical analyses based one large groups of study participants present threshold levels, but on an individual basis, somebody at 548 can present with more TRT induced benefits than somebody at 551. Thus, threshold levels only provide guidance for clinical practice.

      • Jim 8 years ago

        The point I am attempting to make is not that 1 point makes a difference in supplementation, rather that levels must elevated above 550 to see the benefits you discuss in your article. See the study reference below.
        I have heard from others that their docs want to bring them just above the low end of normal (in the morning). This practice is not sufficient to impart the beneficial effects of testosterone replacement therapy.
        J Am Coll Cardiol. 2011 Oct 11;58(16):1674-81.
        High serum testosterone is associated with reduced risk of cardiovascular events in elderly men.

        • Monica 8 years ago

          Yes, but there is still a gradation.
          And yes, many docs will only bring the patients up to the low-end of the normal range. Thus, TRT is not just a question of yes or no, but also of how much to supplement. The latter is what is really generating lively debates.

    • Big A 8 years ago

      You can also help control estrogen with diet. Scientists have isolated a constituent in cruciferous vegetables called Indole-3-Carbinol (I3C) that is especially beneficial to estrogen metabolism.Cruciferous vegetables include broccoli, cauliflower, cabbage, kale, bok choi, kohlrabi, brussels sprouts and mustard, rutabaga and turnip greens. Eat several servings of these vegetables each day. Try to eat them raw (or lightly steamed) to ensure all of the nutrients are live and readily absorbed. Also trying to avoid plastics that might disrupt hormone balances as well.
      I also think its crazy that its harder to get TRT prescribed as a man vs being a woman who wants to become a man. If you are a man and have some issues and want to treat it with TRT the Drs look at you as if you are nuts, but if you are a woman who wants to change your gender identity they seem to be ok with it. I think thats crazy… its harder as a man to get male hormones than it is as a woman who wants to become a man with hormones.

      • Monica 8 years ago

        Yes on the man-test vs woman-man-test issue.
        It is true that Indole-3-Carbinol, which has anti-cancer effects, induces cytochrome P450-dependent metabolism of estradiol, which increases 2-hydroxylation and thereby inactivates of estrogens . However, these data comes from cell culture (in vitro) and animal studies. Thus, whether Indole-3-Carbinol significantly inactivates estrogen in humans, and especially in men who have much higher ambient androgen level, is not known.

      • Jim 8 years ago

        You are absolutely correct that I3C will help with estrogen metabolism. I use it daily.
        My experience is that most docs are not familiar with this area of practice (hence they look at you like you are crazy). So, it generally requires working with a private pay doc or having levels that are extremely low.

  8. Roger 8 years ago

    As I read Monica’s Article about “TRT” I was reminded of my Doctor’s opinion not to prescribe “TRT” for me. I’m a type 2 diabetic ,with cardio vascular diease. And this article open up my eyes more then I can say! I am also 63 years old and felt personally attached to this article. I enjoyed this article tremendously and will follow up with my Doctor ,thank you Monica Mollica!

    • Monica 8 years ago

      I’m glad to hear that. Feel free to share it. 🙂

  9. JB 8 years ago

    Very well written, I cannot believe how much bad information there is out there and this article is well referenced and hits all the subtopics on this topic. Thanks for writing it.

  10. david ross 8 years ago

    I am a firm believer that attending to sexual hormones is important to overall health and energy. I decided to use herbs that affected testosterone levels. My final pick has been the Ayurvedic herb Mucuna Pruriens because it addresses sexual hormones and dopamine levels also; and then I am selecting various Chinese herbs (so-called Superior Tonic herbs) that are documented to support testosterone levels and have other health benefits such as energy, being adaptogens, and improving immunity. I see no down-side.

    • Monica 8 years ago

      Documented where?
      I am, as well as many others here on the BZ, only interested in scientific documentation.
      FYI there are no human data whatsoever showing that those herbs significantly increase testosterone levels in humans. Did you do blood work before you started taking them, and afterwards to really see if they really do elevate your test?
      However, Ayurvedic and Chinese herbs, and other herbs and botanical, have many other beneficial health effects, so I’m not saying that you are wasting your money. Just don’t expect them do things they don’t.

    • Will Brink 8 years ago

      And there’s no upside as they will impact testosterone either not at all, or minimal, and nothing close to what true TRT will achieve. As far as their effects on T, waste of $$$. See article linked above on supposed herbal “testosterone boosters.”
      BTW, I cover testosterone boosting supplements in The Supplement Bible in depth if interested in the topic.

  11. Ken Bolland 8 years ago

    Another fine article!
    I suppose that the indication for testosterone replacement therapy would be from blood work. As I understand it, there are two blood tests: one for total testosterone and the other for free (unbound) testosterone, and the level of free testosterone in the body is much more significant for health. However, my doctor, who’s a very prominent sports-medicine physician and works closely with endocrinologists, told me that the factors involved in calculating free testosterone fave such wide uncertainties that very little credence can be placed on a reading of free T. Have you any opinion on how one would decide on testosterone replacement therapy?

    • Monica 8 years ago

      Yes, that is correct, your blood values reflect your physiological status and indicate whether you are eligible for therapy.
      Free testosterone is usually calculated from total test and SHBG. While the precision isn’t 100%, it doesn’t mean free testosterone reading aren’t relevant. When using the same analysis assays and equations for each analysis, one can still track trends, and measurement of both total and free testosterone levels may help identify the etiology (cause) of the testosterone deficiency.
      Total testosterone level is the measurement generally used to guide testosterone replacement therapy.
      However, it should be noted that an absolute treshold level to define hypogonadism has not been established. A total testosterone level between 300 and 1,000 ng/dL is considered normal. This is though a conservative range; some argue that most men would benefit from being in the 600-1200 range.

  12. William Yung 8 years ago

    Hello Will Brink.
    Whilst this article is indeed informative, I really have only one problem with it ( and many other articles of late). And that is the fact that all this is really, is curated content. Copied and pasted from various sources on the internet. There is not much evidence of genuine, educated thoughtand opinion from what obviously is an extremely smart and talented lady (Monica).
    I would much rather read an article that comes straight from the writers head, based on real life experiences and/or first hand obversations.
    Please, I did not want to set out to offend, as Monica is obviously not only smoking hot, but has intellect to match. But curated content from an assortment of medical journals does not do it for me. I would much rather, in this instance, read about “real world” trials and results, referenced from tests carried out under the personal guidance of Monica. Thankyou

    • Monica 8 years ago

      What do you mean by “real world trials and results” and “curated content”?
      I do give my consultation clients personal guidance, but I am not a doctor and therefore cannot run labs and prescribe drugs.

      • William Yung 8 years ago

        Hello Monica. Curated content is simply aggregated, or re-hashed content from other sites, that is already out there, and turning it into a writing of your own. News sites do this all the time (Huffington Post is another example). While its not considered “duplicate content” as such, due to the way that you have interspersed your own interpretation throughout, it is basically other peoples writing, and shows not allot of your own deeper thoughts and ideas.
        I understand you are not a doctor, and cannot perscribe, however my idea of you writing about “real world” results is simply where there may be a group of men under your personal guidance with varying test levels for instance. And you refer to a diarised course of events of these men, whilst at all time providing anonymity. It would be far more interesting to read something like that i feel, rather than documented hypothesis from medical journals. Thankyou

        • Monica 8 years ago

          First you say “there is not much evidence of genuine, educated thought” then you say
          “not considered duplicate content as such, due to the way that you have interspersed your own interpretation throughout,”…I don’t get your reasoning.
          And fyi,I’m not a fan of anecdotal evidence.

          • William Yung 8 years ago

            My reasoning is that your “interspersed interpretation throughout”, is merely commentary on the curated content. Personally, I would much rather be reading an article from you that is based on your own observations and reports from studies carried out by you personally in a real world situation that we can all relate too. I would much rather read how you found that ” this client of mine displayed “x”, and i suggested he do this and got “x” result. That is something i could relate too more than simply a collection of curated medical journal findings.
            Obviously you are taking what i am writing, not in the way i intended it to be. Like i first said, this is no attack, just my thoughts.
            Thankyou

        • Will Brink 8 years ago

          Scientists like Monica use published data, which takes considerable time to find, read, interpret, for readers. Like any scientist worth their salt, she does not rely on anecdotal subjective “personal experimentation” as other sites tend to offer, period. She’s put considerable effort in bringing readers what you refer to (incorrectly) as “ re-hashed content from other sites,” and offers science based guidance on the topic not found on other sites I have seen, so I recommend you let it go and move on at this point. She’s not going to take a group of men, give them testosterone (both illegal and unethical) and report back on her findings period. I hope I have made myself clear on this issue…

          • William Yung 8 years ago

            Respectfully Will, you are both missing my point here.
            Nowhere in my comments did I ever suggest Monica supply testosterone to men in her gym (obviously!). Simply I stated that if she had canvassed a group of men with testosterone issues, and then detailed their progress whilst under therapy from a CERTIFIED PRACTITIONER, and reported on their results, it would be more “real world” than simply quoting realms of statistics that I can source from medical journals in the public domain.
            I think it would make for far more interesting reading, and allow Monica to present as an authority, rather than merely a content curator. Or even an article based on her own personal experience with the use of testerone, and the effects on women, both positive and negative, would have been far more interesting.
            However, as you have expressed, I will “let it go” and “move on”..
            My intent was never to de-ride the intellect of Monica, and if you feel I have, then I apologise. Thankyou

          • Ken Bolland 8 years ago

            I’m a physicist. It is a contribution to physics for me to publish results of my original research in the Physical Review (the preeminent research journal in the US). It would be a *much greater* contribution, and would have far more impact, for me to write a review article on some topic and publish it in Reviews of Modern Physics. It would also be a tremendous amount of work to write a review article. I don’t think any professional scientist would have a different opinion.
            Writing a review article is essentially what Monica has done. This is incomparably more useful than a report on ONE MORE study, not to speak of more anecdotes. I very much hope that Monica continues to do so, and that Will continues to publish them. In this regard it is important that Monica and Will know that readers are keen to read them.
            I add that “sourc[ing] from medical journals in the public domain” is pretty much useless unless done by someone with the right background, training and experience.
            Please continue, Will and Monica.

          • Monica 8 years ago

            Ken, thank you for appreciating and understanding my approach to scientifically based writing Like yourself, having an academic background, we realize that there are different degrees of quality and reliability of data.
            Data that has been generated in RCT trials that have been submitted for rigorous peer-review in order to get published preeminent research journals is ultimately what counts, and what guides practice in both the non-dogmatic evidence based medical community AND in the “real world”.

    • Jim 8 years ago

      I concur with Ken. Obviously William’s opinion is not going to change anything.
      One more quick point to follow up with Ken. Essentially William is asking Monica to take the basic structure of a study, remove all the controls and validation and then report.
      William: the internet is full of the kind of information you are looking for!

      • Will Brink 8 years ago

        And not full of the type and quality of information Monica supplies in this and other articles, which is easy to see if you have the science background for it to know the difference between a very high value piece of work seen here vs what’s out there on the ‘net.

  13. Big Jim 8 years ago

    Interestingly, I know several women on testosterone injections for low sex drive. In those women, all they had to do was mention it. It works great! Some side effects of course but the fact that it was administered so freely was disturbing considering the trouble I was having just to get my physician to test me! Inky is frustrating to know women can get male hormones easier than I can! Finally on replacement therapy to keep me on the low end of normal. Not particilar happy with the bell curve effect associated with the injectable. Creams and gells did not work well for me????? I am interested in testopell implants but insurance won’t cover the very high cost. Anyone experienced this product? The peaks and troughs associated with injectable are brutal!

    • Jim 8 years ago

      Big Jim:
      You won’t notice the highs and lows of testosterone Cypionate if your docs keeps your trough levels of total testosterone above 800. This puts you in the upper quartile of the normal range. It’s critical that excess aromatase activity be properly managed at this end of the normal T range.

      • Brian 8 years ago

        My doc has me on testosterone enanthate. Slower absorption rate than cypionate. Levels are supposed to stay more consistent. So far it seems to be helping with the highs and lows.

        • Jim 8 years ago

          Hi Brian,
          The only difference between testosterone (T) cypionate and enanthate is the length of the ester chain. They both have exactly the same effects. Cypionate has an 8 carbon ester chain and Enanthate is 7. Longer ester chains generally equal a longer half life. On paper, the enanthate will be slightly faster acting. In practical use there is no difference.
          The best way to avoid the moodiness of injeactable T is to keep your trough levels in the upper quartile of the normal range (800+ or so). One way to verify this is to have your lab sample taken just before your weekly injection. Again, estrogen must be properly managed.
          I’m noticing the beginning of a trend where physicians are more willing to treat low T. Unfortunately those who have not been properly informed believe:
          1. If your levels are just above the low end of normal, then you will not experience the effects of low T;
          2. These same docs will then treat by bringing your peak levels just above the low end; and
          3. They want to treat your lab sample rather than you by over-focusing on the lab data rather than your symptoms.
          Thankfully I have a physician that is well versed in this area of practice (private pay). I was the first of my friends to start T supplementation (about 7 years ago) and have seen many of my friends attempt to get their family doc to prescribe. Based on my observations, it is extremely unlikely that you will change their mind in this area unless you have a well established relationship with them. In virtually every case, their unwillingness to help has been based on a lack of training.
          Your best bet to get the care you need is to find someone who is properly trained in this area of practice and has a large number of men getting treatment in their practice.
          NOTE: Question anyone who insists/suggests that you get your meds directly from the prescribing physician. There should be a wall between profit earned by providing a medical consultation and profit earned by the sale of medications.

  14. Gaetano Borg 8 years ago

    Hi Will,
    Is there a scientific evidense that testosterone can be inproved true diet? Ie: keto diet, and the individual gets to the lower digits of body fat( below 10%)
    Best regards
    Gaetano Borg

    • Will Brink 8 years ago

      Yes, diet can impact T levels, but only up to a point. I cover that in a vid here on the BrinkZone BTW.

  15. Benn 8 years ago

    What about destroying the native ability to produce testosterone when under HRT? That seems the most controversial.

    • Jim 8 years ago

      You start HRT when your ability to produce the necessary levels is compromised. Why does it matter if that is degraded further? HRT is a life long therapy.

  16. CCE...Minnesota 8 years ago

    Hi Monica,
    I’d like to know if you have done any research into Testofen (Fenugreek Seed Extract).
    I think it would make for an interesting article to complement the excellent Testosterone article you provided last summer.
    Thanks much.
    Cliff

    • Monica 8 years ago

      There is not much human data published on Fenugreek and testosterone. It has been shown that supplementing with 500 mg Fenugreek/day in conjunction with resistance-training can increase lean mass and strength, while reducing body fat:
      J Int Soc Sports Nutr. 2010 Oct 27;7:34.
      The effects of a commercially available botanical supplement on strength, body composition, power output, and hormonal profiles in resistance-trained males.
      Poole C, Bushey B, Foster C, Campbell B, Willoughby D, Kreider R, Taylor L, Wilborn C.
      However, in this study, no effect was seen on testosterone. Actually, at the end of 8 weeks, free testosterone tended to be lower in the Fenugreek group compared to the placebo group.

  17. dude 8 years ago

    hello

  18. Kent Ingram 7 years ago

    Like many, I had a concern about cancer and testosterone therapy. Monica opened my eyes to REAL evidence and research, so I wouldn’t be afraid to undergo such therapy. The only drawback is the cost. A couple of clinics have opened up in the last couple of years to deal with Low-T in my metro area and I contacted one of them, recently. The initial cost of the blood tests and first-round of injections was over 4-thousand dollars, which is way out of the realm of reality for me. I’d imagine most of the clinics are probably similar in their pricing structure. Thanks for a great article, Monica!

    • Will Brink 7 years ago

      If actually diagnose with low T, insurance covers it in most cases. Anyone trying to charge you 4k for blood work and T should be avoided unless they are supplying something else you or I are not aware of, which is possible. Simply see your GP, tell them you want your T (total and free recommended) and take it from there.
      If you dont have insurance, paying cash to a doc should still be well below 4k, and you can get blood work done yourself via places like the Life Extension Foundation.

      • Kent Ingram 7 years ago

        Hi, Will: As usual, you’ve switched on the light bulb for me! Thanks. Unfortunately, I don’t have regular health insurance, anymore. I’m in a state-sponsored Medicaid (they put me in a pool, so I don’t know if they cover me for certain things, or not) program and I’d have to research their website to see if T-therapy is covered. I suspect it isn’t, but I can’t say that for sure. The clinic I contacted was CENEGENICS. They advertise quite a bit on the local radio stations, so I decided to contact them and find out about their program. Memory’s a little dim, since it was a few weeks ago, but I’m pretty sure they said insurance wouldn’t cover most of their program and that’s when the 4-Grand figure was bandied about. The other big advertiser is the LOW-T CENTER, but I haven’t called them, as of yet.

        • Monica 7 years ago

          You don’t need to search for a “T-therapy”. Like Will said, just get a regular blood panel that includes total and free testosterone. If it comes back showing you’re below the “normal” range (what constitutes a “normal” range is a topic for another long discussion), no medical institution can deny you a script for testosterone.

    • Monica 7 years ago

      I’m glad you find it informative. If your doctor is anti-testosterone therapy, give him the link to article or a print copy. If he is a good doc, that should change his state.

      • Kent Ingram 7 years ago

        Thanks, Monica, for that ray of hope. The more I listened to the spots, the more I found out. Not only does CENEGENICS provide testing for Low-T, but they also do a wide spectrum hormone analysis, as well as testing for nutritional deficiencies. All in all, I guess you could call it “comprehensive”. The high cost, I assume, is for the complete testing they do for virtually everything. I think this is worth pursuing, as you said. I’ll try to let you know what I find out. I’ll also find out if my doc is okay with the idea. I’m taking your advice to heart, trust me. I just want to feel a lot better than what I do, now.

        • Monica 7 years ago

          If you get your low T level corrected, I guarantee you will feel and perform a lot better!

  19. David Andrews 7 years ago

    Larry, what site and what cream?

  20. roland 7 years ago

    Andropause and testosterone deficiency are almost synonymous. If low testosterone is a concern, men should consult their doctors and choose hormone replacement therapy. Declining levels of testosterone can result in reduced sexual enjoyment, weight gain, loss of muscle strength, and depression. Look up Ageless Male reviews to get a better idea of how hormonal deficiency can upset the quality of life. Furthermore, low T can also be a risk factor for heart disease in later life. Maintain healthy levels of testosterone by eating a nutritious diet and remaining physically active for a long and happy life.

    • Monica 7 years ago

      A healthy lifestyle can prevent disproportionate drops in testosterone, primarily by keeping body fat low (body fat converts testosterone to estrogen). However, as I will outline in an upcoming article, it won’t completely prevent the gradual age-related decline in testosterone.

      • Enrique Delgado Watanabe 7 years ago

        Monica, thank you for your prompt reply. I will take in consideration your comments. God bless you!!!!! Saludos from México.

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